多囊卵巢综合征孕妇肺炎克雷伯菌感染、妊娠结局及影响因素分析

Analysis of the situation of Klebsiella pneumoniae infection,and the pregnancy outcomes and its influencing factors of pregnant women with polycystic ovary syndrome

目的:探讨多囊卵巢综合征(PCOS)孕妇肺炎克雷伯菌感染情况及对妊娠结局影响。方法:收集2020年5月-2021年7月本院收治的PCOS孕妇113例,根据肺炎克雷伯菌感染分为感染组(43例)和非感染组(40例),产前检查健康孕妇30例为对照组,分析病原菌分布情况,分析肺炎克雷伯菌感染情况及临床特点、不良妊娠结局及影响因素。结果:肺炎克雷伯菌感染率在年龄<25岁(13.0%)、25~29岁(8.3%)、30~34岁(18.2%)、35~39岁(4.2%)、≥40岁(5.0%)孕妇中存在差异(P<0.05);感染组感染病原菌以革兰阴性菌为主(共株占70.9%),发生异位妊娠、染色体异常、早期流产、引产、羊水过多总发生率(46.5%)高于非感染组(22.5%)和对照组(26.7%),流产、早产、FGR、巨大儿、死胎总发生率(79.1%)高于对照组(36.7%),妊娠期糖尿病、胎膜早破、霉菌性阴道炎、羊水过多、妊娠晚期高血压总发生率(65.1%)高于对照组(40.0%)和非感染组(23.3%)(均P<0.05);入组后使用抗生素≥2种、机械通气时间≥7d、有肾功能不全是PCOS患者出现多重耐药肺炎克雷伯菌感染的影响因素。结论:肺炎克雷伯菌感染的PCOS孕妇以感染革兰阴性菌为主,肺炎克雷伯菌感染影响妊娠结局,不同治疗方式是其影响因素。

Objective:To investigate the infection situation of Klebsiella pneumoniae of pregnant women with polycystic ovary syndrome(PCOS),and to study its influence on the pregnancy outcomes of these women.Methods:From May 2020 to July 2021,113 pregnant women with PCOS were included and were divided into group A(43 women with Klebsiella pneumoniae infection)and group B(40 women without Klebsiella pneumoniae infection),and other 30 healthy pregnant women were included in group C.The distribution of pathogens was analyzed.The situation and clinical characteristics of the women with Klebsiella pneumoniae infection were analyzed.The adverse pregnancy outcomes of the women with Klebsiella pneumoniae infection and its influence factors were also analyzed.Results:There was significant difference in the rate of Klebsiella pneumoniae infection among the women with<25 years old(13.0%),the women with 25-29 years old(8.3%),the women with 30-34 years old(18.2%),the women with 35-39 years old(4.2%),and the women with≥40 years old(5.0%)(P<0.05).Gram-negative bacteria infection was the main pathogens of the women in group A,the rate of which was 70.9%.The total incidence of ectopic pregnancy,chromosomal abnormality,early abortion,induced labor,and polyhydramnios(46.5%)of the women in group A was significantly higher than that(22.5%)of the women in group B and that(26.7%)of the women in group C.The total incidences of miscarriage,preterm birth,FGR,macrosomia,and stillbirth(79.1%)of the women in group A was significantly higher than that(36.7%)of the women in group C.The total incidence of gestational diabetes mellitus,premature rupture of membranes,mycotic vaginitis,polyhydramnios,and late-pregnancy hypertension(65.1%)of the women in group A was significantly higher than that(23.3%)of the women in group B and that(40.0%)of the women in group C(all P<0.05).The antibiotics used≥2 kinds,mechanical ventilation duration≥7 days,and renal insufficiency of the women with PCOS were the influencing factors of their multidrug-resistant Klebsiella pneumoniae infection.Conclusion:Klebsiella pneumoniae infection of the pregnant women with PCOS is mainly infected by gram-negative bacteria,and which is closely related to the pregnancy outcomes of these women.Different treatment methods of Klebsiella pneumoniae infection are the influencing factors of the pregnancy outcomes of these women.