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1261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、χ^(2)检验或单因素方差分析。P<0.05为差异有统计学意义。结果1261份阴道分泌物标本中,异常病原菌阳性率为22.0%(277/1261)。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。
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 1261 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 1261 vaginal secretion specimens,the positive rate of pathogenic bacteria was 22.0%(277/1261).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.
作者
李雪
肖伊
张弘
LI Xue;XIAO Yi;ZHANG Hong(Department of Obstetrics and Gynecology,Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Women′s Health Care,Suzhou Affiliated Hospital of Nanjing Medical University,Suzhou 215002,China)
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2023年第11期1417-1422,共6页
Journal of Shanghai Jiao tong University:Medical Science
基金
国家自然科学基金(82071726)
苏州大学附属第二医院预研基金(SDFEYGZ2220)。
关键词
阴道菌群
宫颈功能不全
宫颈环扎
围产结局
早产率
vaginal flora
cervical incompetence(CIC)
cervical cerclage
perinatal outcomes
preterm birth rate
