阴道菌群紊乱对宫颈机能不全患者妊娠活产结局的影响

doi:10.3969/j.issn.1674-8115.2026.09.008

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (9): 1233-1241.doi: 10.3969/j.issn.1674-8115.2026.09.008

• 论著 · 临床研究 • 上一篇

阴道菌群紊乱对宫颈机能不全患者妊娠活产结局的影响

李雪¹, 周玲¹, 李吉², 刘娟娟¹, 张弘¹^,³()

^1.苏州大学附属第二医院妇产科生殖中心，苏州 215004
^2.江苏省苏州市明基医院妇产科，苏州 215009
^3.苏州大学附属第一医院江苏省临床免疫研究所，苏州 215006

收稿日期:2026-01-19 接受日期:2026-03-16 出版日期:2026-09-14 发布日期:2026-09-14
通讯作者: 张　弘，主任医师，博士；电子信箱：szzhanghong126@126.com。
基金资助:
国家自然科学基金(82571922);江苏省自然科学基金(BK20241791)

Effect of vaginal microbiota dysbiosis on live birth outcomes in patients with cervical incompetence

Li Xue¹, Zhou Ling¹, Li Ji², Liu Juanjuan¹, Zhang Hong¹^,³()

^1.Reproductive Medical Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
^2.Department of Obstetrics and Gynecology, Suzhou BenQ Medical Center, Jiangsu Province, Suzhou 215009, China
^3.Jiangsu Institute of Clinical Immunology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China

Received:2026-01-19 Accepted:2026-03-16 Online:2026-09-14 Published:2026-09-14
Contact: Zhang Hong, E-mail: szzhanghong126@126.com.
Supported by:
National Natural Science Foundation of China(82571922);Jiangsu Provincial Natural Science Foundation(BK20241791)

摘要/Abstract

摘要：

目的·基于稳健型逆概率加权法（stabilized inverse probability of treatment weighting，sIPTW）及Logistic回归探讨阴道菌群紊乱对宫颈机能不全患者妊娠结局的影响。方法·回顾性分析2013年1月至2023年12月期间于苏州大学附属第二医院妇产科就诊的宫颈机能不全患者的临床资料，根据孕中期阴道分泌物培养结果分为菌群紊乱组（检出致病菌且乳酸杆菌缺失或显著减少）和正常菌群组（乳酸杆菌为优势菌，未检出致病菌）。采用sIPTW对孕次、产次、晚期流产次数、宫颈长度等变量进行平衡加权。比较平衡前后菌群紊乱组与正常菌群组妊娠结局的差异，包括足月产率、活产率、流产率、早产率、新生儿体质量及分娩孕周。通过单因素条件Logistic 回归分析活产结局的影响因素。结果·共纳入756例宫颈机能不全患者，其中菌群紊乱组216例，正常菌群组540例。在sIPTW校正前，阴道菌群紊乱组与正常菌群组的体质量指数（body mass index，BMI）、宫颈长度、宫颈内口扩张情况、是否行宫颈环扎术差异有统计学意义（均P<0.05）。经过sIPTW，2组临床资料对比差异无统计学意义。在sIPTW校正前后，菌群紊乱组的足月产率和活产率均显著低于正常组，流产率及早产率显著高于正常组，新生儿体质量及分娩孕周显著低于正常组（均P<0.05）。单因素条件Logistic回归分析显示，宫颈环扎术（OR=1.090，P<0.010）、查体异常（OR=0.888，P<0.001）、阴道菌群紊乱（OR=0.932，P=0.003）、无晚期流产（OR=0.827，P=0.008）是妊娠活产结局的主要影响因素。结论·阴道菌群紊乱显著降低宫颈机能不全患者的活产率及足月产率，增加流产及早产风险。

关键词: 阴道菌群紊乱, 逆概率加权法, 宫颈机能不全, 活产

Abstract:

