支原体、衣原体感染与不孕、不良妊娠结局的相关性及药物敏感性分析

发布时间：2018-03-04 00:08

本文选题：不孕　切入点：不良妊娠结局　出处：《泰山医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的分析支原体、衣原体在不孕和不良妊娠结局患者的感染情况,进一步探讨支原体、衣原体感染与不孕和不良妊娠结局的相关性；对不孕组支原体阳性者进行培养鉴定计数药敏试验,通过分析药敏结果,了解本地区支原体的药物敏感情况,为临床治疗支原体感染提供可靠的依据。方法采用实时荧光定量PCR法,检测708例不孕患者以及188例不良妊娠结局患者支原体、衣原体感染情况,同时检测100例正常早孕妇女支原体、衣原体感染情况；用液体培养法检测不孕患者核酸检测支原体阳性者的支原体分型鉴定和药物敏感情况。结果一、实时荧光定量PCR方法检测不孕、不良妊娠结局患者支原体、衣原体感染率1.不孕组708例,其中单独支原体感染者438例,阳性率61.9%；单独衣原体感染者68例,阳性率9.6%；混合感染者72例,阳性率10.2%。2.不良妊娠组188例,其中单独支原体感染者56例,阳性率29.8%；单独衣原体感染者32例,阳性率17.0%；混合感染者21例,阳性率11.2%。3.100例正常早孕妇女生殖道单独支原体感染者12例,阳性率12.0%；单独衣原体感染者2例,阳性率2.0%；混合感染者3例,感染率3.0%。二、支原体核酸检测阳性不孕患者支原体分型及药敏结果1.支原体阳性者培养结果为解脲支原体阳性376例,占78.3%,人型支原体阳性12例,占2.5%,解脲支原体和人型支原体双阳性92例,占19.2%。2.单独解脲支原体感染的药物敏感率最高的是强力霉素97.9%,其次敏感率较高的为美满霉索、交沙霉素、克拉霉素、阿奇霉素、加替沙星和红霉素,敏感率依次为97.3%、97.3%、96.3%、94.1%、84.6%和80.9%。耐药率最高的是司帕沙星42.0%,其次为甲砜霉素和克林霉素,耐药率都为33.3%。3.12例单独人型支原体培养阳性的药敏结果显示：单独人型支原体感染药物敏感率较高的依次为强力霉素100.0%、交沙霉素100.0%、克林霉素100.0%、美满霉素83.3%。耐药率较高的由高到低依次为阿奇霉素100.0%、红霉素100.0%、司帕沙星66.7%。4.92例解脲支原体和人型支原体培养阳性的药敏结果显示：药物敏感率较高的为美满霉素和强力霉素,敏感率分别为95.7%。耐药率由高到低依次为罗红霉素93.5%、红霉素89.1%、司帕沙星87.0%、克拉霉素80.4%、阿奇霉素78.3%。结论1.支原体、衣原体感染与不孕和不良妊娠结局有密切的关系,是导致不孕及不良妊娠结局的重要原因之一。2.单独解脲支原体感染的标本药物敏感率较高,敏感药物种类也多,而耐药的药物种类少,而且耐药率很低。敏感率最高的是强力霉素,其次为美满霉素、交沙霉素、克拉霉素、阿奇霉素,耐药率都很低。可将大环内酯类药物交沙霉素、克拉霉素和阿奇霉素作为治疗单独解脲支原体感染的一线用药。3.单纯人型支原体感染的标本中,四环素类的强力霉素和大环内酯类的交沙霉素、克林霉素敏感率最高；红霉素和阿奇霉素的耐药率最高。4.在解脲支原体和人型支原体复合感染的药敏试验中,属于四环素类的美满霉素和强力霉素的敏感率最高；耐药率普遍较高,耐药率由高到低依次为罗红霉素、红霉素、司帕沙星、克拉霉素、阿奇霉素。5.单独解脲支原体感染者在0-5种药物耐药组中所占比例最高,6-11种药物耐药组中所占比例最低,解脲支原体和人型支原体感染12种药物耐受组中所占比例最高。虽然人型支原体感染数量少,但多重耐药情况比较严重,治疗难度较大。
[Abstract]:Objective to analyze the mycoplasma, chlamydia infection in infertility and adverse pregnancy outcomes of patients, to further explore the relationship between mycoplasma, chlamydia infection and infertility and adverse pregnancy outcomes; the infertility group were positive mycoplasma culture identification count drug sensitivity test, through the analysis of the results of drug sensitivity, understanding drug sensitivity of Mycoplasma in the region, to provide a reliable basis for for the clinical treatment of mycoplasma infection. Methods by using real-time quantitative PCR method to detect 708 cases of infertility patients and 188 cases of adverse pregnancy outcome in patients with mycoplasma, chlamydia infection, and 100 cases of normal pregnancy detection of mycoplasma, chlamydia infection; mycoplasma detection of nucleic acid detection of mycoplasma infection in patients with infertility typing and drug sensitivity by using liquid culture. As a result, real time quantitative PCR detection of infertility, adverse pregnancy outcome in patients with Mycoplasma Body, rate of Chlamydia infection in 1. group of 708 cases of infertility, 438 cases of mycoplasma infection alone among them, the positive rate was 61.9%; separate Chlamydia infection in 68 cases, the positive rate was 9.6%; 72 cases of mixed infection, 10.2%.2. positive rate of adverse pregnancy group 188 cases, 56 cases of mycoplasma infection alone among them, the positive rate was 29.8%; Chlamydia alone 32 cases of infection, the positive rate was 17%; 21 cases of mixed infection, 12 cases of 11.2%.3.100 positive rate of normal pregnant women reproductive tract mycoplasma infection alone, the positive rate was 12%; 2 cases of single Chlamydia