乳酸杆菌GR-1&RC-14对妊娠晚期生殖道B族链球菌定植及阴道菌群微生态的影响  

Effect of oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on vaginal Group B Streptococcus colonization and vaginal microbiome in late pregnancy

作　　者：刘映玲 黄郁馨[1] 蔡蔚[1] 李点杰 郑婉婷 肖苑玲[1] 刘映平 赵胡英 潘石蕾[1] LIU Yingling;HUANG Yuxin;CAI Wei;LI Dianjie;ZHENG Wanting;XIAO Yuanling;LIU Yingping;ZHAO Huying;PAN Shilei(Department of Obstetrics and Gynecology,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China;Child Development and Behavior Center,Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510000,China;Department of Obstetrics,Baoan District Maternal and Child Health Hospital,Shenzhen 518000,China)

机构地区：[1]南方医科大学珠江医院妇产科,广东广州510282 [2]中山大学第三附属医院儿童发育行为中心,广东广州510000 [3]深圳市宝安区妇幼保健院产科,广东深圳518000

出　　处：《南方医科大学学报》2020年第12期1753-1759,共7页Journal of Southern Medical University

基　　金：国家重点研发计划《基于国产医疗设备的智慧产科解决方案及应用示范》(2019YFC0121904);广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2016PY035)。

摘　　要：目的探讨乳酸杆菌GR-1&RC-14对妊娠晚期生殖道B族链球菌(GBS)阳性患者GBS定植、妊娠结局及阴道菌群微生态的影响。方法选取2019年3月~2019年11月于南方医科大学珠江医院门诊行妊娠晚期GBS检测且结果阳性患者符合纳排标准155例,剔除乳酸杆菌干预<2周或产后复查32例,根据有无乳酸杆菌干预,分为干预组(60例)、无干预组(63例);干预组60例根据再次检测GBS结果分为转阴组(18例)、持续阳性组(42例);计算GBS转阴率,比较各分组妊娠结局;从干预组60例患者中随机选取配对乳酸杆菌干预前后阴道分泌物5对行扩增子测序及生物信息分析。结果干预组GBS转阴率为30%(18/60),无干预组GBS转阴率为23%(3/13);乳酸杆菌干预降低胎膜早破发生率(P<0.05),并降低抗生素应用(P<0.05)。阴道分泌物OTU分析提示乳酸杆菌干预后总序列数、GBS序列数减少及物种组成增加。乳酸杆菌干预后链球菌属物种丰度降低,差异有统计学意义(P<0.05)。MetaStat提示乳酸杆菌干预后肠球菌、葡萄球菌属、链球菌属物种丰度均减少且差异有统计学意义(P<0.05)。结论乳酸杆菌对妊娠晚期生殖道GBS定植、妊娠结局有一定的改善作用,乳酸杆菌降低链球菌属物种相对丰度及致病菌物种丰度,对阴道菌群微生态有一定改善作用。Objective To explore the effects of intervention with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on vaginal Group B Streptococcus(GBS)colonization,pregnancy outcome and vaginal microbiome in GBS-positive women in the third trimester of pregnancy.Methods This study were conducted among 155 women in the third trimester of pregnancy with positive results of GBS culture in the Outpatient Department of Zhujiang Hospital from March to November,2019.After excluding 32 patients who received lactobacillus intervention for less than 2 weeks or underwent postpartum GBS retesting,the women were divided into oral probiotics intervention group(60 cases)and non-intervention group(63 cases).According to the results of GBS retesting,the 60 women in the intervention group were divided into GBS-negative group(18 cases)and persistent GBS-positive group(42 cases).At the end of the intervention,the rates of negative GBS culture result were calculated and the pregnancy outcomes were compared.From 5 women randomly selected from the intervention group,samples of vaginal secretions were collected before and after the intervention for amplicon sequencing and bioinformatics analysis.Results At the end of the intervention,the GBS-negative rate in the intervention group was 30%(18/60),as compared with 23%(3/13)in the non-intervention group.Probiotic intervention significantly reduced the incidence of premature rupture of membranes(P<0.05)and reduced the use of antibiotics during pregnancy(P<0.05).OTU analysis of the vaginal secretions suggested probiotic intervention decreased the total sequence number and GBS sequence number,increased the species composition,and significantly decreased GBS abundance(P<0.05).Probiotics intervention also significantly decreased the species abundance of Enterococcus,Staphylococcus and Streptococcus in the vaginal flora(P<0.05).Conclusion Intervention with oral probiotics can reduce vaginal GBS colonization in late pregnancy and improve the pregnancy outcome.Lactobacillus is capa

关 键 词：B族链球菌 乳酸杆菌 阴道菌群微生态 

分 类 号：R714.25[医药卫生—妇产科学]