妊娠期糖尿病合并未足月胎膜早破与阴道微生物感染及妊娠结局的相关性

doi:10.12280/gjfckx.20200497

摘要/Abstract

摘要：

目的:探讨妊娠期糖尿病（gestational diabetes mellitus,GDM）合并未足月胎膜早破（preterm premature rupture of membranes,PPROM）与阴道微生物感染及妊娠结局的相关性。方法:选取2019年6月—2020年6月在我院分娩的GDM合并PPROM的产妇为研究组（n=64）,选取同期在我院分娩的正常产妇为对照组（n=50）。2组产妇均在入组时进行分泌物标本收集,取阴道分泌物用于B族链球菌（GBS）、细菌性阴道病（BV）及假丝酵母菌（CM）的检测,取宫颈分泌物进行解脲支原体（UU）及衣原体（CT）的检测。并记录患者阴道微生物感染情况及妊娠结局。结果:2组GBS、UU及CT感染情况差异有统计学意义（均P<0.05）,BV、CM感染情况差异无统计学意义（均P>0.05）,GDM合并PPROM与GBS、UU及CT感染呈正相关（列联系数r分别为0.293、0.202和0.189）,且与GBS感染相关性最显著。绒毛膜羊膜炎的发生率在GBS、CT感染组中显著升高（列联系数r分别为0.375和0.277）,新生儿肺炎的发生率在GBS、CT、BV感染组中显著升高（列联系数r分别为0.248、0.239和0.245）,新生儿病理性黄疸的发生率在UU及CT感染组中显著升高（列联系数r分别为0.489和0.292）。结论:对GDM患者进行阴道微生物检测具有重要意义,尤其是GBS的感染可能会导致PPROM的发生,并进一步导致不良的妊娠结局,如绒毛膜羊膜炎及新生儿肺炎等。

关键词: 糖尿病,妊娠, 未足月胎膜早破, 胎膜早破, 阴道, 念珠菌病,外阴阴道, 阴道病,细菌性, 妊娠结局, 绒毛膜羊膜炎

Abstract:

Objective: To explore the relationship between gestational diabetes mellitus with premature rupture of membranes and vaginal microbial infection and pregnancy outcome. Methods: From June 2019 to June 2020, pregnant women with gestational diabetes mellitus and PPROM in our hospital were selected as the study group (n=64) and normal pregnant women in our hospital at the same time as the control group (n=50). Vaginal secretions were collected for the detection of group B streptococcus (GBS), bacterial vaginosis (BV) and Candida (CM). Cervical secretions were used for the detection of Ureaplasma urealyticum (UU) and Chlamydia (CT). The vaginal microbial infection and pregnancy outcomes were recorded. Results: There was significant difference in GBS, UU and CT infection between the two groups (P<0.05), but there was no significant difference in BV and CM infection (P>0.05). GDM combined with PPROM was positively correlated with GBS, UU and CT infection (r=0.293, 0.202, 0.189, respectively), and GBS infection was most significantly related. The incidence of chorioamnionitis was significantly higher in GBS and CT infection groups (r=0.375, 0.277), neonatal pneumonia was significantly higher in GBS, CT and BV infection groups (r=0.248, 0.239, 0.245), and the incidence of pathological jaundice in UU and CT infection groups was significantly higher (r=0.489, 0.292). Conclusions: It is of great significance to carry out vaginal microbiological detection in women with gestational diabetes mellitus, and the infection of GBS may lead to the occurrence of PPROM, and further lead to adverse pregnancy outcomes, such as chorioamnionitis and neonatal pneumonia.

Key words: Diabetes,gestational, Preterm premature rupture of membranes, Fetal membranes,premature rupture, Vagina, Candidiasis,vulvovaginal, Vaginosis,bacterial, Pregnancy outcome, Chorioamnionitis

贾燚鑫, 宋志慧, 高春燕, 高然. 妊娠期糖尿病合并未足月胎膜早破与阴道微生物感染及妊娠结局的相关性[J]. 国际妇产科学杂志, 2021, 48(1): 105-109.

JIA Yi-xin, SONG Zhi-hui, GAO Chun-yan, GAO Ran. Relationship between Gestational Diabetes Mellitus with Premature Rupture of Membranes and Vaginal Microbial Infection and Pregnancy Outcome[J]. Journal of International Obstetrics and Gynecology, 2021, 48(1): 105-109.