Objective ·To investigate the impact of vaginal microbiota dysbiosis on pregnancy outcomes in patients with cervical incompetence using stabilized inverse probability of treatment weighting (sIPTW) and Logistic regression. Methods ·A retrospective analysis was conducted on the clinical data of 756 patients with cervical incompetence who visited the Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, between January 2013 and December 2023. Based on the results of vaginal secretion culture in the second trimester, the patients were divided into a microbiota dysbiosis group (pathogenic bacteria were detected and lactobacilli were absent or significantly reduced) and a normal microbiota group (lactobacilli were the dominant bacteria and no pathogenic bacteria were detected). The sIPTW method was employed to balance variables such as parity, gravidity, number of late miscarriages, and cervical length. The differences in pregnancy outcomes between the vaginal microbiota dysbiosis group and the normal microbiota group before and after sIPTW were compared, including the full-term delivery rate, live birth rate, miscarriage rate, preterm birth rate, neonatal birth weight, and gestational age at delivery. Univariate conditional Logistic regression analysis was conducted to investigate the influencing factors of live birth outcomes. Results ·A total of 756 patients with cervical insufficiency were included, including 216 cases in the microbiota dysbiosis group and 540 cases in the normal microbiota group. Prior to sIPTW, the vaginal microbiota dysbiosis group and the normal microbiota group exhibited significant differences in body mass index (BMI), cervical length, cervical internal os dilation, and whether cervical cerclage was performed (P<0.05). After sIPTW, no statistically significant differences were observed in clinical data between the two groups. Before and after sIPTW, the full-term delivery rate and live birth rate in the vaginal microbiota dysbiosis group were significantly lower than those in the normal microbiota group. The miscarriage rate and preterm birth rate were significantly higher in the microbiota dysbiosis group, while neonatal birth weight and gestational age at delivery were significantly lower (all P<0.05). Univariate conditional Logistic regression analysis showed that cervical cerclage (OR=1.090, P<0.010), abnormal physical examination (OR=0.888, P<0.001), vaginal microbiota dysbiosis (OR=0.932, P=0.003), and no history of late miscarriage (OR=0.827, P=0.008) were major factors influencing live birth outcomes. Conclusion ·Vaginal microbiota dysbiosis significantly reduces the live birth rate and full-term delivery rate in patients with cervical incompetence, and increases the risk of miscarriage and premature birth.

Key words: vaginal microbiota dysbiosis, inverse probability weighting, cervical incompetence, live birth

中图分类号:

R713.4

李雪, 周玲, 李吉, 刘娟娟, 张弘. 阴道菌群紊乱对宫颈机能不全患者妊娠活产结局的影响[J]. 上海交通大学学报（医学版）, 2026, 46(9): 1233-1241.

Li Xue, Zhou Ling, Li Ji, Liu Juanjuan, Zhang Hong. Effect of vaginal microbiota dysbiosis on live birth outcomes in patients with cervical incompetence[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(9): 1233-1241.

