B族链球菌感染分型对孕产妇未足月胎膜早破的预测价值及其与绒毛膜羊膜炎的关系

Predictive value of group B Streptococcus infection typing for preterm premature rupture of membranes of pregnant women and its relationship with chorioamnionitis

目的为探讨阴道定植B族链球菌感染的血清分型对孕产妇未足月胎膜早破(PPROM)的预测价值及其与绒毛膜羊膜炎的关系。方法去选取2019年1月至2022年12月于广东省深圳市华中科技大学协和深圳医院行定期产检并完成分娩的247例B族链球菌感染孕产妇作为研究对象,分为PPROM组(72例)和正常组(175例)。比较两组孕产妇的一般资料,应用多因素Logistic回归分析孕产妇未足月胎膜早破的危险因素,建立Logistic回归分析预测模型并进行模型验证。Logistic回归分析不同B族链球菌感染分型发生绒毛膜羊膜炎的风险。结果两组孕产妇在糖尿病家族史(χ^(2)=3.924、P=0.048),妊娠期糖尿病(χ^(2)=4.773、P=0.029),血清锌(t=3.176、P=0.002),阴道炎(χ^(2)=9.076、P=0.003),孕期体重增长(t=2.181、P=0.030),孕期经常食油炸食物(χ^(2)=4.287、P=0.038),孕期饮食偏咸(χ^(2)=4.061、P=0.044)差异均有统计学意义。PPROM患者B族链球菌感染以Ⅲ型为主,感染率为76.39%,显著高于正常组(χ^(2)=24.442、P<0.001)。妊娠期糖尿病(OR=1.730、95%CI:1.067~2.289、P=0.013)、阴道炎(OR=1.632、95%CI:1.356~2.931、P=0.016)、B族链球菌Ⅱ型(OR=2.009、95%CI:1.674~2.783、P=0.009)均为PPROM发生的独立危险因素,血清锌>10.25μmol/L(OR=0.516、95%Cl:0.282~0.927、P=0.010)为PPROM发生的保护因素。Logistic回归分析显示,校正混杂因素后B族链球菌Ⅰa型(OR=0.79、95%Cl:0.54~0.95)、Ⅴ型(OR=0.68、95%CI:0.43~0.94)、Ⅱ型(OR=0.54、95%CI:0.14~0.83)和Ⅰb型(OR=0.30、95%CI:0.18~0.65)患者发生绒毛膜羊膜炎的风险显著低于B族链球菌Ⅲ型患者,差异均有统计学意义(P均<0.001)。结论PPROM患者B族链球菌感染以Ⅱ型为主,B族链球菌Ⅲ型感染是孕产妇未足月胎膜早破的独立危险因素,且感染B族链球菌Ⅲ型者发生绒毛膜羊膜炎的风险显著高于其他分型感染者。

Objective To investigate the predictive value of serum typing of group B Streptococcus infection in vaginal colonization for preterm premature rupture of membrane(PPROM)of pregnant women and its relationship with chorioamnionitis.Methods Total of 247 pregnant women with group B Streptococcus infection who underwent regular prenatal checkups and completed delivery at Huazhong University of Science and Technology Union Shenzhen Hospital(Nanshan Hospital),Guangdong Province from January 2019 to December 2022 were selected.They were divided into PPROM group(72 cases)and normal group(175 cases).The general information of two groups of pregnant and postpartum women were compared,the risk factors of premature rupture of membranes in pregnant and postpartum women were analyzed by multiple Logistic regression analysis,a Logistic regression analysis prediction model and the validated model were established,respectively.The relationship between different subtypes of group B Streptococcus infection and chorioamnionitis were analyzed by Logistic regression analysis.Results There were significant differences between the two groups in family history of diabetes(χ^(2)=3.924,P=0.048),diabetes in pregnancy(χ^(2)=4.773,P=0.029),serum zinc(t=3.176,P=0.002),vaginitis(χ^(2)=9.076,P=0.003),weight gain in pregnancy(t=2.181,P=0.030),frequent consumption of fried food in pregnancy(χ^(2)=4.287,P=0.038)and salty diet in pregnancy(χ^(2)=4.061,P=0.044).Group B Streptococcus infection in PPROM patients was mainly type Ⅱ,with an infection rate of 76.39%,which was significantly higher than that of the normal group(χ^(2)=24.442,P<0.001).Pregnant diabetes(OR=1.730.95%CI:1.067-2.289,P=0.013),vaginitis(OR=1.632,95%CI:1.356-2.931,P=0.016),group B Streptococcus type Ⅱ(OR=2.009,95%CI:1.674-2.783,P=0.009)were all independent risk factors for PPROM,and serum zinc>10.25μmol/L(OR=0.516,95%CI:0.282-0.927,P=0.010)was protective factors for PPROM.Logistic regression results showed that after adjusting for confounding factors,the risk of developing chorioamnionitis in patients with group B Streptococcus type Ⅰa(OR=0.79,95%CI:0.54-0.95),type Ⅴ(OR=0.68.95%CI:0.43-0.94),type Ⅱ(OR=0.54,95%CI:0.14-0.83)and type Ⅰb(OR=0.30,95%CI:0.18-0.65)infection were significantly lower than that in patients with group B Streptococcus type Ⅲ infeciton,with significant differences(all P<0.001).Conclusions PPROM patients are mainly infected with group Ⅲ Streptococcus,which is an independent risk factor for preterm premature rupture of membranes.The risk of developing chorioamnionitis in group Ⅲ Streptococcus infection is significantly higher than that of other subtypes infeciton.