妊娠期无症状菌尿65例临床分析

Clinical analysis of 65 women with asymptomatic bacteriuria during pregnancy

目的:探讨妊娠期无症状菌尿(ASB)的临床特点。方法:回顾性分析近10年在北京妇产医院建册、产检、分娩的65例妊娠期ASB产妇及同时间内非ASB产妇150例的临床资料,比较两组产妇的一般情况、妊娠期并发症及新生儿结局,分析ASB病原学特点。结果:ASB组初产妇占比61.5%,小于对照组的84%;分娩孕周ASB组(36.5±5.7)周小于对照组的(38.5±2.2)周;ASB组低出生体重儿发生率为10.8%,明显高于对照组的2.0%;ASB组早产、胎儿生长受限、妊娠期高血压疾病的发病率分别为23.1%、26.2%、29.2%,明显高于对照组的6.7%、5.3%、4.7%(P<0.05)。两组孕妇孕晚期或发病时的粒细胞/淋巴细胞数比值(NLR)分别为3.27±1.33、5.14±0.96,均高于孕初期的4.47±1.82、3.84±1.41(P<0.05),但两组间NLR差异无统计学意义。两组产妇年龄、孕次、胎膜早破发生率、新生儿Apgar评分比较差异无统计学意义。病例组致病菌以大肠埃希菌为主,对哌拉西拉舒巴坦、头孢曲松、头孢呋辛、头孢他啶等多种抗生素存在耐药性。结论:妊娠期ASB与不良妊娠结局的发生有关,主要致病菌为以大肠埃希菌为主的革兰阴性杆菌。

Objective:To study the clinical characteristics of women with asymptomatic bacteriuria(ASB)during pregnancy.Methods:The clinical data of 65women with ASB during pregnancy who had registered,examined,and delivered in Beijing Obstetrics and Gynecology Hospital in the past 10years(in study group),and 150women without ASB during the same period(in control group)were analyzed retrospectively.The general condition,the pregnant complications situations,and the neonatal outcomes of women were compared between the two groups.The etiological characteristics of the women with ASB were analyzed.Results:The proportion of primipara(61.5%)in the study group was significantly lower than that(84%)in the control group.The gestational weeks(36.5±5.7weeks)of the women at delivery in the study group was significantly shorter than that(38.5±2.2weeks)of the women in the control group.The incidence of low birth weight(10.8%)of the infants in the study group was significantly higher than that(2.0%)of the infants in the control group.The incidences of the preterm birth,the fetal growth restriction,and the pregnancy?induced hypertension of the women in the study group were 23.1%,26.2%,and 29.2%,respectively,and which were significantly higher than those(6.7%,5.3%,and 4.7%,respectively)of the women in the control group(P<0.05).The granulocyte to lymphocyte number ratio(NLR)of the women during the third trimester of pregnancy or at the onset of ASB in the two groups were 3.27±1.33and 5.14±0.96,which were all significantly higher than those(4.47±1.82and 3.84±1.41)of the women during the first trimester of pregnancy(P<0.05),but which of the women had no significant difference between the two groups.There were no significant differences in the maternal age,the number of pregnancies,the incidence of premature rupture of membranes,and the neonatal Apgar score of the women between the two groups.Escherichia coli was the main pathogenic bacteria of the women with ASB,and which was resistant to a variety of antibiotics,including piperacillin sulbactam,ceftriaxone,cefuroxime,and ceftazidime.Conclusion:There is a correlation between ASB of the pregnant women and their adverse pregnancy outcomes.The main pathogenic bacteria of the women with ASB are gram negative bacillus,with mainly escherichia coli.