B族链球菌感染对孕妇阴道菌群、凝血功能的影响及炎性介质变化

Influence of group B Streptococcus infection on vaginal microbiota and coagulation function of pregnant women and changes of inflammatory mediators

目的探讨B族链球菌感染对孕妇阴道菌群、凝血功能的影响及炎性介质变化。方法选取2020年1月-2023年5月聊城市第二人民医院收治的83例B族链球菌感染孕妇为A组,另选同期产检的101名无B族链球菌感染孕妇为B组。对两组阴道菌群微生态、凝血功能、炎性介质及母婴结局进行比较。结果相比于B组,A组菌群多样性为Ⅳ级、阴道清洁度为Ⅲ、Ⅳ度及阴道pH值>4.50的患者占比均更高(P<0.05)。相比于B组,A组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)均更短,国际标准化比率(INR)更低,纤维蛋白原(FIB)更高(P<0.05)。A组血清干扰素-γ(IFN-γ)、白细胞介素(IL)-2水平均高于B组;血清IL-4、IL-10水平均低于B组(P<0.05)。相比于B组,A组胎膜早破、羊水污染、早产、胎儿窘迫、产褥感染、新生儿感染的患者占比均更高(P<0.05)。结论妊娠期孕妇B族链球菌感染会显著增加不良妊娠结局的风险,且与孕妇阴道菌群失衡、凝血功能异常及炎性介质表达密切相关。

OBJECTIVE To explore the influence of group B Streptococcus(GBS)infection on vaginal microbiota and coagulation function of the pregnant women and observe the changes of inflammatory mediators.METHODS A total of 83 pregnant women with GBS infection who were treated in Liaocheng Second People′s Hospital from Jan.2020 to May 2023 were assigned as group A,meanwhile,101 pregnant women without GBS infection who received prenatal examination were chosen as the group B.The microecological characteristics of vaginal microbiota,coagulation function indexes,inflammatory mediators and mother-infant outcomes were observed and compared between the two groups.RESULTS The proportions of pregnant women with gradeⅣof microbiota diversity,gradeⅢandⅣof vaginal cleanness,and vaginal pH value more than 4.50 were higher in the group A than in the group B(P<0.05).The activated partial thromboplastin time(APTT),prothrombin time(PT)and thrombin time(TT)were shorter in the group A than in the group B;the international normalized ratio(INR)of the group A was lower than that of the group B,and the fibrinogen(FIB)of the group A was higher than that of the group B(P<0.05).The levels of serum interferon-γ(IFN-γ)and interleukin(IL)-2 of the group A were higher than those of the group B;while the levels of serum IL-4 and IL-10 of the group A were lower than those of the group B(P<0.05).The proportions of pregnant women with premature rupture of membranes,amniotic fluid contamination,premature delivery,fetal distress,puerperal infection and neonatal infection were higher in the group A than in the group B(P<0.05).CONCLUSION The gestational GBS infection may lead to a significant increase of risk for adverse pregnancy outcomes and is also closely associated with the imbalance of vaginal flora,abnormal coagulation function and expressions of inflammatory mediators.