图/表 5

参考文献 26

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Characteristic	Before sIPTW				After sIPTW
Characteristic	Normal group (n=540)	Vaginal dysbiosis group (n=216)	P value	SMD	Normal group (n=544.07)	Vaginal dysbiosis group (n=216.69)	P value	SMD
Age/n(%)			0.110	0.145			0.767	0.030
≤35 years	477 (88.3)	200 (92.6)			487.7 (89.6)	192.2 (88.7)
>35 years	63 (11.7)	16 (7.4)			56.4 (10.4)	24.5 (11.3)
BMI/(kg·m^-2)	22.41 (20.82, 24.41)	21.91 (20.44, 23.94)	0.011	0.198	22.21 (20.69, 24.30)	22.22 (20.69, 24.61)	0.763	0.063
Gravidity/n(%)			0.836	0.049			0.797	0.059
1	24 (4.4)	8 (3.7)			22.5 (4.1)	6.7 (3.1)
2	230 (42.6)	96 (44.4)			235.8 (43.3)	96.6 (44.6)
≥3	286 (53.0)	112 (51.9)			285.8 (52.5)	113.5 (52.4)
Parity/n(%)			0.235	0.110			0.769	0.028
0	483 (89.4)	200 (92.6)			491.2 (90.3)	197.4 (91.1)
≥1	57 (10.6)	16 (7.4)			52.9 (9.7)	19.3 (8.9)
Prior history of cerclage/n(%)			0.772	0.036			0.355	0.101
No	500 (92.6)	202 (93.5)			504.6 (92.7)	194.8 (89.9)
Yes	40 (7.4)	14 (6.5)			39.5 (7.3)	21.9 (10.1)
Number of late miscarriage/n(%)			0.864	0.043			0.915	0.036
0	49 (9.1)	22 (10.2)			50.7 (9.3)	18.0 (8.3)
1	309 (57.2)	120 (55.6)			310.5 (57.1)	125.8 (58.1)
≥2	182 (33.7)	74 (34.3)			182.8 (33.6)	72.8 (33.6)
Cervical examination/n(%)			0.131	0.128			0.975	0.003
Normal	363 (67.2)	132 (61.1)			351.1 (64.5)	140.1 (64.7)
Abnormal	177 (32.8)	84 (38.9)			193.0 (35.5)	76.6 (35.3)
Methods of pregnancy/n(%)			0.164	0.128			0.589	0.061
Natural pregnancy	483 (89.4)	201 (93.1)			492.9 (90.6)	192.3 (88.7)
IVF	57 (10.6)	15 (6.9)			51.2 (9.4)	24.4 (11.3)
History of LEEP/n(%)			0.180	0.131			0.717	0.040
No	511 (94.6)	210 (97.2)			518.8 (95.4)	204.7 (94.5)
Yes	29 (5.4)	6 (2.8)			25.3 (4.6)	12.0 (5.5)
History of PCOS/n(%)			0.490	0.077			0.649	0.044
No	533 (98.7)	211 (97.7)			530.9 (97.6)	212.8 (98.2)
Yes	7 (1.3)	5 (2.3)			13.2 (2.4)	3.9 (1.8)
Cervical length/n(%)			0.007	0.249			0.822	0.055
<25 mm	73 (13.5)	48 (22.2)			91.4 (16.8)	35.6 (16.4)
25‒30 mm	173 (32.0)	71 (32.9)			175.9 (32.3)	75.6 (34.9)
>30 mm	294 (54.4)	97 (44.9)			276.8 (50.9)	105.5 (48.7)
Dilation of cervical os/n(%)			0.009	0.214			0.754	0.027
No	423 (78.3)	149 (69.0)			405.1 (74.4)	163.8 (75.6)
Yes	117 (21.7)	67 (31.0)			139.0 (25.6)	52.9 (24.4)
Cervical cerclage/n(%)			<0.001	0.379			0.672	0.036
No	146 (27.0)	97 (44.9)			178.2 (32.8)	67.4 (31.1)
Yes	394 (73.0)	119 (55.1)			365.9 (67.2)	149.3 (68.9)

