产后6~8周女性阴道微生态的特征及乳杆菌比例影响因素分析  

Analysis of the Characteristics of Vagina Microecology and the Factors Influencing the Ratio of Lactobacilli in 6-8 Weeks Postpartum Women

作　　者：石慧丽 牛菊敏[2] 孙建华[2] 史聪 张铭[2] 赵爽[2] 刘倩男 SHI Huili;NIU Jumin;SUN Jianhua(Graduate School of Jinzhou Medical University,Jinzhou Liaoning 121001,China;Department of Gynecology,Shenyang Women's and Children's Hospital,Shenyang Liaoning 110011,China)

机构地区：[1]锦州医科大学研究生学院,辽宁锦州121001 [2]沈阳市妇婴医院妇科,辽宁沈阳110011

出　　处：《实用妇产科杂志》2021年第2期152-156,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探究产后女性阴道微生态特征及产后女性乳杆菌比例的影响因素。方法:收集2018年12月至2020年1月就诊于沈阳市妇婴医院,行产后复查女性864例为产后组,同期就诊健康体检女性815例为对照组。根据产后组乳杆菌比例将产后组分为乳杆菌比例正常组(n=203)及乳杆菌比例降低组(n=661)。采集患者阴道分泌物行阴道微生态检测,并收集分娩相关信息,分析两组阴道微生态的总体情况及影响产后女性乳杆菌比例的相关因素。结果:产后组阴道炎检出率明显低于对照组(16.09%vs 35.71%,P<0.01),无阴道炎菌群抑制发生率更高(60.55%vs 14.89%,P<0.01),产后组以需氧菌性阴道炎(AV)(75.24%)及AV+细菌性阴道炎(BV)(97.06%)为主。阴道微生态检测中,产后组上皮细胞、菌群密集度及多样性均少于对照组,产后组较对照组乳杆菌比例更低(P<0.01),白细胞及致病菌阳性率均低于对照组(P<0.01),且阴道清洁度优于对照组(P<0.01);但Nugent和AV评分及阴道pH均高于对照组(P<0.01)。过氧化氢(H2O2)、白细胞酯酶阳性率高于对照组,而唾液酸酐酶及凝固酶阳性率则低于对照组,以上差异均有统计学意义(P<0.01)。产后女性中乳杆菌比例下降与体质量指数(BMI)和分娩方式有关,BMI<25 kg/m^(2)、剖宫产是产后女性生殖道内乳杆菌比例降低的危险因素[OR 1.817,95%CI(1.309,2.520),P<0.001;OR 1.820,95%CI(1.294,2.558),P=0.001]。结论:阴道微生态的失衡、乳杆菌比例的降低在产后女性中普遍存在,剖宫产女性更应关注阴道微生态状况。恢复阴道内乳杆菌的数量及功能,是产后女性生殖健康保健的重中之重,并且均需要警惕需氧菌性阴道炎、细菌性阴道炎的发生。Objective:To explore vaginal microecological characteristics of postpartum women and related factors affecting the proportion of lactobacilli.Methods:A total of 864 women who underwent postpartum review in Shenyang Women′s and Children′s Hospital from December 2018 to January 2020 were collected as the postpartum group,and 815 healthy women were treated as the control group during the same period.According to the proportion of Lactobacillus,the postpartum group was divided into normal Lactobacillus proportion group(n=203)and low Lactobacillus proportion group(n=661).The vaginal secretions of the patients were collected for vaginal microecology test,and information on childbirth was also collected.The overall situation of vaginal microecology between the two groups and related factors affecting Lactobacilli in postpartum women were analyzed.Results:The vaginitis rate of postpartum women was significantly lower than that of control group(16.09%vs 35.71%,P<0.01),but the incidence of bacterial flora inhibition was higher(60.55%vs 14.89%,P<0.01).In the postpartum group,aerobic vaginitis(AV)(75.24%)and AV+bacterial vaginitis(BV)(97.06%)were the main symptoms.In the vaginal microecology test,epithelial cells,flora density and diversity,and the proportion of Lactobacilli were lower in postpartum group than those in the control group(P<0.01).The positive rate of white blood cells and pathogenic bacteria was significantly lower in postpartum group(P<0.01);the vaginal cleanliness was better than control group(P<0.01).However,Nugent and AV score and vaginal pH were higher than those in control group(P<0.01).The positive rates of hydrogen peroxide and leukocyte esterase were higher in postpartum group than those in control group,while the positive rates of sialidase and coagulase were lower.The above differences were statistically significant(P<0.01).The reduceof Lactobacilli in postpartum women was associated with BMI and mode of delivery.BMI<25 kg/m^(2) and Cesarean section were risk factors for the reduction of Lactoba

关 键 词：阴道微生态 产后 乳杆菌 影响因素 

分 类 号：K714[历史地理—世界史]