妊娠期糖尿病合并生殖道感染危险因素及其免疫状态

目的探究妊娠期糖尿病合并生殖道感染危险因素及其免疫功能情况。方法选取2017年3月-2019年12月宁波市鄞州人民医院收治的妊娠期糖尿病患者(n=135)作为研究对象,编制调查问卷收集患者资料,分析妊娠期糖尿病合并生殖道感染的危险因素;根据是否出现生殖道感染分为感染组和非感染组,另募集同期产检健康的孕妇50名作为对照组,采集受试者分娩前外周静脉血,以免疫散射比浊法检测血清免疫球蛋白(IgG、IgM及IgA)表达水平,流式细胞仪检测外周血T细胞亚群和自然杀伤(NK)细胞比例,酶联免疫吸附法检测免疫细胞分泌细胞因子白细胞介素(IL)-4、IL-10、肿瘤坏死因子α(TNF-α)及γ干扰素(IFN-γ)水平。结果妊娠期糖尿病患者生殖道感染发生率为20.74%(28/135),高于对照组(P<0.05);生殖系统感染史(OR=1.788)、血糖得到控制(OR=0.960)、混用洗外阴用具(OR=1.726)均为患者发生生殖道感染的独立危险因素(P<0.05);感染组IgG、CD4⁺T细胞、CD4⁺/CD8⁺、NK细胞、IL-4及IL-10水平低于非感染组和对照组,IgA、TNF-α及IFN-γ水平高于非感染组和对照组,差异具有统计学意义(P<0.05)。结论妊娠期糖尿病患者生殖道感染发生率较高,影响因素多,患者体液免疫及细胞免疫功能明显失衡,且合并生殖道感染者免疫异常更为严重。

Risk factors for genital tract infection in patients with gestational diabetes mellitus and immune status

OBJECTIVE To explore the risk factors for genital tract infection in patients with gestational diabetes mellitus(GDM)and observe the immune status.METHODS A total of 135 patients with GDM who were treated in Yinzhou People’s Hospital from Mar 2017 to Dec 2019 were recruited as the study subjects.Questionnaire survey was conducted to collect data of the patients,the risk factors for genital tract infection in the GDM patients were analyzed,the patients were divided into the infection group and the non-infection group according to the status of genital tract infection,meanwhile,50 healthy pregnant women who received prenatal examination were set as the control group.The peripheral venous blood specimens were collected from the subjects,the levels of serum immunoglobulins(IgG,IgM,IgA)were detected by immunoturbidimetry,the percentages of T cell subsets and natural killer(NK)cells in peripheral blood were detected by flow cytometry,and the levels of immune cells secrete cytokines interleukin-4(IL-4),IL-10,tumor necrosis factorα(TNF-α)and interferonγ(IFN-γ)were detected by means of enzyme-linked immunosorbent assay(ELISA).RESULTS The incidence of genital tract infection of the GDM patients was 20.74%(28/135),significantly higher than that of the patients in the control group(P<0.05).The history of genital system infection(OR=1.788),control of blood glucose(OR=0.960)and mixed use of vulva washing appliances(OR=1.726)were independent risk factors for the genital tract infection(P<0.05).The levels of IgG,CD4⁺T cell,CD4⁺/CD8⁺,NK cell,IL-4 and IL-10 of the infection group were significantly lower than those of the non-infection group and the control group,the levels of IgA,TNF-αand IFN-γof the infection group were significantly higher than those of the non-infection group and the control group(P<0.05).CONCLUSION The incidence of genital tract infection is high among the GDM patients,there are a variety of influencing factors.The humoral immune function and cellular immune function are significantly unbalanced,and the immune abnormalities are more severe in the patients complicated with genital tract infection.