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参考文献 20

[1]	Meller CH, Carducci ME, Ceriani Cernadas JM, et al. Preterm premature rupture of membranes[J]. Arch Argent Pediatr, 2018,116(4):e575-575e581. doi: 10.5546/aap.2018.eng.e575. doi: 10.5546/aap.2018.eng.e575 pmid: 30016035
[2]	Tchirikov M, Schlabritz-Loutsevitch N, Maher J, et al. Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome[J]. J Perinat Med, 2018,46(5):465-488. doi: 10.1515/jpm-2017-0027. doi: 10.1515/jpm-2017-0027 pmid: 28710882
[3]	Tomaiuolo R, Veneruso I, Cariati F, et al. Microbiota and Human Reproduction: The Case of Female Infertility[J]. High Throughput, 2020,9(2):45-49. doi: 10.3390/ht9020012.
[4]	Margarita V, Fiori PL, Rappelli P. Impact of Symbiosis Between Trichomonas vaginalis and Mycoplasma hominis on Vaginal Dysbiosis: A Mini Review[J]. Front Cell Infect Microbiol, 2020,10:179. doi: 10.3389/fcimb.2020.00179. doi: 10.3389/fcimb.2020.00179 pmid: 32457847
[5]	苗志荣, 吴红花. 妊娠期糖尿病诊断与治疗研究进展[J]. 中国糖尿病杂志, 2017,25(4):365-370. doi: 10.3969/j.issn.1006-6187.2017.04.017.
[6]	中华医学会妇产科学分会产科学组. 胎膜早破的诊断与处理指南(2015)[J]. 中华妇产科杂志, 2015,50(1):3-8. doi: 10.3760/cma.j.issn.0529-567x.2015.01.002.
[7]	Li YY, Kong CW, To W. Pathogens in preterm prelabour rupture of membranes and erythromycin for antibiotic prophylaxis: a retrospective analysis[J]. Hong Kong Med J, 2019,25(4):287-294. doi: 10.12809/hkmj197991. doi: 10.12809/hkmj197991 pmid: 31402340
[8]	Lei LL, Lan YL, Wang SY, et al. Perinatal complications and live-birth outcomes following assisted reproductive technology: a retrospective cohort study[J]. Chin Med J(Engl), 2019,132(20):2408-2416. doi: 10.1097/CM9.0000000000000484.
[9]	Kalia N, Singh J, Kaur M. Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review[J]. Ann Clin Microbiol Antimicrob, 2020,19(1):5. doi: 10.1186/s12941-020-0347-4. doi: 10.1186/s12941-020-0347-4 pmid: 31992328
[10]	Pruski P, Lewis HV, Lee YS, et al. Assessment of microbiota:host interactions at the vaginal mucosa interface[J]. Methods, 2018,149:74-84. doi: 10.1016/j.ymeth.2018.04.022. doi: 10.1016/j.ymeth.2018.04.022 pmid: 29705211
[11]	Achilles SL, Austin MN, Meyn LA, et al. Impact of contraceptive initiation on vaginal microbiota[J]. Am J Obstet Gynecol, 2018, 218(6):622.e1-622.e10. doi: 10.1016/j.ajog.2018.02.017. doi: 10.1016/j.ajog.2018.02.017
[12]	Serrano MG, Parikh HI, Brooks JP, et al. Racioethnic diversity in the dynamics of the vaginal microbiome during pregnancy[J]. Nat Med, 2019,25(6):1001-1011. doi: 10.1038/s41591-019-0465-8. doi: 10.1038/s41591-019-0465-8 pmid: 31142850
[13]	Vrbanac A, Riestra AM, Coady A, et al. The murine vaginal microbiota and its perturbation by the human pathogen group B Streptococcus[J]. BMC Microbiol, 2018,18(1):197. doi: 10.1186/s12866-018-1341-2. doi: 10.1186/s12866-018-1341-2 pmid: 30477439
[14]	Surve MV, Anil A, Kamath KG, et al. Membrane Vesicles of Group B Streptococcus Disrupt Feto-Maternal Barrier Leading to Preterm Birth[J]. PLoS Pathog, 2016,12(9):e1005816. doi: 10.1371/journal.ppat.1005816. doi: 10.1371/journal.ppat.1005816 pmid: 27583406
[15]	Miyoshi Y, Suga S, Sugimi S, et al. Vaginal Ureaplasma urealyticum or Mycoplasma hominis and preterm delivery in women with threatened preterm labor[J]. J Matern Fetal Neonatal Med, 2020: 1-6. doi: 10.1080/14767058.2020.1733517. doi: 10.1080/14767058.2021.1888287 pmid: 33615967
[16]	Zhang LX, Sun Y, Zhao H, et al. A Bayesian Stepwise Discriminant Model for Predicting Risk Factors of Preterm Premature Rupture of Membranes: A Case-control Study[J]. Chin Med J(Engl), 2017,130(20):2416-2422. doi: 10.4103/0366-6999.216396.
[17]	Oh KJ, Romero R, Park JY, et al. The earlier the gestational age, the greater the intensity of the intra-amniotic inflammatory response in women with preterm premature rupture of membranes and amniotic fluid infection by Ureaplasma species[J]. J Perinat Med, 2019,47(5):516-527. doi: 10.1515/jpm-2019-0003. doi: 10.1515/jpm-2019-0003 pmid: 31141489
[18]	Andrade C. Adverse Gestational Outcomes Associated With Attention-Deficit/Hyperactivity Disorder Medication Exposure During Pregnancy[J]. J Clin Psychiatry, 2018,79(1). doi: 10.4088/JCP.18f12136. pmid: 29370483
[19]	Tajik P, van der Ham DP, Zafarmand MH, et al. Using vaginal Group B Streptococcus colonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials[J]. BJOG, 2014, 121(10):1263-1272; discussion 1273. doi: 10.1111/1471-0528.12889. doi: 10.1111/1471-0528.12889 pmid: 24862166
[20]	张燕, 林曼, 王秀妹. 妊娠期阴道假丝酵母菌感染与胎膜早破的关系及对母婴结局的影响[J]. 中国性科学, 2018,27(8):77-79. doi: 10.3969/j.issn.1672-1993.2018.08.023.

