宫颈功能不全患者阴道菌群的分布特征及妊娠结局

doi:10.3969/j.issn.1674-8115.2023.11.009

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (11): 1417-1422.doi: 10.3969/j.issn.1674-8115.2023.11.009

• 论著 · 临床研究 • 上一篇

宫颈功能不全患者阴道菌群的分布特征及妊娠结局

李雪¹(), 肖伊², 张弘¹()

^1.苏州大学附属第二医院妇产科，苏州 215004
^2.南京医科大学附属苏州医院妇女保健科，苏州 215002

收稿日期:2023-09-18 接受日期:2023-10-29 出版日期:2023-11-28 发布日期:2023-11-28
通讯作者: 张弘 E-mail:zlanling@163.com;szzhanghong126@126.com
作者简介:李　雪（1986—），女，副主任医师，博士生；电子信箱：zlanling@163.com。
基金资助:
国家自然科学基金(82071726);苏州大学附属第二医院预研基金(SDFEYGZ2220)

Distribution characteristics of vaginal flora and pregnancy outcomes in cervical incompetence patients

LI Xue¹(), XIAO Yi², ZHANG Hong¹()

^1.Department of Obstetrics and Gynecology, Second Affiliated Hospital of Soochow University, Suzhou 215004, China
^2.Department of Women′s Health Care, Suzhou Affiliated Hospital of Nanjing Medical University, Suzhou 215002, China

Received:2023-09-18 Accepted:2023-10-29 Online:2023-11-28 Published:2023-11-28
Contact: ZHANG Hong E-mail:zlanling@163.com;szzhanghong126@126.com
Supported by:
National Natural Science Foundation of China(8207176);Pre-research Funding of Second Affiliated Hospital of Soochow University(SDFEYGZ2220)

摘要/Abstract

摘要：

目的·探讨宫颈功能不全（cervical incompetence，CIC）患者的阴道菌群分布特点，以及异常阴道菌群CIC患者行宫颈环扎术对妊娠结局的影响。方法·纳入2016年1月—2020年12月在苏州大学附属第二医院妇产科就诊的1 261例妊娠期女性，根据诊断分为宫颈功能不全组（CIC组）及正常妊娠组（NP组），其中CIC组又随机分为宫颈环扎组（CIC-C组）以及期待组（CIC-E组），同时进行阴道分泌物培养，通过阴道菌群的结果，CIC-C组及CIC-E组进一步分为正常阴道菌群环扎组（CIC-C-N组）及期待组（CIC-E-N组）和异常阴道菌群环扎组（CIC-C-A组）及期待组（CIC-E-A组），随访对比妊娠结局。组间比较使用t检验、χ²检验或单因素方差分析。P<0.05为差异有统计学意义。结果·1 261份阴道分泌物标本中，异常病原菌阳性率为22.0%（277/1 261）。CIC患者异常菌群阳性率（32.9%，229/696）明显高于NP组（8.5%，48/565）。CIC患者检出菌群23种，NP组检出菌群9种。CIC-C组、CIC-E组及NP组的足月产率比较，差异具有统计学意义（P=0.000）。阴道菌群异常的CIC患者中，CIC-E-A组的足月产率明显低于CIC-C-A组（61.84% vs 77.78%，P=0.011），妊娠期并发症发生率明显高于CIC-C-A组（22.37% vs 9.15%，P=0.006），差异均具有统计学意义。结论·CIC患者与正常妊娠女性的阴道菌群的分布及多样性存在差异。异常阴道菌群CIC患者行宫颈环扎术可改善妊娠结局。

关键词: 阴道菌群, 宫颈功能不全, 宫颈环扎, 围产结局, 早产率

Abstract:

Objective ·To investigate the distribution characteristics of vaginal flora in patients with cervical incompetence (CIC), and the effect of cervical cerclage on pregnancy outcome in patients with CIC with abnormal vaginal flora. Methods ·A total of 1 261 pregnant women participated in the study. According to the diagnosis, they were divided into cervical incompetence group (CIC group) and normal pregnancy group (NP group). The CIC group patients randomly received cervical cerclage (CIC-C group) or expectation therapy (CIC-E group). Vaginal secretion samples of the patients in the groups were collected and analyzed in the laboratory. Meanwhile, through the results of vaginal flora, the CIC-C group and CIC-E group were further divided into normal vaginal flora groups (CIC-C-N group and CIC-E-N group) and abnormal vaginal flora groups (CIC-C-A group and CIC-E-A group). All groups were processed accordingly and analyzed on pregnancy outcomes. T-test and Chi-squared test were used for comparison between the groups, and One-way ANOVA was used for comparison among the three groups. Statistical significance was accepted at a value of P<0.05. Results ·Among 1 261 vaginal secretion specimens, the positive rate of pathogenic bacteria was 22.0% (277/1 261). The pathogen detection rates in the CIC group and NP group were 32.9% (229/696) and 8.5% (48/565). Twenty-three types of vaginal flora were detected in the CIC group, and 9 were detected in the NP group. The proportions of women who had term birth were 75.94% in the CIC-C group, 70.03% in the CIC-E group, and 87.79% in the NP group (P=0.000). Compared with the CIC-C-A group, the CIC-E-A group had a lower term delivery rate (61.84% vs 77.78%, P=0.011) and a higher incidence of pregnancy complications (22.37% vs 9.15%, P=0.006). Conclusion ·There are differences in the distribution and diversity of vaginal flora between CIC patients and normal pregnant women. Cervical cerclage can improve pregnancy outcomes in CIC patients with abnormal vaginal flora.