Characteristic	Before sIPTW				After sIPTW
Characteristic	Normal group (n=540)	Vaginal dysbiosis group (n=216)	P value	SMD	Normal group (n=544.07)	Vaginal dysbiosis group (n=216.69)	P value	SMD
Age/n(%)			0.110	0.145			0.767	0.030
≤35 years	477 (88.3)	200 (92.6)			487.7 (89.6)	192.2 (88.7)
>35 years	63 (11.7)	16 (7.4)			56.4 (10.4)	24.5 (11.3)
BMI/(kg·m^-2)	22.41 (20.82, 24.41)	21.91 (20.44, 23.94)	0.011	0.198	22.21 (20.69, 24.30)	22.22 (20.69, 24.61)	0.763	0.063
Gravidity/n(%)			0.836	0.049			0.797	0.059
1	24 (4.4)	8 (3.7)			22.5 (4.1)	6.7 (3.1)
2	230 (42.6)	96 (44.4)			235.8 (43.3)	96.6 (44.6)
≥3	286 (53.0)	112 (51.9)			285.8 (52.5)	113.5 (52.4)
Parity/n(%)			0.235	0.110			0.769	0.028
0	483 (89.4)	200 (92.6)			491.2 (90.3)	197.4 (91.1)
≥1	57 (10.6)	16 (7.4)			52.9 (9.7)	19.3 (8.9)
Prior history of cerclage/n(%)			0.772	0.036			0.355	0.101
No	500 (92.6)	202 (93.5)			504.6 (92.7)	194.8 (89.9)
Yes	40 (7.4)	14 (6.5)			39.5 (7.3)	21.9 (10.1)
Number of late miscarriage/n(%)			0.864	0.043			0.915	0.036
0	49 (9.1)	22 (10.2)			50.7 (9.3)	18.0 (8.3)
1	309 (57.2)	120 (55.6)			310.5 (57.1)	125.8 (58.1)
≥2	182 (33.7)	74 (34.3)			182.8 (33.6)	72.8 (33.6)
Cervical examination/n(%)			0.131	0.128			0.975	0.003
Normal	363 (67.2)	132 (61.1)			351.1 (64.5)	140.1 (64.7)
Abnormal	177 (32.8)	84 (38.9)			193.0 (35.5)	76.6 (35.3)
Methods of pregnancy/n(%)			0.164	0.128			0.589	0.061
Natural pregnancy	483 (89.4)	201 (93.1)			492.9 (90.6)	192.3 (88.7)
IVF	57 (10.6)	15 (6.9)			51.2 (9.4)	24.4 (11.3)
History of LEEP/n(%)			0.180	0.131			0.717	0.040
No	511 (94.6)	210 (97.2)			518.8 (95.4)	204.7 (94.5)
Yes	29 (5.4)	6 (2.8)			25.3 (4.6)	12.0 (5.5)
History of PCOS/n(%)			0.490	0.077			0.649	0.044
No	533 (98.7)	211 (97.7)			530.9 (97.6)	212.8 (98.2)
Yes	7 (1.3)	5 (2.3)			13.2 (2.4)	3.9 (1.8)
Cervical length/n(%)			0.007	0.249			0.822	0.055
<25 mm	73 (13.5)	48 (22.2)			91.4 (16.8)	35.6 (16.4)
25‒30 mm	173 (32.0)	71 (32.9)			175.9 (32.3)	75.6 (34.9)
>30 mm	294 (54.4)	97 (44.9)			276.8 (50.9)	105.5 (48.7)
Dilation of cervical os/n(%)			0.009	0.214			0.754	0.027
No	423 (78.3)	149 (69.0)			405.1 (74.4)	163.8 (75.6)
Yes	117 (21.7)	67 (31.0)			139.0 (25.6)	52.9 (24.4)
Cervical cerclage/n(%)			<0.001	0.379			0.672	0.036
No	146 (27.0)	97 (44.9)			178.2 (32.8)	67.4 (31.1)
Yes	394 (73.0)	119 (55.1)			365.9 (67.2)	149.3 (68.9)

Vaginal microbiota	Total (n=756)
Enterococcus faecalis/n(%)	10 (1.32)
Candida albicans/n(%)	48 (6.35)
Candida tropicalis/n(%)	4 (0.53)
Candida glabrata/n(%)	23 (3.04)
Escherichia coli/n(%)	30 (3.97)
Streptococcus agalactiae/n(%)	14 (1.85)
Gardnerella vaginalis/n(%)	54 (7.14)
Klebsiella pneumoniae/n(%)	4 (0.53)
Staphylococcus aureus/n(%)	9 (1.12)
Proteus mirabilis/n(%)	8 (1.06)
Haemophilus parainfluenzae/n(%)	3 (0.40)
Enterobacter aerogenes/n(%)	1 (0.13)
Hemophilus ducreyi/n(%)	1 (0.13)
Streptococcus milleri/n(%)	1 (0.13)
Staphylococcus haemolyticus/n(%)	1 (0.13)
Morganella morganii/n(%)	1 (0.13)
Burkholderia cepacia/n(%)	1 (0.13)
Enterobacter cloacae/n(%)	3 (0.40)

