孕妇阴道微生态失衡及解脲支原体感染对早产及新生儿呼吸系统炎症的影响研究

Impact of vaginal microbiota imbalance and ureaplasma urealyticum infection during pregnancy on preterm birth and neonatal respiratory inflammation

摘要

目的 探讨孕妇阴道微生态因素和解脲支原体(UU)感染与早产风险及新生儿呼吸系统炎症病变的相关性。方法 回顾性纳入2022年1月至2024年1月于我院产科分娩的248例孕妇及其新生儿为研究对象。根据早产发生情况分为早产组(n=83)和足月组(n=165);根据新生儿肺炎发生情况分为肺炎组(n=64)和非肺炎组(n=184)。孕妇入院后检测阴道微生态指标,包括酸碱度pH值、白细胞脂酶、过氧化氢酶、乙酰氨基葡萄糖苷酶、唾液酸苷酶。检测阴道分泌物菌群情况,包括滴虫、假丝酵母菌、细菌、人型支原体。使用荧光定量聚合酶链式反应(PCR)法测定UU。分别比较新生儿早产组与足月组、肺炎组与非肺炎组孕妇的pH值、白细胞脂酶、过氧化氢酶、乙酰氨基葡萄糖苷酶、唾液酸苷酶阳性以及滴虫感染、假丝酵母菌感染、细菌感染、人型支原体感染和UU感染比例。采用受试者工作特征(ROC)曲线分析各因素对早产预测价值。多变量Logistics回归分析新生儿肺炎发生的影响因素。结果 早产组和肺炎组孕妇滴虫感染、假丝酵母菌感染、细菌感染、阴道pH值＞4.5、过氧化氢酶、乙酰氨基葡萄糖苷酶、唾液酸苷酶以及孕妇和新生儿UU阳性率均显著高于足月组(χ²值介于8.332~79.262,P＜0.05)和非肺炎组(χ²值介于5.000~56.801,P＜0.05),且肺炎组新生儿早产比例高于非肺炎组(χ²=17.444,P＜0.05);ROC曲线分析显示,过氧化氢酶阳性[曲线下面积(AUC):0.732,95%CI:0.660~0.803]、乙酰氨基葡萄糖苷酶阳性(AUC:0.729,95%CI:0.655~0.803)对早产的发生有一定预测价值,两者联合预测效能更好(AUC:0.852,95%CI:0.795~0.909);多因素Logistic回归分析显示,滴虫感染(OR=1.780,95%CI:1.164~2.635)、假丝酵母菌感染(OR=1.441,95%CI:1.070~1.961)、细菌感染(OR=1.639,95%CI:1.146~2.348)、pH值＞4.5(OR=1.908,95%CI:1.320~2.930)、过氧化氢酶阳性(OR=1.513,95%CI:1.085~2.075)、乙酰氨基葡萄糖苷酶阳性(OR=1.307,95%CI:1.067~1.778)、唾液酸苷酶阳性(OR=1.599,95%CI:1.096~2.267)以及孕妇UU阳性(OR=2.109,95%CI:1.461~3.244)和新生儿UU阳性(OR=1.861,95%CI:1.265~2.704)、新生儿早产(OR=1.662,95%CI:1.306~2.115)均为新生儿肺炎发生的影响因素(均P＜0.05)。结论 孕妇阴道微生态失衡和UU感染能够影响早产结局及新生儿肺炎的发生。过氧化氢酶、乙酰氨基葡萄糖苷酶对早产的发生有一定的预测价值,两者联合预测效能更好。孕妇阴道滴虫感染、假丝酵母菌感染、细菌感染、pH值＞4.5、过氧化氢酶、乙酰氨基葡萄糖苷酶、唾液酸苷酶以及孕妇、新生儿UU阳性及新生儿早产是新生儿肺炎发生的危险因素。

Abstract

Objective To explore the correlation between pregnant women's vaginal microecological imbalance and Ureaplasma urealyticum (UU) infection,the risk of preterm birth and neonatal respiratory inflammation. Methods A total of 248 pregnant women and their newborns born in the obstetrics department of our hospital from January 2022 to January 2024 were retrospectively selected as the research subjects.According to the occurrence of premature birth,they were divided into preterm group (n=83) and term group (n=165);according to the occurrence of neonatal pneumonia,they were divided into pneumonia group (n=64) and non-pneumonia group(n=184).After pregnant women were admitted to hospital,vaginal microecological indicators were tested,including pH value,leukocyte esterase,catalase,acetylglucosaminidase (NAG),and sialidase,and vaginal secretion microbiota is tested,including Trichomonas and Candida,bacteria and Mycoplasma hominis,UU was measured using fluorescence quantitative PCR method.The pH value,leukocyte lipase,catalase,acetylglucosaminidase,and sialidase positivity,as well as Trichomonas,Candida,and bacterial infections in pregnant women were compared between the preterm and term groups,and between the pneumonia and non-pneumonia groups,respectively.Mycoplasma hominis infection and UU infection. Results The preterm and pneumonia groups had significantly higher rates of Trichomonas infection,Candida infection,bacterial infection,vaginal pH value ＞4.5,catalase,acetylglucosaminidase,sialidase,and UU positive rate in pregnant women and newborns than the term group(χ² values ranged from 8.332 to 79.262,P＜0.05) and the non-pneumonia group(χ² values ranged from 5.000,to 56.801,P＜0.05).The preterm birth rate in the pneumonia group was higher than that in the non-pneumonia group (χ²=17.444,P＜0.05).ROC curve analysis showed that catalase positivity[area under the curve(AUC),95% CI:0.660-0.803]and acetylglucosaminidase positivity(AUC:0.729,95%CI:0.655-0.803) have certain predictive value for the occurrence of preterm birth,and the combination of the two has better predictive performance (AUC:0.852,95%CI:0.795-0.909);Multivariate logistic regression analysis showed that trichomonas infection(OR=1.780,95%CI:1.164-2.635),Candida infection(OR=1.441,95%CI:1.070-1.961),bacterial infection(OR =1.639,95%CI:1.146-2.348),pH value ＞4.5(OR =1.908,95%CI:1.320-2.930),catalase positive(OR=1.513,95%CI:1.085-2.075),acetylglucosamine Enzyme positivity(OR=1.307,95%CI:1.067-1.778),sialidase positivity(OR=1.599,95%CI:1.096-2.267) and UU positivity in pregnant women(OR=2.109,95%CI:1.461-3.244) and neonatal UU positivity(OR=1.861,95%CI:1.265-2.704),preterm birth (OR =1.662,95%CI:1.306-2.115) are both influencing factors of neonatal pneumonia (all P＜0.05). Conclusion Pregnant women's vaginal microecological imbalance and UU infection can affect the outcome of premature birth and the occurrence of neonatal pneumonia.Catalase and acetylglucosaminidase have certain predictive value for the occurrence of premature birth.Trichomonas infection,Candida infection,bacterial infection,pH value ＞4.5,positive catalase,acetylglucosaminidase,sialidase,UU positivity in pregnant women and newborns and preterm birth are risk factors for neonatal pneumonia.