Key words: vaginal flora, cervical incompetence (CIC), cervical cerclage, perinatal outcomes, preterm birth rate

中图分类号:

R714.4

李雪, 肖伊, 张弘. 宫颈功能不全患者阴道菌群的分布特征及妊娠结局[J]. 上海交通大学学报（医学版）, 2023, 43(11): 1417-1422.

LI Xue, XIAO Yi, ZHANG Hong. Distribution characteristics of vaginal flora and pregnancy outcomes in cervical incompetence patients[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(11): 1417-1422.

图/表 4

参考文献 24

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Flora	Vaginal flora/n (%)		χ²	P value
Flora	CIC group (n=696)	NP group(n=565)	χ²	P value
Enterococcus faecalis	11 (1.58)	3 (0.53)	3.131	0.077
Candida albicans	55 (7.90)	14 (2.48)	17.965	0.000
Candida tropicalis	6 (0.86)	8 (1.41)	4.905	0.027
Candida glabrata	33 (4.74)	10 (1.77)	8.402	0.004
Escherichia coli	21 (3.01)	2 (0.35)	12.455	0.000
Streptococcus agalactiae	11 (1.58)	5 (0.88)	1.203	0.273
Gardnerella vaginalis	48 (6.90)	7 (1.24)	24.353	0.000
Klebsiella pneumoniae	5 (0.71)	1 (0.18)	1.930	0.165
Staphylococcus aureus	5 (0.71)	0 (0)	4.082	0.044
Staphylococcus epidermidis	3 (0.43)	1 (0.18)	0.636	0.425
Streptococcus bovis	2 (0.29)	0 (0)	1.626	0.203
Acinetobacter baumannii	1 (0.14)	0 (0)	0.812	0.368
Proteus mirabilis	3 (0.43)	0 (0)	2.442	0.118
Haemophilus parainfluenzae	1 (0.14)	0 (0)	0.812	0.368
Enterobacter aerogenes	2 (0.29)	0 (0)	1.626	0.203
Hemophilus ducreyi	1 (0.14)	0 (0)	0.812	0.368
Streptococcus milleri	1 (0.14)	0 (0)	0.812	0.368
Neisseria subflava	1 (0.14)	0 (0)	0.812	0.368
Staphylococcus haemolyticus	2 (0.29)	0 (0)	1.626	0.203
Morganella morganii	2 (0.29)	0 (0)	1.626	0.203
Burkholderia cepacia	1 (0.14)	0 (0)	0.812	0.368
Pseudomonas aeruginosa	1 (0.14)	0 (0)	0.812	0.368
Enterobacter cloacae	1 (0.14)	0 (0)	0.812	0.368

Flora	Vaginal flora/n (%)		χ²	P value
Flora	CIC group (n=696)	NP group(n=565)	χ²	P value
Enterococcus faecalis	11 (1.58)	3 (0.53)	3.131	0.077
Candida albicans	55 (7.90)	14 (2.48)	17.965	0.000
Candida tropicalis	6 (0.86)	8 (1.41)	4.905	0.027
Candida glabrata	33 (4.74)	10 (1.77)	8.402	0.004
Escherichia coli	21 (3.01)	2 (0.35)	12.455	0.000
Streptococcus agalactiae	11 (1.58)	5 (0.88)	1.203	0.273
Gardnerella vaginalis	48 (6.90)	7 (1.24)	24.353	0.000
Klebsiella pneumoniae	5 (0.71)	1 (0.18)	1.930	0.165
Staphylococcus aureus	5 (0.71)	0 (0)	4.082	0.044
Staphylococcus epidermidis	3 (0.43)	1 (0.18)	0.636	0.425
Streptococcus bovis	2 (0.29)	0 (0)	1.626	0.203
Acinetobacter baumannii	1 (0.14)	0 (0)	0.812	0.368
Proteus mirabilis	3 (0.43)	0 (0)	2.442	0.118
Haemophilus parainfluenzae	1 (0.14)	0 (0)	0.812	0.368
Enterobacter aerogenes	2 (0.29)	0 (0)	1.626	0.203
Hemophilus ducreyi	1 (0.14)	0 (0)	0.812	0.368
Streptococcus milleri	1 (0.14)	0 (0)	0.812	0.368
Neisseria subflava	1 (0.14)	0 (0)	0.812	0.368
Staphylococcus haemolyticus	2 (0.29)	0 (0)	1.626	0.203
Morganella morganii	2 (0.29)	0 (0)	1.626	0.203
Burkholderia cepacia	1 (0.14)	0 (0)	0.812	0.368
Pseudomonas aeruginosa	1 (0.14)	0 (0)	0.812	0.368
Enterobacter cloacae	1 (0.14)	0 (0)	0.812	0.368

