摘要
目的探讨早发型子痫前期(PE)并发未足月胎膜早破(PPROM)孕妇的阴道菌群分布情况及不同阴道菌群分布对妊娠结局的影响。方法选取2019年1月至2022年1月该院收治的早发型PE孕妇120例为研究对象,将其中67例并发PPROM的孕妇作为观察组,53例未并发PPROM的孕妇作为对照组。比较两组孕妇的阴道菌群分布情况,并分析不同阴道菌群分布的早发型PE并发PPROM孕妇的妊娠结局。结果优势菌方面,观察组的乳杆菌占比低于对照组,革兰阳性杆菌、革兰阴性杆菌、革兰阳性球菌占比高于对照组,差异均有统计学意义(P<0.05)。致病菌方面,观察组的溶血葡萄糖球菌、阴沟肠杆菌占比高于对照组,差异均有统计学意义(P<0.05)。阴道菌群密集度方面,观察组的Ⅱ、Ⅲ级占比低于对照组,差异有统计学意义(P<0.05)。阴道菌群多样性方面,观察组的Ⅱ、Ⅲ级占比低于对照组,差异有统计学意义(P<0.05)。观察组的阴道微生态系统失调率为80.60%,高于对照组的45.28%,差异有统计学意义(χ^(2)=81.340,P<0.001)。与对照组比较,观察组治疗后血压偏高、24 h尿量偏低、24 h尿蛋白偏高、血小板偏高、凝血酶原时间和活化部分凝血活酶时间延长(均P<0.05)。观察组胎儿生长受限10例、胎儿宫内窘迫8例、新生儿窒息4例,对照组胎儿生长受限3例、胎儿宫内窘迫1例、新生儿窒息0例,观察组围生儿并发症发生率为32.84%,明显高于对照组的7.55%(P<0.05)。在67例早发型PE并发PPROM孕妇中,有54例菌群失调(菌群失调组),13例菌群正常(菌群正常组)。菌群失调组不良妊娠结局发生率为81.48%,高于菌群正常组的46.15%(χ^(2)=5.089,P=0.024)。与菌群正常组比较,菌群失调组新生儿出生体重明显降低(t=2.196,P=0.032),住院时间明显延长(t=7.463,P<0.001)。结论早发型PE并发PPROM孕妇的阴道菌群分布失调,容易导致不良妊娠结局。在临床中,需重视阴道菌群的变化并及时干预,以降低不良妊娠结局的风险。
Objective To investigate the distribution of vaginal microbiota in women with early-onset preeclampsia(PE)complicated by preterm premature rupture of membranes(PPROM)and the effect of different vaginal microbiota distribution on pregnancy outcomes.Methods A total of 120 pregnant women with early-onset PE admitted to this hospital from January 2019 to January 2022 were selected as the research objects.Among them,67 pregnant women complicated with PPROM were selected as the observation group,and 53 pregnant women without PPROM were selected as the control group.The distribution of vaginal microflora was compared between the two groups,and the pregnancy outcomes of patients with early-onset PE complicated with PPROM were analyzed.Results In terms of dominant bacteria,the proportion of Lactobacillus in the observation group was lower than that in the control group,and the proportion of Gram-positive bacilli,Gram-negative bacilli and Gram-positive cocci in the observation group were higher than that in the control group,and the differences were statistically significant(P<0.05).In terms of pathogenic bacteria,the proportion of Glucococcus haemolyticus and Enterobacter cloacae in the observation group were higher than that in the control group,and the differences were statistically significant(P<0.05).In terms of vaginal flora density,the proportion ofⅡandⅢgrade in the observation group were lower than that in the control group,and the differences were statistically significant(P<0.05).In terms of the diversity of vaginal flora,the proportion ofⅡandⅢgrade in the observation group were lower than that in the control group,and the differences were statistically significant(P<0.05).The imbalance rate of vaginal microecosystem in the observation group was 80.60%,which was higher than 45.28%in the control group,and the difference was statistically significant(χ^(2)=81.340,P<0.001).Compared with the control group,the blood pressure was higher,24 h urine volume was lower,24 h urinary protein was higher,platelet was higher,prothrombin time and activated partial thromboplastin time were prolonged in the observation group after treatment(all P<0.05).There were 10 cases of fetal growth restriction,8 cases of fetal intrauterine distress and 4 cases of neonatal asphyxia in the observation group,and 3 cases of fetal growth restriction,1 case of fetal intrauterine distress and 0 case of neonatal asphyxia in the control group.The incidence of perinatal complications in the observation group(32.84%)was significantly higher than that in the control group(7.55%),and the difference was statistically significant(P<0.05).Among 67 cases of early-onset PE complicated with PPROM,54 cases had dysbiosis(dysbiosis group)and 13 cases had normal microflora(normal microflora group).The incidence of adverse pregnancy outcomes in the dysbiosis group was 81.48%,which was higher than 46.15%in the normal microflora group(χ^(2)=5.089,P=0.024).Compared with the normal microflora group,the neonatal birth weight of the dysbiosis group was significantly lower(t=2.196,P=0.032),and the length of hospital stay was significantly longer(t=7.463,P<0.001).Conclusion The imbalance of vaginal flora in women with early-onset PE complicated with PPROM may lead to adverse pregnancy outcomes.In clinical practice,it is necessary to pay attention to the changes of vaginal flora and intervene in time to reduce the risk of adverse pregnancy outcomes.
作者
王梦梅
苏立
李雪
WANG Mengmei;SU Li;LI Xue(Department of Obstetrics,Baoding Second Hospital,Baoding,Hebei 071000,China)
出处
《国际检验医学杂志》
CAS
2024年第12期1448-1452,共5页
International Journal of Laboratory Medicine
基金
保定市科技计划项目(1951ZF041)。
关键词
早发型子痫前期
未足月胎膜早破
阴道菌群分布
妊娠结局
early-onset preeclampsia
preterm premature rupture of membranes
vaginal microbiota distribution
pregnancy outcomes