关键词

孕妇 / 阴道微生态 / 解脲支原体 / 早产 / 新生儿肺炎

Key words

pregnant woman / vaginal vaginal microecological imbalance / ureaplasma urealyticum / preterm birth / neonatal pneumonia

参考文献

[1] 智艳芳, 刘慧, 张婷, 等. 阴道微生态失衡与HR-HPV感染及宫颈病变的关系[J]. 中国妇幼健康研究, 2022, 33(9): 90-96.

[2] Dong H, Yang X. Research progress on the correlation between gestational vaginal microecology and vaginal infectious diseases[J]. Infection International, 2017, 6(3): 77-82.

[3] 王桂, 韩茹, 符霄云, 等. 孕妇生殖道解脲支原体感染对妊娠结局的影响[J]. 中华医院感染学杂志, 2022, 32(13): 2058-2061.

[4] Sun T, Fu J. Analysis of the clinical features of intrauterine ureaplasma urealyticum infection in preterm infants:a case-control study[J]. Front Pediatr, 2021, 9: 774150.

[5] 中华医学会妇产科学分会感染性疾病协作组. 阴道微生态评价的临床应用专家共识[J]. 中华妇产科杂志, 2016, 51(10): 721-723.

[6] 王冬, 张华. 实用临床妇产科学[M]. 郑州: 郑州大学出版社, 2020: 348.

[7] 邵肖梅, 叶鸿瑁, 丘小汕, 等. 实用新生儿学[M].第5版. 北京: 人民卫生出版社, 2019.

[8] 刘睿, 王俊侠, 李晓文, 等. 不同类型胎膜早破孕妇阴道微生态的对比研究[J]. 中国妇幼健康研究, 2017, 28(5): 538-540.

[9] 魏飞燕, 徐丽丽, 牟娜, 等. 孕妇GBS感染和阴道微生态失衡与新生儿围产期感染的相关性及其影响因素[J]. 中华医院感染学杂志, 2022, 32(19): 3007-3011.

[10] Huang J, Zheng L, Su Y, et al. Effects of group B streptococcus infection on vaginal micro-ecology and pregnancy outcomes of pregnant women in late pregnancy[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 267: 274-279.

[11] 郭婷婷, 杨小风. 妊娠妇女阴道微生态和B族链球菌与胎膜早破及母婴结局的相关性[J]. 中国微生态学杂志, 2023, 35(10): 1207-1211.

[12] Baud A, Hillion K H, Plainvert C, et al. Microbial diversity in the vaginal microbiota and its link to pregnancy outcomes[J]. Sci Rep, 2023, 13(1): 9061.

[13] Cobo T, Kacerovsky M, Jacobsson B. Risk factors for spontaneous preterm delivery[J]. Int J Gynaecol Obstet, 2020, 150(1): 17-23.

[14] 裴菲, 张媛媛, 李青. 先兆早产孕妇的临床特征及自发性早产发生风险模型的构建与验证[J]. 中国妇幼健康研究, 2023, 34(11): 1-10.

[15] 谭莉莎, 吕荣, 王卓. 产妇阴道微生物群变化与早产风险相关性研究[J]. 中国微生态学杂志, 2019, 31(8): 952-954, 963.

[16] Jonduo M E, Vallely L M, Wand H, et al. Adverse pregnancy and birth outcomes associated with Mycoplasma hominis,Ureaplasma urealyticum and Ureaplasma parvum:a systematic review and meta-analysis[J]. BMJ Open, 2022, 12(8): e062990.

[17] 李绪兰, 陈静, 徐晶. 育龄期女性解脲支原体感染后阴道微生态和Th17细胞及相关炎性因子的变化[J]. 中国微生态学杂志, 2021, 33(7): 821-824.

[18] 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, 2022, 35(5): 878-883.

基金资助

北京市通州区科技计划项目(KJ2022CX055)