慢性子宫内膜炎宫腔菌群与不同妊娠结局的相关性研究  

Study on the correlation between intrauterine flora of chronic endometritis and different pregnancy outcomes

作　　者：谢毅 陈晴[1] 胡启彩 魏蔚霞[1] Xie Yi;Chen Qing;Hu Qicai;Wei Weixia(Department of Obstetrics and Gynecology,Peking University Shenzhen Hospital,Shenzhen Guangdong 518000,P.R.China)

机构地区：[1]北京大学深圳医院妇产科,广东深圳518000

出　　处：《中国计划生育和妇产科》2023年第10期65-68,I0004,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：深圳市科技研发资金(项目编号:JCYJ20190809144801670);北京大学深圳医院临床研究(项目编号:LCYJ2021024)。

摘　　要：目的分析慢性子宫内膜炎(chronic endometritis,CE)患者的宫腔细菌分布特点,探讨其与不同妊娠结局间的相关性。方法选取2019年1月至2020年12月因IVF-ET失败、不孕症及复发性流产于北京大学深圳医院生殖外科行宫腔镜手术,术后病理诊断为CE的患者29例,通过16S rRNA测序法分析CE患者的宫腔菌群分布情况,术后规范治疗并随访1年,根据随访结果分为妊娠组(gestation,G)和未妊娠组(non gestation,NG),回顾性分析两组未治疗前的宫腔菌群分布差异及其与CE患者不良妊娠结局的关系。结果CE患者宫腔内存在一个由乳杆菌、假单胞菌、甲基杆菌-原单胞菌、棒状杆菌及其它细菌组成的复杂微生物群,乳杆菌是其宫内主要定植菌。G组宫腔内细菌的定植模式与NG组不同,G组不动杆菌中位定植丰度低于NG组(16.50 vs 142.00),差异有统计学意义(P=0.01)。纳入研究的29例CE患者,经规范抗炎治疗后,其中20例有妊娠结局(18例足月分娩,2例胚胎停育),9例尚未妊娠,临床妊娠率为68.97%(20/29),活产率为62.07%(18/29)。结论CE患者宫腔存在多样性细菌定植,乳杆菌是其宫内主要定植菌,宫腔不动杆菌高丰度定植可能与CE不良妊娠结局有关。Objective To analyze the distribution characteristics of uterine cavity bacteria in patients with chronic endometritis(CE),and to explore its correlation with different pregnancy outcomes.Methods From January 2019 to December 2020,29 patients who underwent hysteroscopic surgery due to IVF-ET failure,infertility,and recurrent abortion in the Department of Reproductive Surgery,Peking University Shenzhen Hospital and were diagnosed as CE by postoperative pathology were selected.The distribution of uterine flora in CE patients was analyzed by 16S rRNA sequencing.After standard treatment and follow-up for 1 year,they were divided into gestation group(G)and non-gestation group(NG)according to the follow-up results.The difference in the distribution of intrauterine flora before treatment between the two groups and its relationship with adverse pregnancy outcomes in CE patients were retrospectively analyzed.Results There was a complex microflora composed of Lactobacillus,Pseudomonas,Methylobacterium-Methylorubrum,Corynebacterium and other bacteria in the uterine cavity of CE patients.Lactobacillus was the main colonization bacteria in the uterus.The colonization pattern of bacteria in the uterine cavity of group G was different from that of group NG.The median colonization abundance of Acinetobacter in group G was lower than that in group NG(16.50 vs 142.00),and the distribution difference was statistically significant(P=0.01).Among the 29 CE patients included in the study,after standard anti-inflammatory treatment,20 had pregnancy outcomes(18 cases of full-term delivery,2 cases of embryo arrest),and 9 had not been pregnant.The clinical pregnancy rate was 68.97%(20/29),and the live birth rate was 62.07%(18/29).Conclusion There are diverse bacterial colonization in the uterine cavity of CE patients,and Lactobacillus is the main colonization bacteria in the uterus.The high abundance of Acinetobacter in the uterine cavity may be related to the adverse pregnancy outcome of CE.

关 键 词：慢性子宫内膜炎 16S rRNA 宫腔微生态 宫腔菌群 

分 类 号：R711.32[医药卫生—妇产科学] R37[医药卫生—临床医学]