Vaginal microbiota	Total (n=756)
Enterococcus faecalis/n(%)	10 (1.32)
Candida albicans/n(%)	48 (6.35)
Candida tropicalis/n(%)	4 (0.53)
Candida glabrata/n(%)	23 (3.04)
Escherichia coli/n(%)	30 (3.97)
Streptococcus agalactiae/n(%)	14 (1.85)
Gardnerella vaginalis/n(%)	54 (7.14)
Klebsiella pneumoniae/n(%)	4 (0.53)
Staphylococcus aureus/n(%)	9 (1.12)
Proteus mirabilis/n(%)	8 (1.06)
Haemophilus parainfluenzae/n(%)	3 (0.40)
Enterobacter aerogenes/n(%)	1 (0.13)
Hemophilus ducreyi/n(%)	1 (0.13)
Streptococcus milleri/n(%)	1 (0.13)
Staphylococcus haemolyticus/n(%)	1 (0.13)
Morganella morganii/n(%)	1 (0.13)
Burkholderia cepacia/n(%)	1 (0.13)
Enterobacter cloacae/n(%)	3 (0.40)

Pregnancy outcome	Before sIPTW			After sIPTW
Pregnancy outcome	Normal group (n=540)	Vaginal dysbiosis group (n=216)	P value	Normal group (n=544.1)	Vaginal dysbiosis group (n=216.7)	P value
Term birth/n(%)	433 (80.2)	105 (48.6)	<0.001	422.6 (77.7)	111.4 (51.4)	<0.001
Miscarriage/n(%)	43 (8.0)	41 (19.0)	<0.001	46.4 (8.5)	32.1 (14.8)	<0.001
Preterm birth/n(%)	64 (11.9)	70 (32.4)	<0.001	75.1 (13.8)	73.2 (33.8)	<0.001
Live birth/n(%)	503 (93.1)	177 (81.9)	<0.001	503.1 (92.5)	186.0 (85.8)	0.006
Pregnancy complication/n(%)	49 (9.1)	28 (13.0)	0.143	50.7 (9.3)	38.7 (17.9)	0.013
Birth weight/g	3 154.44±532.49	2 841.44±690.62	<0.001	3 141.26±544.59	2 887.90±695.62	<0.001
Gestational age at delivery/week	37.66±2.22	36.48±2.82	<0.001	37.59±2.27	36.59±2.81	<0.001
Vaginal delivery/n(%)	428 (85.1)	156 (88.1)	0.381	428.1 (85.1)	161.1 (86.6)	0.678
Cesarean section/n(%)	75 (14.9)	21 (11.9)	0.317	75.0 (14.9)	24.9 (13.4)	0.398

阴道菌群紊乱对宫颈机能不全患者妊娠活产结局的影响

Effect of vaginal microbiota dysbiosis on live birth outcomes in patients with cervical incompetence

