柳州地区育龄妇女产后阴道微生态特征分析
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摘要
目的探讨产后妇女阴道微生态状况,为进一步施行干预措施提供实验依据。方法采用病例对照研究,采集研究对象下阴道2/3的白带样本进行阴道微生态检测,判定研究对象的阴道微生态状况。结果共纳入538名产后妇女及404名正常体检妇女进行阴道微生态的基本情况分析,产后6～8周妇女的阴道微生态失衡率高于非孕妇女。阴道微生态中存在炎症:即白细胞阳性(OR=1. 82,P=0. 006)、白细胞酯酶阳性(OR=24. 24,P <0. 001);阴道检出致病性病原体如革兰阳性球菌(OR=3. 85,P=0. 006)、加德纳/普雷沃菌(OR=50. 00,P <0. 001);和由于阴道微生态环境中存在的厌氧性细菌如加德纳/普雷沃菌导致了Nugent评分较高(OR=2. 23,P <0. 001),最后各因素共同作用,导致了产后6～8周的妇女阴道微生态处于失衡的状态。结论产后妇女由于雌激素水平的急剧改变,容易发生需氧性阴道炎及细菌性阴道炎等,临床医师需及时监测产后妇女的阴道微生态环境,治疗极端的炎症后积极培育阴道有益菌,早日恢复产后妇女阴道微生态的平衡状态。
Objective To investigate the status of vaginal microecology in postpartum women,and to provide experimental evidence for further intervention. Methods A case-control study was conducted to collect 2/3 leucorrhea samples from the lower vagina of the subjects for vaginal microecology detection and to investigate the vaginal microecology status of the study subjects. Results A total of 538 women in postpartum and 404 normal women were enrolled in the analysis of vaginal microecology. The imbalance rate of vaginal microecology in postpartum women was higher than that in non-pregnant women. The vaginal microecological imbalances that affected postpartum women were positive for white blood cell( OR = 1. 82,P= 0. 006),Gardner( OR = 50. 00,P < 0. 001),Gram-positive cocci( OR = 3. 85,P = 0. 006),and Leukocyte esterase( OR =24. 24,P < 0. 001). Nugent score was higher because of anaerobic bacteria in vaginal microecology of postpartum women( OR =2. 23,P < 0. 001). Conclusion The imbalance of vaginal microecology exists in the postpartum women in this region. A reasonable intervention measure should be proposed to reduce the risk of vaginal dysbiosis in postpartum women.
Objective To investigate the status of vaginal microecology in postpartum women,and to provide experimental evidence for further intervention. Methods A case-control study was conducted to collect 2/3 leucorrhea samples from the lower vagina of the subjects for vaginal microecology detection and to investigate the vaginal microecology status of the study subjects. Results A total of 538 women in postpartum and 404 normal women were enrolled in the analysis of vaginal microecology. The imbalance rate of vaginal microecology in postpartum women was higher than that in non-pregnant women. The vaginal microecological imbalances that affected postpartum women were positive for white blood cell( OR = 1. 82,P= 0. 006),Gardner( OR = 50. 00,P < 0. 001),Gram-positive cocci( OR = 3. 85,P = 0. 006),and Leukocyte esterase( OR =24. 24,P < 0. 001). Nugent score was higher because of anaerobic bacteria in vaginal microecology of postpartum women( OR =2. 23,P < 0. 001). Conclusion The imbalance of vaginal microecology exists in the postpartum women in this region. A reasonable intervention measure should be proposed to reduce the risk of vaginal dysbiosis in postpartum women.
引文
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[10] Macintyre DA,Chandiramani M,Lee YS,et al. The vaginal microbiome during pregnancy and the postpartum period in a European population[J]. Scientific Reports,2015,5:8988.
[11] Donders GG,Bellen G,Grinceviciene S,et al. Aerobic vaginitis:no longer a stranger[J]. Research in Microbiology,2017,168(9/10,SI):845-858.
[12] Redelinghuys MJ,Ehlers MM,Dreyer AW,et al. Normal flora and bacterial vaginosis in pregnancy:an overview[J]. Critical Reviews in Microbiology,2016,42(3):352-363.
[2]马薇,金措.女性一生不同阶段阴道微生态菌群特征研究进展[J].中国实用妇科与产科杂志,2016,32(08):817-820.
[3]陈婉珍,闫颖,吴林玲.妊娠期妇女阴道微生态研究进展[J].中国微生态学杂志,2016,28(4):489-492,3.
[4]陈霞,杨静秀,王玉平,等.门诊妊娠妇女阴道菌群微生态调查[J].中华医院感染学杂志,2015,25(24):5683-5685.
[5]丁燕玲,傅锦坚,吴宇碧,等.孕晚期妇女阴道微生态流行病学调查分析[J].中国微生态学杂志,2018,30(4):461-464.
[6]谢家滨,陈光元,黄平.围生期孕妇支原体感染与产后子宫内膜炎的关系[J].海南医学,2017,28(19):3229-3230.
[7]王辰,薛凤霞.阴道微生态评价对需氧菌性阴道炎的诊断作用[J].中国实用妇科与产科杂志,2017,33(8):779-782.
[8]郭雪冬,樊尚荣.阴道微生态的形态学诊断[J].中国实用妇科与产科杂志,2017,33(8):800-804.
[9] González-Fernández D,Koski KG,Sinisterra OT,et al. Interactions among urogenital,intestinal,skin,and oral infections in pregnant and lactating Panamanian Ng? be women:a neglected public health challenge[J]. American Journal of Tropical Medicine and Hygiene,2015,92(6):1100-1110.
[10] Macintyre DA,Chandiramani M,Lee YS,et al. The vaginal microbiome during pregnancy and the postpartum period in a European population[J]. Scientific Reports,2015,5:8988.
[11] Donders GG,Bellen G,Grinceviciene S,et al. Aerobic vaginitis:no longer a stranger[J]. Research in Microbiology,2017,168(9/10,SI):845-858.
[12] Redelinghuys MJ,Ehlers MM,Dreyer AW,et al. Normal flora and bacterial vaginosis in pregnancy:an overview[J]. Critical Reviews in Microbiology,2016,42(3):352-363.