infection, the positive rate was 2%; 3 cases of mixed infection, the infection rate of 3.0%. two, nucleic acid detection of Mycoplasma positive patients with infertility Mycoplasma typing and drug sensitivity results of 1. Mycoplasma positive Ureaplasma urealyticum culture results were positive in 376 cases, accounting for 78.3%, Mycoplasma hominis positive 12 cases, accounting for 2.5%, Ureaplasma urealyticum and Mycoplasma hominis positive 92 cases, accounting for 19.2%.2. of Ureaplasma The drug sensitivity of mycoplasma infection rate is the highest 97.9% doxycycline, second rate high is sensitive to josamycin, minocycline, clarithromycin, azithromycin, gatifloxacin and erythromycin sensitive rate were 97.3%, 97.3%, 96.3%, 94.1%, 84.6% and 80.9%. resistant rate is 42% followed by sparfloxacin, thiamphenicol and clindamycin the resistance rate of 33.3%.3.12, all cases of mycoplasma culture and drug sensitivity alone positive results showed that the drug sensitive rate is higher in 100% doxycycline, josamycin 100%, clindamycin alone 100% Mycoplasma hominis infection, minocin 83.3%. high resistance rate from high to low is 100% azithromycin, erythromycin 100%, sparfloxacin 66.7%.4.92 cases of Ureaplasma urealyticum mycoplasma and mycoplasma culture and drug sensitivity results showed that the positive rate of drug sensitivity is high sensitive to minocycline and doxycycline. Rates were 95.7%. resistance rate from high to low as roxithromycin, erythromycin 89.1%, 93.5%, 87% and 80.4% of sparfloxacin, clarithromycin, azithromycin 1. 78.3%. conclusion mycoplasma, chlamydia infection has close relationship with infertility and adverse pregnancy outcomes, is the cause of infertility and adverse pregnancy outcomes were drugs is an important cause of.2. infection of Ureaplasma urealyticum susceptibility high sensitive drugs are more kinds of drugs, and drug resistance, and the resistance rate is very low. The highest sensitivity is followed by doxycycline, minocycline, josamycin, clarithromycin, azithromycin, drug resistance rate is very low. The macrolides such as josamycin, clarithromycin and azithromycin as first-line therapy use.3. simple Mycoplasma hominis infection of Ureaplasma urealyticum infection alone specimens, tetracycline doxycycline and josamycin macrolide, The highest rate of clindamycin sensitive drug sensitivity test; drug resistance of erythromycin and azithromycin was the highest.4. in Ureaplasma urealyticum and Mycoplasma hominis infection in the composite, belongs to the tetracycline minocycline and doxycycline sensitive rate is the highest; resistance rate is generally high, the resistance rate from high to low as roxithromycin, erythromycin, clarithromycin, azithromycin and sparfloxacin..5. single infection of Ureaplasma urealyticum in 0-5 kinds of drug resistance groups accounted for the highest proportion, 6-11 kinds of drug resistance group in the lowest proportion of 12 kinds of drug tolerance group accounted for the highest proportion of Ureaplasma urealyticum and Mycoplasma hominis infection of Mycoplasma hominis infection. Although the quantity is less, but the multiple drug resistance is serious, treatment difficult.

【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.6

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