生殖道GBS感染对妊娠晚期妇女阴道微生态环境及免疫因子的影响

Effects of GBS infection in reproductive tract on vaginal microecological environment and immune factors in women in late pregnancy

目的探讨妊娠晚期生殖道B族溶血性链球菌(GBS)感染对阴道微生态环境及免疫因子的影响。方法收集2021年7月至2022年7月本院76例GBS筛查阳性妊娠晚期妊娠妇女(GBS阳性组),另选取同期GBS筛查阴性的76例妊娠晚期妊娠妇女(对照组),比较2组阴道微生态情况、血清免疫炎症因子(IL-1β、IL-6)水平及妊娠结局;另根据阴道微生态评价结果将GBS阳性组妊娠妇女进一步分为微生态失调组(n=56)和微生态正常组(n=20),比较2组妊娠结局。结果GBS阳性组和对照组研究对象的阴道pH值、细菌性阴道病(BV)发生率、外阴阴道假丝酵母菌病(VVC)发生率、阴道菌群密集度、阴道菌群多样性及微生态失调发生率比较差异均有统计学意义(χ2=8.550、5.842、5.156、4.682、5.339、14.341,均P<0.05),2组研究对象滴虫性阴道炎发生率、阴道清洁度比较差异均无统计学意义(χ2=0.541、1.685,均P>0.05)。GBS阳性组血清IL-1β、IL-6水平显著高于对照组(t=16.711、19.388,均P<0.05)。GBS阳性组早产、产褥感染、胎儿窘迫及病理性黄疸发生率显著高于对照组(χ2=5.365、10.059、7.938、5.787,均P<0.05),2组研究对象胎膜早破、产后出血、新生儿窒息及新生儿肺炎发生率比较差异均无统计学意义(χ2=1.849、0.882、2.027、2.027,均P>0.05)。微生态失调组胎膜早破、胎儿窘迫发生率显著高于微生态正常组(χ2=4.113、4.113,均P<0.05),2组研究对象早产、产褥感染、产后出血、新生儿窒息、病理性黄疸和新生儿肺炎发生率比较差异均无统计学意义(χ2=2.805、1.281、0.384、0.734、0.880、0.734,均P>0.05)。结论妊娠晚期GBS感染妊娠妇女易发生阴道微生态及炎症因子失调,增加不良妊娠结局发生风险。

Objective To explore the effects of group B Streptococcus(GBS)infection in reproductive tract on vaginal microecological environment and immune factors in late pregnancy.Methods A total of 76 women with GBS and 76 women without GBS during late pregnancy in the hospital were enrolled as GBS positive group and control group between July 2021 and July 2022,respectively.The vaginal microecology,serum immune inflammatory factors(IL-1β,IL-6)and pregnancy outcomes were compared between the two groups.According to evaluation results of vaginal microecology,women in GBS positive group were divided into disordered group(n=56)and normal group(n=20),and pregnancy outcomes in the two groups were compared.Results There were significant differences in vaginal pH,incidence of bacterial vaginosis(BV)and vulvovaginal candidiasis(VVC),density and diversity of vaginal flora,and the incidence of microecological disorder between the two groups(χ2=8.550,5.842,5.156,4.682,5.339,14.341,all P<0.05),but there was no significant difference in the incidence of trichomoniasis vaginitis(TV)or vaginal cleanliness(χ2=0.541,1.685,all P>0.05).The levels of serum IL-1βand IL-6 in GBS positive group were significantly higher than those in control group(t=16.711,19.388,all P<0.05).The incidence rates of premature delivery,puerperal infection,fetal distress and pathological jaundice in GBS positive group were significantly higher than those in control group(χ2=5.365,10.059,7.938,5.787,all P<0.05),but there were no significant differences in the incidences of premature rupture of membranes,postpartum hemorrhage,neonatal asphyxia and neonatal pneumonia between the two groups(χ2=1.849,0.882,2.027,2.027,all P>0.05).The incidence rates of premature rupture of membranes and fetal distress in disordered group were significantly higher than those in normal group(χ2=4.113,4.113,all P<0.05),but there were no significant differences in the incidences of premature delivery,puerperal infection,postpartum hemorrhage,neonatal asphyxia,pathological jaundice and neonatal pneumonia between the two groups(χ2=2.805,1.281,0.384,0.734,0.880/0.734,all P>0.05).Conclusion GBS infection will increase the incidence of vaginal microecology and immune inflammatory factors disorder,and the risk of adverse pregnancy outcomes in women in late pregnancy.