早产与足月产女性早孕期阴道微生态差异分析  

Differences in vaginal microbiome between preterm and full-term delivery parturients

作　　者：陈华云 王昱洁 黄振宇[1] 张琼琼 王颖[1] 张蕾[1] 吕涛[1] 赵萌[1] 廖秦平[1] CHEN Huayun;WANG Yujie;HUANG Zhenyu;ZHANG Qiongqiong;WANG Ying;ZHANG Lei;LYU Tao;ZHAO Meng;LIAO Qinping(Department of Obstetrics and Gynecology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;不详)

机构地区：[1]清华大学附属北京清华长庚医院妇产科,清华大学临床医学院,北京102218 [2]清华大学附属北京清华长庚医院医学数据科学中心,清华大学临床医学院

出　　处：《中国微生态学杂志》2024年第9期1086-1091,共6页Chinese Journal of Microecology

基　　金：国家自然科学基金委员会重点仪器研发项目(61927819);清华大学精准医学院重点实验室项目(20219990012);北京市培育计划(PX2022039);北京清华长庚医院研究基金(12023C01009)。

摘　　要：目的比较早产和足月产女性早孕期阴道微生态的差异,探寻早产的预测方法。方法采用回顾性病例对照研究法,以2022年6月至2023年12月在清华大学附属北京清华长庚医院分娩的2247例妊娠期女性为研究对象,其中98例早产(早产组),2149例足月产(足月产组)。采用倾向性评分匹配法,以年龄、孕次、产次作为协变量,匹配足月产妇98例。回顾分析入选对象在孕6~8周时阴道微生态检测结果,比较早产和足月产女性孕早期阴道分泌物功能、形态和阴道炎发生情况。结果倾向性评分匹配前后早产组女性平均分娩孕周和新生儿平均体重均小于足月产组(均P<0.001),且匹配前后两组女性年龄、孕次和产次差异均无统计学意义(均P>0.050)。早产组女性阴道优势菌G+b(L)比例为82.5%,低于足月产组的91.8%(χ^(2)=10.260,P=0.001);早产组阴道乳杆菌分级为Ⅰ~Ⅱa的比例为84.5%,低于足月产组的91.4%(χ^(2)=5.039,P=0.021)。经倾向性评分匹配后,早产组以上两项指标亦显著低于足月产组(χ^(2)=8.000,P=0.005;χ^(2)=4.765,P=0.029);两组女性阴道菌群密度和多样性差异无统计学意义(χ^(2)=0.002,P=0.963;χ^(2)=0.416,P=0.519);经倾向性评分匹配后,两组女性阴道菌群密集度差异无统计学意义(χ^(2)=0.200,P=0.655),但早产组菌群多样性++~+++比例显著高于足月产组(χ^(2)=5.120,P=0.024)。早产组阴道分泌物平均pH值为5.09±0.37,显著高于足月产组的4.96±0.43(t=3.470,P<0.001);经倾向性评分匹配后,早产组亦显著高于足月产组(t=4.570,P<0.001)。两组女性阴道过氧化氢阳性率在倾向性评分匹配前后差异均无统计学意义(χ^(2)=0.725,P=0.338;χ^(2)=0.014,P=0.906)。早产组女性需氧菌性阴道炎(AV)检出率为12.4%,高于足月产组的5.2%(χ^(2)=9.049,P=0.003);经倾向性评分匹配后,早产组亦显著高于足月产组(χ^(2)=6.727,P=0.009)。两组女性细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)�Objective To compare the differences in vaginal microbiome between preterm and full-term parturients in early pregnance,and explore the potential factors that predict preterm birth.Methods A total of 2,247 pregnant women who gave birth in our hospital from June 2022 to December 2023 were selected,including 98 cases of preterm delivery parturients(preterm group)and 2,149 cases of full-term delivery parturients(full-term group),among which 98 full-term parturients were matched with the baseline indicators of maternal age,gravidity and parity as covariables by propensity score matching(PSM).The results of vaginal microbiota testing at 6-8 weeks of pregnancy were retrospectively analyzed,and the differences in the function and morphology of vaginal microbiome,and onset of vaginitis between the two groups were compared.Results Before and after PSM,the mean gestational age and mean weight of newborns in the preterm delivery group were lower than those in the full-term delivery group(all P<0.050).There were no significant differences in age,gravidity and parity between the two groups(all P>0.050).Before and after PSM,the proportion of G+b(L)and Lactobacillary grades(LBG)in the preterm group were lower than those in the full-term group(all P<0.050).There were no significant differences in vaginal flora density and diversity between the two groups(χ^(2)=0.002,P=0.963;χ^(2)=0.416,P=0.519),but the difference in vaginal flora diversity was statistically significant after PSM(χ^(2)=5.120,P=0.024).The average pH value of vaginal discharge in the preterm group was 5.09±0.37,higher than the 4.96±0.43 in the full-term group(t=3.470,P<0.001);the difference in pH value was statistically significant after PSM(t=4.570,P<0.001).There was no significant difference in the positive rate of hydrogen peroxide(H2O2)between the two groups before and after PSM(χ^(2)=0.725,P=0.338;χ^(2)=0.014,P=0.906).The detection rate of aerobic vaginitis(AV)in the preterm group was 12.4%,higher than the 5.2%in the full-term group(χ^(2)=9.049,P=0.003

关 键 词：早产预测 阴道微生态 早孕期 阴道优势菌 pH值 阴道炎 

分 类 号：R714.21[医药卫生—妇产科学]