组织学急性绒毛膜羊膜炎患者的胎膜组织病原菌分布及母婴结局分析

Distribution of Pathogenic Bacteria in Fetal Membranes of Patients with Histologic Acute Chorioamnionitis and Analysis of Maternal and Infant Outcomes

目的分析组织学急性绒毛膜羊膜炎(HAC)患者的胎膜组织病原菌分布及母婴结局。方法选取8704例孕妇为研究对象,回顾性分析母婴临床资料,对确诊HAC患者的胎膜组织病原菌分布及母婴结局情况进行分析。结果8704例孕妇中,确诊HAC孕妇614例,175例HAC孕妇经胎膜组织培养出阳性致病菌,分离得到26个菌种共180株,I期HAC孕妇病原菌分布种类及数量分别为24个(92.31%)、159株(88.33%)高于Ⅱ期HAC的7个(26.92%)、21株(11.67%),大肠埃希菌是HAC胎膜组织的主要病原菌种,共107株(59.44%)、其次为粪肠球菌有18株(10.00%);HAC组孕妇胎膜早破与正常分娩的发生率13.52%与7.17%均低于非HAC组的19.06%与59.37%(P<0.05),而胎盘早剥、死胎、早产、自然流产及其他妊娠结局的发生率3.26%、2.28%、25.90%、4.40%、43.49%均高于非HAC组的0.57%、0.10%、9.20%、0.70%、11.00%(P<0.05);194例孕妇产后新生儿伴有窒息或呼吸窘迫综合征,其中HAC确诊孕妇51例,HAC组孕妇产后新生儿呼吸窘迫综合征发生率21.57%低于非HAC组的41.26%(P<0.05),而新生儿窒息发生率78.43%高于非HAC组的58.74%(P<0.05)。结论HAC孕妇的胎膜组织病原菌分布26个菌种共180株且I期多于Ⅱ期,大肠埃希菌是HAC的主要菌种,HAC可增加孕妇胎盘早剥、死胎、早产、自然流产与其他不利妊娠结局的发生率以及产后新生儿窒息的发生率。

Objective To analyze the distribution of pathogens in fetal membranes of patients with histologic acute chorioamnionitis(HAC)and the maternal and infant outcomes.Methods 8704 pregnant women were selected as the study objects,and the clinical data of mothers and infants were analyzed retrospectively.The distribution of pathogenic bacteria in fetal membrane tissue of patients with confirmed HAC and the maternal and infant outcomes were analyzed.Results Among 8704 pregnant women,614 women were diagnosed as HAC,175 women with HAC had positive pathogens by fetal membrane tissue culture,and a total of 180 strains of 26 bacteria were isolated.The distribution and number of pathogenic bacteria in women with HAC in Phase I were 24(92.31%),159(88.33%),and 21(11.67%),respectively.The number of pathogenic bacteria in women with HAC in Phase I was higher than that in women with HAC in PhaseⅡ(26.92%).Escherichia coli was the main pathogenic bacteria in fetal membrane tissue of HAC,with a total of 107(59.44%)The second was enterococcus faecalis,18 strains(10.00%);The incidences of premature rupture of membranes and normal delivery in HAC group were 13.52%and 7.17%lower than those in non HAC group(19.06%and 59.37%,P<0.05),while the incidences of placental abruption,stillbirth,premature delivery,spontaneous abortion and other pregnancy outcomes in HAC group were 3.26%,2.28%,25.90%,4.40%,43.49%higher than those in non HAC group(0.57%,0.10%,9.20%,0.70%,11.00%,P<0.05);194 pregnant women and neonates were accompanied by asphyxia or respiratory distress syndrome,51 of whom were diagnosed by HAC.The incidence of neonatal respiratory distress syndrome in HAC group was 21.57%lower than that in non HAC group(41.26%,P<0.05),while the incidence of neonatal asphyxia was 78.43%higher than that in non HAC group(58.74%,P<0.05).Conclusion There are 180 strains of pathogenic bacteria in the fetal membrane tissue of HAC pregnant women with 26 strains,and the number of phase I is more than that of phaseⅡ.Escherichia coli is the main strain of HAC.HAC can increase the incidence of placental abruption,stillbirth,premature delivery,spontaneous abortion and other adverse pregnancy outcomes,as well as the incidence of postpartum neonatal asphyxia.