妊娠期外阴阴道假丝酵母菌病患者烯醇化酶含量与妊娠结局的关系

doi:10.12280/gjfckx.20231013

摘要/Abstract

摘要：

目的： 探讨妊娠期外阴阴道假丝酵母菌病（vulvovaginal candidiasis，VVC）患者烯醇化酶（enolase，Eno）含量、阴道微生态与妊娠结局的相关性。方法： 选取2021年4月—2022年4月在中国人民解放军联勤保障部队第九八〇医院产科住院并分娩的77例妊娠期VVC患者为研究对象，根据妊娠结局分为不良妊娠结局组49例、正常妊娠结局组28例。比较2组患者一般资料、阴道微生态指标、(1,3)-β-D-葡聚糖和Eno水平。Logistic回归分析妊娠期VVC患者发生不良妊娠结局的影响因素。受试者工作特征（receiver operator characteristic，ROC）曲线分析(1,3)-β-D-葡聚糖、Eno对妊娠期VVC患者不良妊娠结局的诊断价值。结果： 不良妊娠结局组抗感染治疗患者比例低于正常妊娠结局组（χ²=4.270，P=0.039）。不良妊娠结局组阴道菌群密集度Ⅱ~Ⅲ级、菌群多样性Ⅱ~Ⅲ级、清洁度Ⅰ~Ⅱ度、pH值3.8~4.5、过氧化氢阳性和白细胞酯酶阴性患者的比例均低于正常妊娠结局组（均P<0.05）。不良妊娠结局组(1,3)-β-D-葡聚糖和Eno水平均高于正常妊娠结局组，差异有统计学意义（均P<0.001）。(1,3)-β-D-葡聚糖和Eno升高均是妊娠期VVC患者发生不良妊娠结局的危险因素（P<0.05），阴道菌群密集度为Ⅱ~Ⅲ级是保护因素（P<0.05）。(1,3)-β-D-葡聚糖、Eno两者联合诊断妊娠期VVC患者不良妊娠结局的曲线下面积（area under the curve，AUC）高于单一指标，联合诊断的敏感度为95.92%，特异度为82.14%，二者联合优于(1,3)-β-D-葡聚糖（Z=2.092，P=0.036）、Eno（Z=2.703，P=0.007）各自单独诊断。结论： (1,3)-β-D-葡聚糖和Eno水平升高、阴道微生态发生异常均可增加妊娠期VVC患者发生不良妊娠结局的风险，可利用(1,3)-β-D-葡聚糖和Eno联合对妊娠期VVC患者进行不良妊娠结局的风险筛查。

关键词: 孕妇, 念珠菌病, 外阴阴道, 磷酸丙酮酸水合酶, 念珠菌属, 妊娠结局

Abstract:

Objective: To investigate the relationship between enolase (Eno) content, vaginal microecology and pregnancy outcomes in patients with vulvovaginal candidiasis (VVC) during pregnancy. Methods: A retrospective study was conducted on 77 pregnant VVC patients who were hospitalized and delivered in the obstetrics department of the 980th Hospital of PLA Joint Logistics Support Forces from April 2021 to April 2022. The pregnancy outcomes of pregnant VVC patients were observed and statistically analyzed, and they were divided into 49 cases with adverse pregnancy outcomes and 28 cases with normal pregnancy outcomes. The general data, vaginal microecological indicators, (1,3)-β-D-glucan and Eno levels were compared between the two groups. Logistic regression was applied to analyze the influencing factors of adverse pregnancy outcomes in VVC patients during pregnancy. Receiver operating characteristic curve was applied to analyze the diagnostic value of (1,3)-β-D-glucan and Eno for adverse pregnancy outcomes in patients with VVC during pregnancy. Results: The proportion of patients treated with anti-infection treatment in the adverse pregnancy outcome group was lower than that in the normal pregnancy outcome group, and the difference was statistically significant ( χ²=4.270, P=0.039). The proportions of vaginal flora density of grade Ⅱ-Ⅲ, flora diversity of grade Ⅱ-Ⅲ, cleanliness of grade Ⅰ-Ⅱ, pH value 3.8-4.5, hydrogen peroxide positivity, and leukocyte esterase negativity in the adverse pregnancy outcome group were lower than those in the normal pregnancy outcome group, the differences were statistically significant (all P<0.05). The levels of (1,3)-β-D-glucan and Eno in the adverse pregnancy outcome group were higher than those in the normal pregnancy outcome group, the differences were statistically significant (all P<0.001). (1,3)-β-D-glucan and Eno were independent risk factors for adverse pregnancy outcomes in patients with VVC during pregnancy (P<0.05), the vaginal flora density of grade Ⅱ-Ⅲ was protective factor (P<0.05). The AUC of (1,3)-β-D-glucan and Eno in the combined to diagnosis adverse pregnancy outcomes in patients with VVC during pregnancy was higher than that of a single index, with a sensitivity of 95.92% and a specificity of 82.14%. The combination of the two methods was better than that of (1,3)-β-D-glucan (Z=2.092, P=0.036) and Eno (Z=2.703, P=0.007). Conclusions: Elevated levels of (1,3)-β-D-glucan and Eno, and abnormalities in vaginal microecology can increase the risk of adverse pregnancy outcomes in VVC patients during pregnancy, and (1,3)-β-D-glucan combined with Eno can be used to screen the risk of adverse pregnancy outcomes in patients with VVC during pregnancy.

