生殖道感染孕妇阴道分泌物中人β防御素表达水平及临床意义  

Expression of human β-defensins in vaginal secretions of pregnant women with genital tract infections and clinical sisnificance

作　　者：巢世兰[1] 李玉琴[2] 阿祥仁[1] 李子安[1] 刘兰民[1] 郑佳[1] CHAO Shi-lan;LI Yu-qin;A Xiang-ren;LI Zi-an;LIU Lan-min;ZHENG Jia(Qinghai Provincial People’s Hospital,Xining,Qinhai 810007,China)

机构地区：[1]青海省人民医院医学检验科,青海西宁810007 [2]青海省人民医院产科,青海西宁810007

出　　处：《中华医院感染学杂志》2021年第21期3327-3331,共5页Chinese Journal of Nosocomiology

基　　金：青海省人民医院科学技术研究专项课题基金资助项目(2018-SF-L3)。

摘　　要：目的探究孕妇阴道分泌物中人β防御素(HBD)-1、HBD-2、HBD-3及mRNA表达水平及临床意义。方法选择青海省人民医院2016年4月-2020年4月疑诊生殖道感染的100例初产妇,根据有无生殖道感染分为感染组52例和无感染组48例,并检测阴道分泌物中HBD-1、HBD-2、HBD-3及mRNA表达水平和血白细胞计数(WBC)、C-反应蛋白(CRP)、白细胞介素(IL)-4、、IL-6水平;分析感染产妇病原菌分布,不同感染状况产妇检查结果和新生儿结局。结果 100例初产妇生殖道感染52例,感染病原体以真菌为主占比40.38%,且以白假丝酵母居多占比30.77%;感染组产妇阴道pH值、不良新生儿结局发生率高于无感染组(P<0.05);感染组初产妇WBC、CRP、IL-4及IL-6水平、HBD-2、HBD-3及相关mRNA表达水平均高于无感染组初产妇(P<0.05);感染组初产妇HBD-1及相关mRNA水平与无感染组比较,无统计学差异;ROC显示,女性阴道分泌物中HBD-2及其mRNA、HBD-3及其mRNA诊断孕龄期女性生殖道感染的敏感度和特异度较低,指标并联诊断效能较好,敏感度98.08%,特异度93.75%。结论孕妇生殖道感染病原体以白假丝酵母为主,检测阴道分泌物中HBD-2、HBD-3及相关mRNA表达水平可判断其是否存在生殖道感染,尽早对应治疗,避免不良妊娠结局发生。OBJECTIVE To explore the expression levels of human β-defensin-1(HBD-1), HBD-2, HBD-3 and related mRNAs in vaginal secretions of pregnant women. METHODS A total of 100 primiparas who had suspected genital tract infection in Qinghai Provincial People’ s Hospital from Apr 2016 to Apr 2020 were enrolled in the study and divided into the infection group with 52 cases and the no infection group with 48 cases according to the status of genital tract infection. The expression levels of HBD-1, HBD-2, HBD-3 and mRNA in vaginal secretions as well as levels of serum white blood cells(WBC), C-reactive protein(CRP), interleukin-4(IL-4) and IL-6 were detected, the distribution of pathogens was observed, and the result of examinations and neonatal outcomes were analyzed. RESULTS Of the 100 primiparas, 52 had genital tract infection, 40.38% of whom had fungal infection, and 30.77% had Candida albicans infection. The vaginal pH value and incidence of adverse neonatal outcomes of the infection group were significantly higher than those of the no infection group(P<0.05). The expression levels of WBC, CRP, IL-4, IL-6, HBD-2, HBD-3 and related mRNA of the infection group were significantly higher than those of the no infection group(P<0.05);there were no significant differences in the levels of HBD-1 and related mRNA between the infection group and the no infection group. ROC showed that the sensitivity and specificity of the vaginal secretions HBD-2 and its mRNA, HBD-3 and its mRNA were low in diagnosis of genital tract infection in the pregnant women, but the joint detection of the above indexes had a high diagnostic efficiency, with the sensitivity 98.08%, the specificity 93.75%. CONCLUSION C.albicans is predominant species of pathogen causing genital tract infection in the pregnant women, the expression levels of HBD-2, HBD-3 and related mRNA in vaginal secretions may facilitate the diagnosis of genital tract infection so as to take treatment measures as early as possible and prevent adverse pregnancy outcomes.

关 键 词：孕龄期女性 生殖道感染 阴道分泌物 Β防御素 

分 类 号：R714.259[医药卫生—妇产科学]