妊娠糖尿病患者血糖控制与阴道微生态及妊娠结局的关系  

Association between glycemic control and vaginal microecology and pregnancy outcome in patients with gestational diabetes mellitus

作　　者：朱艳[1] 朱维培[1] ZHU Yan;ZHU Weipei(Department of Gynecology,the Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215000,China)

机构地区：[1]苏州大学附属第二医院妇产科,江苏苏州215000

出　　处：《中国优生与遗传杂志》2023年第10期2000-2007,共8页Chinese Journal of Birth Health & Heredity

摘　　要：目的 探讨妊娠糖尿病(GDM)患者血糖控制与阴道微生态及妊娠结局的关系。方法 选取2020年10月至2022年10月于苏州大学附属第二医院行血糖控制干预后分娩的GDM患者179例,分为血糖控制理想(n=82)和血糖控制不理想(n=97)。另取同期健康孕妇90例纳入对照组。多因素Logistic回归分析关联性,ROC曲线下面积(AUC)评估预测价值。结果 血糖控制不理想GDM患者H_(2)O_(2)、乳酸杆菌较低,pH、分泌物清洁度较高,菌群密集度和多样性多为Ⅰ级或Ⅳ级(P<0.05),其阴道微生态异常率(46.39%)高于血糖控制理想者(26.83%)和对照组(15.56%)。血糖控制不理想和微生态异常是不良妊娠结局的独立危险因素(P<0.05)。菌群丰富度AUC血糖控制前为0.762和0.602、控制后为0.618和0.751;Shannon-Wiener指数AUC血糖控制前为0.721和0.594、控制后为0.589和0.742。结论 血糖控制不理想和微生态异常是妊娠结局不良的危险因素,阴道菌群丰富度和Shannon-Wiener指数对妊娠结局有预测价值。Objective To investigate the relationship between glycemic control and vaginal microecology and pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods From October 2020 to October 2022,179 patients with GDM who delivered after blood glucose control intervention in the Second Affiliated Hospital of Soochow University were enrolled,which were divided into ideal blood glucose control(n=82)and unsatisfactory glycemic control(n=97).Another 90 healthy pregnant women were included in the control group.Multivariate Logistic regression analysis correlation,area under the ROC curve(AUC)to assess the predictive value.Results Patients with poor glycemic control and GDM had low H_(2)O_(2),lactobacilli,high pH and secretion cleanliness,and the density and diversity of flora were mostly gradeⅠorⅣ(P<0.05).The rate of abnormal vaginal microecology(46.39%)in patients with unsatisfactory glucose control GDM was higher than that in those with ideal glycemic control(26.83%)and control groups(15.56%).Poor glycaemic control and microbiome abnormalities were independent risk factors for adverse pregnancy outcomes(P<0.05).AUCs of microbiota richness were 0.762 and 0.602 before glycemic control.AUCs of the microbiota richness were 0.618 and 0.751 after glycemic control.AUCs of the Shannon-Wiener index were 0.721 and 0.594 before glycemic control.AUCs of the Shannon-Wiener index were 0.589 and 0.742 after glycemic control.Conclusion Poor glycaemic control and microbiome abnormalities are risk factors for poor pregnancy outcomes.Vaginal microbiota richness and Shannon-Wiener index were predictive of pregnancy outcomes.

关 键 词：妊娠糖尿病 血糖控制 阴道菌群 微生态 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]