妊娠期阴道、宫颈微生态的评价

目的了解妊娠期阴道、宫颈感染状况，探讨妊娠期进行阴道分泌物检测及宫颈分泌物HPV、衣原体检测的临床意义。方法产前门诊常规围产保健孕妇980例（早孕期159例、中孕期612例、晚孕期209例）采集阴道分泌物，测定pH值、涂片常规检查及，宫颈分泌物行杂交捕获试验检测人乳头瘤病毒（HPV）及送微生物室行免疫层析法检测沙眼衣原体抗原。妇科门诊非阴道炎就诊的患者（年龄≤40岁）100例进行相同的检查作为非孕期对照。结果阴道pH值在妊娠期、非孕期分别为3．88±0．20及4．28±0．33，孕期低于非孕期（P〈0．01）。孕期细菌性阴道病（BV）、外阴阴道假丝酵母菌病（VVC）及沙眼衣原体（CT）感染率分别是23．9％、21．5％、22．0％，非孕期三项感染率分别为12．0％、11．0％、6．0％，孕期显著高于非孕期（P〈0．01）。孕期HPV感染率同非妊娠期。无症状体征孕妇中，仍有29．8％存在阴道微生态失调。在HPV阳性孕妇中BV、VVC、CT的患病率分别为48．7％、41．7％、45．2％，HPV阴性组中分别为20．6％、18．8％、19．0％，HPV阳性组BV、VVC、CT患病率明显高于阴性组（均P〈0．01）。结论妊娠期阴道微生态发生改变，表现为pH值降低，微生态失调比例升高，与HPV感染密切相关。

Microecological evaluation of vaginal and cervical microflora in gestational period

Objective To investigate the status of vaginal and cervical microflora and discuss the clinical significance of microecological evaluation of vaginal and cervical microflora in gestational period. Methods Specimens of vaginal and cervical secretion were collected from 980 pregnant women for routine prenatal care, 159 in the first trimester 612 in the second trimester, and 209 in the last trimester, to measure the vaginal pH value and undergo smear examination by Gram＇ s staining. Hybrid capture （HC）- Ⅱ test was conducted to detect the human papilloma virus （HPV）-DNA. Specimens of cervical secretion underwent immunochromatography to detect Chlamydia trachomatis antigen. One hundred gynecological out-patient without vaginitis aged ≤ 40 were used as non-pregnant controls. Results The average vaginal pH level during the gestational period was （3.84±0.20）, significantly lower than that in the non-gestational period （29.74±3.45）, P〈 0.05]. The incidence rates of BV, vulvovaginal candodiasis （VVC）, and Chlamydia trachomatis （CT） infedction during the gestational period were 23.9%, 21.5%, and 22.0% respectively, all significantly higher than those in the non-gestational period （12.0%, 11.0%, and 6%, all P〈 0.01）. There was not significant difference in the infection rate of HPV between the gestational and non-gestational periods. 29.8% of the asymptomatic pregnant womenshowed vaginal ecological disturbance. The BV, VVC, CT prevalence rates of the HPV-positive pregnant women were 48.7%, 41.7%, and 45.2% respectively, all significantly higher than those of the HPV-negative group （ 20.6%, 18.8%, and 20.0% respectively, all P 〈 0.01）. Conclusion The vaginal microecosystem changes in the gestational period （decrease of pH value and increase of microecosystem imbalance are related to the infection of HPV.