Key words: Pregnant women, Candidiasis, vulvovaginal, Phosphopyruvate hydratase, Candida, Pregnancy outcome

王芳芳, 赵会海, 吴洋, 孙莉. 妊娠期外阴阴道假丝酵母菌病患者烯醇化酶含量与妊娠结局的关系[J]. 国际妇产科学杂志, 2024, 51(4): 468-472.

WANG Fang-fang, ZHAO Hui-hai, WU Yang, SUN Li. Relationship between Enolase Level and Pregnancy Outcome in Patients with Vulvovaginal Candidiasis during Pregnancy[J]. Journal of International Obstetrics and Gynecology, 2024, 51(4): 468-472.

图/表 6

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组别	n	年龄（岁）	孕周（周）	婚姻状况（已婚）	首次妊娠	文化程度（高中及以上）	不良妊娠史	居住地（农村）	妊娠期糖尿病	抗感染治疗
正常妊娠结局组	28	29.12±5.54	37.13±2.31	21（75.00）	19（67.86）	15（53.57）	2（7.14）	11（39.29）	7（25.00）	26（92.86）
不良妊娠结局组	49	28.81±5.77	37.72±2.25	42（85.71）	32（65.31）	23（46.94）	6（12.24）	27（55.10）	10（20.41）	36（73.47）
t或χ²		0.230	1.096	1.375	0.052	0.314	0.498	1.783	0.218	4.270
P		0.819	0.276	0.241	0.820	0.575	0.480	0.182	0.640	0.039

组别	n	年龄（岁）	孕周（周）	婚姻状况（已婚）	首次妊娠	文化程度（高中及以上）	不良妊娠史	居住地（农村）	妊娠期糖尿病	抗感染治疗
正常妊娠结局组	28	29.12±5.54	37.13±2.31	21（75.00）	19（67.86）	15（53.57）	2（7.14）	11（39.29）	7（25.00）	26（92.86）
不良妊娠结局组	49	28.81±5.77	37.72±2.25	42（85.71）	32（65.31）	23（46.94）	6（12.24）	27（55.10）	10（20.41）	36（73.47）
t或χ²		0.230	1.096	1.375	0.052	0.314	0.498	1.783	0.218	4.270
P		0.819	0.276	0.241	0.820	0.575	0.480	0.182	0.640	0.039

组别	n	阴道菌群密集度（Ⅱ~Ⅲ级）	阴道菌群多样性（Ⅱ~Ⅲ级）	清洁度（Ⅰ~Ⅱ度）	pH值3.8~4.5	过氧化氢阳性	白细胞酯酶阴性
正常妊娠结局组	28	13（46.43）	14（50.00）	18（64.29）	22（78.57）	19（67.86）	17（60.71）
不良妊娠结局组	49	7（14.29）	10（20.41）	13（26.53）	12（24.49）	16（32.65）	14（28.57）
χ²		9.574	7.273	10.560	21.135	8.907	7.654
P		0.002	0.007	0.001	<0.001	0.003	0.006

组别	n	阴道菌群密集度（Ⅱ~Ⅲ级）	阴道菌群多样性（Ⅱ~Ⅲ级）	清洁度（Ⅰ~Ⅱ度）	pH值3.8~4.5	过氧化氢阳性	白细胞酯酶阴性
正常妊娠结局组	28	13（46.43）	14（50.00）	18（64.29）	22（78.57）	19（67.86）	17（60.71）
不良妊娠结局组	49	7（14.29）	10（20.41）	13（26.53）	12（24.49）	16（32.65）	14（28.57）
χ²		9.574	7.273	10.560	21.135	8.907	7.654
P		0.002	0.007	0.001	<0.001	0.003	0.006

组别	n	(1,3)-β-D-葡聚糖（pg/mL）	Eno（μg/mL）
正常妊娠结局组	28	104.35±31.59	0.25±0.08
不良妊娠结局组	49	226.51±73.42	0.57±0.18
t		8.355	8.899
P		<0.001	<0.001