组别	n	年龄（岁）	BMI（kg/m²）	孕周（周）	孕次（次）	产次（次）
研究组	64	32.54±3.45	27.32±2.51	32.51±4.03	2.71±0.63	1.83±0.48
对照组	50	32.34±3.57	26.64±2.33	37.71±2.45	2.54±0.58	1.66±0.49
t		0.301	1.495	8.505	1.480	1.859
P		0.764	0.139	0.000	0.142	0.066

组别	n	年龄（岁）	BMI（kg/m²）	孕周（周）	孕次（次）	产次（次）
研究组	64	32.54±3.45	27.32±2.51	32.51±4.03	2.71±0.63	1.83±0.48
对照组	50	32.34±3.57	26.64±2.33	37.71±2.45	2.54±0.58	1.66±0.49
t		0.301	1.495	8.505	1.480	1.859
P		0.764	0.139	0.000	0.142	0.066

组别	n	GBS	BV	CM	UU	CT
研究组	64	44（68.8）	12（18.8）	7（10.9）	11（17.2）	16（25.0）
对照组	50	19（38.0）	8（16.0）	3（6.0）	2（4.0）	5（10.0）
χ²		10.740	0.150	0.860	4.830	4.200
P		0.001	0.702	0.355	0.028	0.040
r		0.293	-	-	0.202	0.189

组别	n	GBS	BV	CM	UU	CT
研究组	64	44（68.8）	12（18.8）	7（10.9）	11（17.2）	16（25.0）
对照组	50	19（38.0）	8（16.0）	3（6.0）	2（4.0）	5（10.0）
χ²		10.740	0.150	0.860	4.830	4.200
P		0.001	0.702	0.355	0.028	0.040
r		0.293	-	-	0.202	0.189

微生物	组别	n	胎儿窘迫	绒毛膜羊膜炎	新生儿肺炎	新生儿病理性黄疸
GBS	感染组	44	16（36.4）	28（63.4）	12（27.3）	11（25.0）
	未感染组	20	7（35.0）	4（20.0）	1（5.0）	3（15.0）
	χ²		0.010	10.470	4.210	0.800
	P		0.916	0.001	0.040	0.370
	r		-	0.375	0.248	-
UU	感染组	11	5（45.4）	6（54.5）	2（18.2）	6（54.5）
	未感染组	53	18（34.0）	26（49.1）	11（20.8）	8（15.1）
	χ²		10.740	0.110	0.040	20.100
	P		0.470	0.740	0.847	0.004
	r		-	-	-	0.489
CT	感染组	16	7（43.8）	12（75.0）	6（37.5）	7（43.8）
	未感染组	48	16（33.3）	20（41.7）	7（14.6）	7（14.6）
	χ²		0.570	5.330	3.890	5.970
	P		0.452	0.021	0.049	0.015
	r		-	0.277	0.239	0.292
BV	感染组	12	6（50.0）	8（66.7）	5（33.3）	5（41.7）
	未感染组	52	17（32.7）	24（46.2）	8（17.3）	9（17.3）
	χ²		1.270	1.640	4.160	3.390
	P		0.260	0.200	0.041	0.066
	r		-	-	0.245	-
CM	感染组	7	1（68.8）	2（18.8）	0（10.9）	1（17.2）
	未感染组	57	22（38.0）	30（16.0）	13（6.0）	13（4.0）
	χ²		1.600	1.440	2.000	0.260
	P		0.206	0.230	0.157	0.607
	r		-	-	-	-