Top	Vaginal flora/n (%)
Top	CIC group (n=696)		NP group (n=565)
Total percent		168 (24.13)		44 (7.78)
1	Candida albicans	55 (7.90)	Candida albicans	14 (2.48)
2	Gardnerella vaginalis	48 (6.90)	Candida glabrata	10 (1.77)
3	Candida glabrata	33 (4.74)	Candida tropicalis	8 (1.41)
4	Escherichia coli	21 (3.01)	Gardnerella vaginalis	7 (1.24)
5	Streptococcus agalactiae	11 (1.58)	Streptococcus agalactiae	5 (0.88)

Top	Vaginal flora/n (%)
Top	CIC group (n=696)		NP group (n=565)
Total percent		168 (24.13)		44 (7.78)
1	Candida albicans	55 (7.90)	Candida albicans	14 (2.48)
2	Gardnerella vaginalis	48 (6.90)	Candida glabrata	10 (1.77)
3	Candida glabrata	33 (4.74)	Candida tropicalis	8 (1.41)
4	Escherichia coli	21 (3.01)	Gardnerella vaginalis	7 (1.24)
5	Streptococcus agalactiae	11 (1.58)	Streptococcus agalactiae	5 (0.88)

Item	Pregnancy outcome			P value
Item	CIC-C group (n=399)	CIC-E group (n=297)	NP group (n=565)	P value
Gestational weeks at delivery	36.1±5.2	35.3±4.5	37.3±3.5	0.362
Pregnancy loss/n(%)	34 (8.52)	30 (10.10)	31 (5.49)	0.034
Preterm birth/n(%)	62 (15.54)^①	59 (19.87)^①②	38 (6.72)	0.000
Term birth/n(%)	303 (75.94)^①	208 (70.03)^①③	496 (87.79)	0.000
Live birth/n(%)	371 (92.98)	273 (91.92)	534 (94.51)	0.315
Pregnancy complications/n(%)	26 (6.51)^④	27 (9.09)^①⑤	16 (2.83)	0.000
Puerperal infection/n(%)	5 (1.25)	5 (1.68)	3 (0.53)	0.245

宫颈功能不全患者阴道菌群的分布特征及妊娠结局

Distribution characteristics of vaginal flora and pregnancy outcomes in cervical incompetence patients

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Outcome	Normal vaginal flora		P value	Abnormal vaginal flora		P value
Outcome	CIC-C-N group (n=246)	CIC-E-N group (n=221)	P value	CIC-C-A group (n=153)	CIC-E-A group (n=76)	P value
Pregnancy loss/n(%)	25 (10.16)	21 (9.50)	0.812	9 (5.88)	9 (11.84)	0.116
Preterm birth/n(%)	37 (15.04)	29 (13.12)	0.553	25 (16.33)	20 (26.32)	0.074
Term birth/n(%)	184 (74.8)	171 (77.38)	0.516	119 (77.78)	47 (61.84)	0.011
Vaginal delivery/n(%)	112 (45.52)	97 (43.89)	0.722	70 (45.75)	33 (43.42)	0.738
Caesarean section/n(%)	109 (44.30)	103 (46.60)	0.619	74 (48.36)	34 (44.74)	0.604
Premature rupture of membrane/n(%)	5 (2.03)	4 (1.81)	0.864	4 (2.61)	1 (1.32)	0.529
Pregnancy complications/n(%)	12 (4.88)	10 (4.52)	0.440	14 (9.15)	17 (22.37)	0.006
Chorioamnionitis/n(%)	1 (0.41)	2 (0.90)	0.266	3 (1.96)	4 (5.26)	0.173
Puerperal infection/n(%)	2 (0.81)	2 (0.90)	0.569	3 (1.96)	3 (3.95)	0.378
Asphyxia neonatorum/n(%)	4 (1.62)	2 (0.90)	0.812	2 (1.31)	2 (2.63)	0.473
Small for gestational age/n(%)	27 (10.98)	28 (12.67)	0.572	22 (14.38)	13 (17.1)	0.591

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