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Metrics

Characteristic	Before sIPTW			After sIPTW
Characteristic	Live birth group (n=680)	Non-live birth group (n=76)	P value	Live birth group (n=689.0)	Non-live birth group (n=71.6)	P value
Age/n(%)			1.000			0.935
≤35 years	609 (89.6)	68 (89.5)		616.0 (89.4)	63.8 (89.1)
>35 years	71 (10.4)	8 (10.5)		73.1 (10.6)	7.8 (10.9)
BMI/(kg·m^-2)	22.10 (20.58, 24.24)	23.19 (21.10, 25.04)	0.027	22.10 (20.58, 24.30)	23.19 (21.10, 24.84)	0.031
Gravidity/n(%)			<0.001			<0.001
1	18 (2.6)	14 (18.4)		15.9 (2.3)	13.3 (18.6)
2	302 (44.4)	24 (31.6)		310.5 (45.1)	21.9 (30.5)
≥3	360 (52.9)	38 (50.0)		362.8 (52.6)	36.4 (50.9)
Parity/n(%)			0.634			0.272
0	616 (90.6)	67 (88.2)		626.5 (90.9)	62.0 (86.6)
≥1	64 (9.4)	9 (11.8)		62.6 (9.1)	9.6 (13.4)
Prior history of cerclage/n(%)			0.663			0.650
No	630 (92.6)	72 (94.7)		632.4 (91.8)	66.9 (93.5)
Yes	50 (7.4)	4 (5.3)		56.8 (8.2)	4.7 (6.5)
Number of late miscarriage/n(%)			<0.001			<0.001
0	43 (6.3)	28 (36.8)		42.3 (6.1)	26.5 (36.9)
1	405 (59.6)	24 (31.6)		415.4 (60.3)	20.9 (29.2)
≥2	232 (34.1)	24 (31.6)		231.4 (33.6)	24.3 (33.9)
Cervical examination/n(%)			<0.001			<0.001
Normal	472 (69.4)	23 (30.3)		469.7 (68.2)	21.5 (30.0)
Abnormal	208 (30.6)	53 (69.7)		219.4 (31.8)	50.1 (70.0)
Methods of pregnancy/n(%)			0.914			0.898
Natural pregnancy	616 (90.6)	68 (89.5)		620.9 (90.1)	64.2 (89.6)
IVF	64 (9.4)	8 (10.5)		68.2 (9.9)	7.4 (10.4)
History of LEEP/n(%)			0.245			0.261
No	646 (95.0)	75 (98.7)		653.2 (94.8)	70.3 (98.2)
Yes	34 (5.0)	1 (1.3)		36.0 (5.2)	1.3 (1.8)
History of PCOS/n(%)			1.000			0.186
No	669 (98.4)	75 (98.7)		672.6 (97.6)	71.2 (99.4)
Yes	11 (1.6)	1 (1.3)		16.6 (2.4)	0.5 (0.6)
Vaginal microbiota/n(%)			<0.001			0.006
Normal	503 (74.0)	37 (48.7)		503.1 (73.0)	41.0 (57.2)
Dysbiosis	177 (26.0)	39 (51.3)		186.0 (27.0)	30.7 (42.8)
Cervical cerclage/n(%)			<0.001			<0.001
No	200 (29.4)	43 (56.6)		206.0 (29.9)	39.5 (55.2)
Yes	480 (70.6)	33 (43.4)		483.1 (70.1)	32.1 (44.8)
Cervical length/n(%)			<0.001			0.001
<25 mm	97 (14.3)	24 (31.6)		104.8 (15.2)	22.2 (31.0)
25‒30 mm	216 (31.8)	28 (36.8)		224.4 (32.6)	27.1 (37.8)
>30 mm	367 (54.0)	24 (31.6)		360.0 (52.2)	22.3 (31.2)
Dilation of cervical os/n(%)			<0.001			0.001
No	529 (77.8)	43 (56.6)		527.2 (76.5)	41.7 (58.2)
Yes	151 (22.2)	33 (43.4)		161.9 (23.5)	30.0 (41.8)

Variable	Clinical data	β	SE	P	OR	LLCI	ULCI
Independent variable	Vaginal microbiota (dysbiosis)	-0.071	0.024	0.003	0.932	0.889	0.976
Covariate	Number of late miscarriage (1)	0.055	0.028	0.053	1.056	0.999	1.116
	Number of late miscarriage (0)	-0.190	0.071	0.008	0.827	0.719	0.951
	Cervical examination (abnormal)	-0.119	0.025	<0.001	0.888	0.845	0.932
	Dilation of cervical os	-0.018	0.032	0.567	0.982	0.922	1.045
	Cervical cerclage	0.086	0.024	<0.001	1.090	1.039	1.143
	BMI	-0.002	0.004	0.599	0.998	0.991	1.005
	Cervical length (25‒30 mm)	-0.029	0.039	0.458	0.971	0.899	1.049
	Cervical length (>30 mm)	0.005	0.038	0.889	1.005	0.932	1.084
	Gravidity (2)	0.126	0.101	0.211	1.134	0.931	1.383
	Gravidity (≥3)	0.118	0.101	0.243	1.125	0.923	1.371

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[2]	何萍, 邵飞雪, 郭丽丽, 李克婷, 毛笑园, 包怡榕, 王磊. 宫颈机能不全孕妇早、中孕期盆底结构变化初探[J]. 上海交通大学学报（医学版）, 2023, 43(4): 459-465.