妊娠早期细菌性阴道病妇女负压吸引术前后宫颈阴道菌群的研究

Study of cervicovaginal microbiome in early pregnancy women with bacterial vaginosis peri-vacuum aspiration

目的本研究旨在检测接受负压吸引术的细菌性阴道病(BV)和非BV中国早孕妇女阴道和宫颈管微生物群落的变化。方法选取2016年1月~2017年9月北京市海淀医院妇科孕8周以内接受负压吸引术的BV妇女进行前瞻性纵向研究,以了解宫颈和阴道微生物群落的变化。分别在两个时间点收集样本,即首次诊断怀孕时和负压吸引术后2周随访时;样本来自两个部位,即阴道上1/3及宫颈管。使用循证推荐的BV治疗和负压吸引术预防抗生素进行干预,运用Illumina Miseq高通量测序方法和Majorbio云平台检测和分析阴道和宫颈微生物群落。结果在属水平上,对照组4个样本中乳杆菌属的比例差异无统计学意义;BV组术前2组乳杆菌属占比小,加德纳菌属、普雷沃菌属、纤毛菌属和巨球菌属是优势菌,杂菌明显比对照组多;术后2组乳杆菌属占比明显增加,加德纳菌属和普雷沃菌属偏多。在种水平上,对照组的惰性乳杆菌属手术前后变化不大,而BV组术后各组明显增加。对照组詹氏乳杆菌属术后增加差异具有统计学意义。种水平8组相关性网络分析图显示:詹氏乳杆菌、未分类的乳杆菌和未培养的乳杆菌之间正相关,同时詹氏乳杆菌与BV相关菌呈负相关。结论早期妊娠妇女阴道及宫颈管菌群极为相似。阴道菌群正常的早期妊娠妇女负压吸引术前、术后阴道及宫颈管细菌群落均以乳杆菌属为优势菌,手术对菌群无明显影响。惰性乳杆菌属在合并BV的负压吸引术妇女阴道菌群恢复中发挥主要作用,其机制需进一步研究。

Objective This study was designed to detect the changes of vaginal and cervical canal microbial communities among early pregnant Chinese women with bacterial vaginosis(BV)and without BV who receiving vacuum aspiration(VA).Methods A prospective longitudinal study was conducted to characterize changes in the cervical and vaginal microbiota among less 8 weeks pregnant Chinese women with BV and without BV who receiving VA at Beijing Haidian Hospital from January 2016 to September 2017.Samples were collected at two time points,that is,at the first diagnosis of pregnancy and at 2 weeks of follow-up after VA;samples from two sites,namely,upper vagina 1/3 and cervical canal.Evidence-based BV therapy and VA antibiotics were used for intervention.Illumina Miseq high-throughput sequencing and Majorbio Cloud Platform was used to detect and analyze the microbial community in the vagina and cervix.Results On the genus level,the proportions of Lactobacillus in the four control groups were not statistical difference.In the BV groups the preoperative percentage of Lactobacillus was small,then,Gardnerella,Prevotella,Sneathia and Megasphaera are dominant bacteria,and the miscellaneous bacteria are more significantly than one of the control groups,then Lactobacillus was the dominant bacterium in the BV groups after surgery,Gardnerella and Prevotella still accounted for more.On the species level,the L.iners did not change much before and after surgery in the control group,and increased significantly in the BV groups after surgery.The control group had L.jensenii,and the increase was statistically significant.The result of 8 groups correlation network analysis at species level shows that there is positive relationship among L.jensenii,unclassified Lactobacillus and uncultured bacterium Lactobacillus,meanwhile,L.jensenii had negative relationship with BV-associated bacteria.Conclusion The flora of the vagina and cervical canal in early pregnancy women is very similar.Lactobacillus is the dominant bacteria in the vaginal and cervical canal bacterial communities of early pregnant women with normal vaginal flora before and after VA,and surgery has no significant effect on the flora.L.iners in the vagina and cervical canal significantly increased in women with BV after VA.L.iners plays a major role in the recovery of vaginal flora in women with BV before and after VA,and its mechanism needs further study.