基于列线图探讨妊娠期阴道菌群特征与自发性早产发生的关系

Study on relationship between characteristics of vaginal flora during pregnancy and spontaneous preterm delivery based on a nomogram

摘要

目的 基于列线图探讨妊娠期阴道菌群特征与自发性早产发生的关系。方法 研究采用病例对照设计,选择2020年1月至2023年12月期间西北妇女儿童医院妇产科收治的79例自发性早产孕妇(早产组)和156例足月分娩孕妇(对照组)为研究对象。所有参与者在妊娠晚期采集阴道拭子分析微生物群,Logistic回归分析孕妇早产发生的独立影响因素,并进一步构建预测列线图。受试者工作特征(ROC)曲线及曲线下面积(AUC)分析诊断价值。结果 与对照组相比,早产组血白细胞(WBC)增加,差异有统计学意义(t=3.875,P<0.05);与对照组相比,早产组感染异常微生物群比例、球菌样微生物比例、真菌比例均增加,差异有统计学意义(χ²值介于10.459~13.045之间,P<0.05);与对照组相比,早产组感染念珠菌属、阴道嗜血杆菌、人型支原体、解脲支原体比例增加,乳酸杆菌属比例降低,差异均有统计学意义(χ²值介于14.774~20.490之间,P<0.05);Logistic回归显示WBC高水平、Nugent高评分、感染球菌样微生物、真菌、念珠菌属、阴道嗜血杆菌、人型支原体、解脲支原体是孕妇早产发生的独立危险因素(OR值介于1.086~11.095之间,P<0.05);ROC曲线分析显示列线图预测早产的AUC为0.88(95%CI:0.81~0.94),准确度为0.79,灵敏度为0.76,特异度为0.85;Hosmer-Lemeshow校准曲线显示模型拟合度较好(P=0.491)。结论 血液中白细胞升高和阴道分泌物中特定细菌的存在,如真菌、念珠菌属、阴道嗜血杆菌、人型支原体、解脲支原体,与孕妇较高的自发性早产密切相关。用这些因素构建的列线图模型具有良好的区分度、一致性与临床实用性,可为孕妇早产的筛查提供指导。

Abstract

Objective To explore relationship between characteristics of vaginal flora during pregnancy and spontaneous preterm delivery based on a nomogram. Methods In case-control design,79 pregnant women with spontaneous preterm delivery (preterm delivery group) and 156 full-term pregnant women (control group) who admitted to Department of Obstetrics in our hospital from January 2020 to December 2023 were selected as study subjects.Vaginal swab samples were taken for all participants in the third trimester of pregnancy to analyze microbiota in the vagina.Logistic regression analysis was used to analyze independent risk factors of preterm delivery in the pregnant women.Using R package “rms” in version R4.4.0,a prediction nomogram for preterm delivery in the pregnant women was established.Receiver operating characteristic (ROC) curve was drawn and area under the curve (AUC) was employed to analyze predictive values of risk factors for preterm delivery. Results Compared with the control group,the serum white blood cell (WBC) level of the pregnant women in the preterm delivery group was higher,the difference was significant (t=3.875,P<0.05).The proportions of abnormal microflora,coccoid microbiota and fungi infections in the pregnant women in the preterm delivery group were higher than those in the control group,the differences were significant (χ ²=10.459-13.045,all P<0.05).Also,the infection rates of Candida spp.,Haemophilus vaginalis,Mycoplasma hominis and Ureaplasma urealyticum in the preterm delivery group were higher,while the proportion of Lactobacillus spp.was lower,with statistically significant differences compared with the control group (χ ²=14.774-20.490,all P<0.05).Logistic regression analysis showed that high WBC level,high Nugent score,and infections of coccoid microbiota,fungi,Candida spp.,Haemophilus vaginalis,Mycoplasma hominis and Ureaplasma urealyticum were independent risk factors for preterm delivery in the pregnant women (OR=1.086-11.095,all P<0.05).ROC curve analysis showed that AUC of the nomogram for predicting preterm delivery was 0.88 (95%CI:0.81-0.94),with an accuracy of 0.79,a sensitivity of 0.76 and a specificity of 0.85.The Hosmer-Lemeshow calibration curve revealed that the model had high goodness of fit (P=0.491). Conclusion The elevated WBC in plasma and presence of specific bacteria,such as fungi,Candida species,Haemophilus vaginalis,Mycoplasma hominis and Ureaplasma urealyticum in vaginal discharge are closely associated with higher incidence of spontaneous preterm delivery in pregnant women.The nomogram model constructed by these factors has good discrimination,consistency and clinical practicability,and is helpful for screening preterm delivery in pregnant women.

关键词

妊娠期 / 阴道菌群 / 自发性早产 / 列线图

Key words

pregnancy / vaginal flora / spontaneous preterm delivery / nomogram

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基金资助

陕西省重点研发计划项目(2021SF-210)