妊娠期妇女阴道微生态状况的研究

目的:了解不同孕期妊娠期妇女阴道微生态状况,评价血清E2与阴道酸碱度之间的关系,并了解妊娠期妇女阴道微生态状况与妊娠不良结局间的关系。方法:选取常规进行产前检查的健康无症状单胎妊娠妇女101例分早孕期组(≤13周)36例、中孕期组(13～28周)35例及晚孕期组(≥28周)30例,取其阴道分泌物进行pH值、H2O2含量检测及细菌培养,并经革兰染色后在油镜下观察,进行阴道微生态(阴道菌群的密集度、多样性、优势菌、炎症反应状况等)状况评价。同时检测其血清E2水平,观察妊娠结局:胎膜早破、早产、产褥感染、新生儿出生后1 min Apgar评分、出生体重。结果:①随着孕周的增加,血清E2升高,但没有发现随着E2升高阴道pH值下降;妊娠期不同孕期阴道pH值相比差异无统计学意义(P>0.05)。②妊娠各期均有无症状细菌性阴道病(BV)与外阴阴道假丝酵母菌病(VVC)发生,且发生率较高。③阴道菌群状况:健康无症状妊娠期妇女孕早期、孕中期、孕晚期有不同比例的阴道微生态失调发生。阴道常规镜检妊娠各期总的假丝酵母菌阳性率为6.93%(7/101),细菌培养结果显示需氧菌阳性率为14.85%(15/101),其中白假丝酵母菌、光滑假丝酵母菌和克柔假丝酵母菌阳性率分别为60.00%(9/15)、26.67%(4/15)、6.67%(1/15),阴道菌群中可检出表皮葡萄球菌、粪肠球菌、金黄色葡萄球菌、大肠埃希菌、链球菌等。④妊娠结局:101例孕妇中阴道微生态正常者72例,阴道微生态失调者29例,阴道微生态正常组胎膜早破发生率明显低于阴道微生态失调组,差异有统计学意义;比较两组新生儿出生后1 min Apgar评分、出生体重差异无统计学意义(P>0.05);早产率及产褥感染率因例数太少无法比较。结论:健康无症状妊娠期妇女在不同孕期阴道微生态改变明显,微生态失调发生率高,其中外阴阴道假丝酵母菌病感染在妊娠期阴道炎中居首位,培养显示以白假丝酵母菌感染为主,其次是光滑假丝酵母菌和克柔假丝酵母菌。对妊娠期阴道微生态状况应引起重视。

Study on the status of vaginal microecosystem of pregnant women

Objective:To understand the status of vaginal microecosystem of pregnant women at different gestational weeks,evaluate the relationship between serum estradiol and vaginal pH value,and explore the relationship between the status of vaginal microecosystem of pregnant women and adverse pregnancy outcome. Methods:One hundred and one healthy pregnant women of single pregnancy who received routine prenatal examination in the hospital and had no symptoms were selected,then they were divided into early pregnancy group(≤13 gestational weeks,36 pregnant women),mid-pregnancy group(13-28 gestational weeks,35 pregnant women),and late pregnancy group(≥28 gestational weeks,30 pregnant women),the vaginal secretion samples were obtained for pH value detection,H2O2 content detection,and bacterial culture,then the samples were observed under oil immersion lens after Gram staining,the status of vaginal microecosystem was evaluated,the indexes included the closeness,diversity,predominant bacteria,and inflammatory response of vaginal flora.Meanwhile,the serum estradiol level was detected;the pregnancy outcome was observed,the contents included premature rupture of membrane(PROM),premature birth,puerperal infection,neonatal one minute Apgar score,and birth weight. Results:The serum estradiol level increased with gestational weeks,but vaginal pH value didn’t decrease with the increase of serum estradiol level;there was no significant difference in vaginal pH value among different groups(P>0.05).Asymptomatic bacterial vaginosis and vulvovaginal candidiasis occurred in the three groups,and the incidences were high.The status of vaginal flora: different proportions of vaginal microecosystem disorder occurred in the three groups.Routine colposcopy found that the total positive rate of Candida during different gestational periods was 6.93%(7/101),the results of bacterial culture showed that the total positive rate of aerobic bacteria was 14.85%(15/101),the positive rates of Candida albicans,Candida glabrata,and Candida krusei were 60.00%(9/15),26.67%(4/15),and 6.67%(1/15),respectively.Staphylococcus epidermidis,Enterococcus faecalis,Staphylococcus aureus,Colon bacillus and Streptococcus were detected in vaginal flora.Pregnancy outcome: among 101 pregnant women,72 pregnant women were found with normal vaginal microecosystem,and 29 pregnant women were found with vaginal microecosystem disorder,the incidence of PROM in normal vaginal microecosystem group was significantly lower than that in vaginal microecosystem disorder group;there was no significant difference in neonatal one minute Apgar score and birth weight between the two groups(P>0.05);the incidences of premature birth and puerperal infection couldn’t be compared because the sample size was small. Conclusion:The vaginal microecosystem of healthy and asymptomatic pregnant women varied significantly,the incidence of vaginal microecosystem disorder was high.The incidence of vulvovaginal candidiasis was the highest among different vaginal inflammatory diseases during pregnancy,the results of bacterial culture showed that Candida albicans was the main bacterium in vaginal flora,followed by Candida glabrata and Candida krusei.Vaginal microecosystem during pregnancy should be paid more attention to.