B族链球菌感染与胎膜早破的相关性研究

发布时间：2018-08-04 14:31

【摘要】：胎膜早破(premature rupture of membrane,PROM)是指临产前胎膜破裂,其常见原因包括:生殖道感染、羊膜腔压力增高、胎膜受力不均、营养因素缺乏等。其中感染是胎膜早破的重要致病因素,在引起感染的病原体中,以B族溶血性链球菌(GBS)穿透力最强,致病率最高。GBS正常寄居于阴道和直肠,是一种条件致病菌,对绒毛膜有较强吸附能力和穿透能力,接种2小时内即可吸附于母体组织,继而侵入绒毛膜,通过炎症细胞的吞噬作用及细菌产生的蛋白水解酶的直接侵袭,使胎膜局部张力减低,从而导致胎膜早破。目前,国内外对于GBS的预防方案主要采用抗生素预防。但近年来,全球GBS的耐药性逐年上升。对于是否应常规对GBS阳性孕妇进行预防性抗生素治疗,目前尚存在争议。目的探讨孕妇生殖道B族链球菌(GBS)感染与胎膜早破的关系。分析对于B族链球菌阳性患者在产前给予抗生素治疗是否能预防胎膜早破的发生及改善母婴结局。方法搜集于2015年8月至2016年3月青岛大学附属医院产科门诊病人1121例,以148例因胎膜早破住院、或住院后发生胎膜早破的孕妇为研究组,随机抽取150例相同孕周的正常孕妇为对照组,比较两组阴道分泌物B族链球菌阳性率;将62例门诊筛查阴道分泌物B族链球菌阳性的35-37周孕妇分为治疗组和未治疗组,其中接受产前24小时内给予抗生素治疗的20例为治疗组,未接受任何药物干预治疗的42例为未治疗组。分别比较治疗组与非治疗组之间的胎膜早破、早产、宫内感染、新生儿感染、产褥感染情况,分析抗B族链球菌感染对母婴预后的影响。结果148例胎膜早破孕妇的生殖道分泌物中,GBS培养阳性38例,占25.68%。而150名无胎膜早破早产孕妇中GBS培养阳性12例,占8.00%。两组经统计学分析,差异有统计学意义(P0.05)。以62例妊娠晚期GBS检测阳性者作为研究对象,接受产前24小时内给予抗生素治疗的20例,发生胎膜早破4例,占20.00%,未接受任何药物干预治疗的42例,发生胎膜早破14例,占33.33%,治疗组和非治疗组的胎膜早破发生率比较,差异无统计学意义(P0.05),治疗组发生早产的有3例,占15.00%,对照组的发生早产8例,占19.05%,两者比较,差异无统计学意义(P0.05)。治疗组发生宫内感染的有0例,占00.00%,对照组发生宫内感染0例,占00.00%,两者比较,差异无统计学意义(P0.05)。治疗组发生新生儿感染的有0例,占0.00%,对照组的发生新生儿感染3例,占7.14%,两者比较,差异无统计学意义(P0.05)。治疗组无产褥感染发生,未治疗组有5例产妇发生了产褥感染,占11.90%,两者比较,差异无统计学意义(P0.05)。结论(1)胎膜早破与B族链球菌的感染密切相关,其产前感染的发生明显高于非胎膜早破组。(2)接受预防性抗生素治疗患者胎膜早破、早产、新生儿感染及产褥感染发生率较未治疗者低,但差异无统计学意义,对母婴结局无显著改善。
[Abstract]:Premature rupture of (premature rupture of membrane (prom) refers to rupture of membranes before labor. The common causes include: genital tract infection, increased pressure of amniotic cavity, uneven force of fetal membrane, lack of nutrition, etc. Infection is an important pathogenic factor of premature rupture of fetal membranes. Among the pathogens causing the infection, Group B hemolytic streptococcus (GBS) has the strongest penetration and the highest pathogenicity. It is a conditional pathogen, living in vagina and rectum normally. The chorionic membrane could be adsorbed on the mother tissue within 2 hours after inoculation, and then invaded into the chorionic villi. The phagocytosis of inflammatory cells and the direct invasion of proteolytic enzymes produced by bacteria were observed. Reduce the local tension of membranes, leading to premature rupture of membranes. At present, antibiotic prophylaxis is mainly used to prevent GBS at home and abroad. But in recent years, the drug resistance of GBS has been increasing year by year. It is still controversial whether routine prophylactic antibiotic therapy should be given to GBS-positive pregnant women. Objective to investigate the relationship between group B streptococcus (GBS) infection and premature rupture of membranes in pregnant women. To analyze whether antibiotic therapy in group B streptococcus positive patients can prevent premature rupture of membranes and improve maternal and infant outcomes. Methods from August 2015 to March 2016, 1121 outpatients in obstetrical department of Qingdao University affiliated Hospital were collected. 148 pregnant women who were hospitalized because of premature rupture of membranes or had premature rupture of membranes after hospitalization were selected as study group. 150 normal pregnant women of the same gestational age were randomly selected as the control group, and the positive rates of Group B streptococcus B in vaginal secretions were compared between the two groups, and 62 pregnant women who were screened for Group B streptococcus in the outpatient clinic were divided into treatment group and untreated group. Among them, 20 cases were treated with antibiotics within 24 hours of antepartum, and 42 cases were not treated with any drug intervention. Premature rupture of membranes, preterm delivery, intrauterine infection, neonatal infection and puerperal infection were compared between the treatment group and the non-treated group, and the effects of anti-B streptococcus infection on the prognosis of mother and infant were analyzed. Results among 148 pregnant women with premature rupture of membranes, 38 cases (25.68%) were positive for GBS culture. GBS culture was positive in 12 cases (8.00%) in 150 preterm delivery women without premature rupture of membranes. The difference between the two groups was statistically significant (P0.05). Among the 62 cases of GBS positive in the third trimester of pregnancy, 20 cases were treated with antibiotics within 24 hours before delivery, 4 cases (20.00%) developed premature rupture of membranes, 42 cases did not receive any drug intervention, and 14 cases had premature rupture of membranes. There was no significant difference in the incidence of premature rupture of membranes between the treatment group and the non-treatment group (P0.05). There were 3 cases of premature delivery in the treatment group (15.00%) and 8 cases in the control group (19.05%). There was no significant difference between the two groups (P0.05). There were 0 cases of intrauterine infection in the treatment group and 0 cases in the control group. The difference between the two groups was not statistically significant (P0.05). There were 0 cases of neonatal infection in the treatment group and 3 cases in the control group (7.14%). There was no significant difference between the two groups (P0.05). No puerperal infection occurred in the treatment group, and there were 5 cases of puerperal infection in the untreated group, accounting for 11.90%, the difference was not statistically significant (P0.05). Conclusion (1) premature rupture of membranes is closely related to group B streptococcus infection, and the incidence of prenatal infection is significantly higher than that of non-fetal membrane premature rupture group. (2) premature rupture of membranes and preterm delivery in patients treated with prophylactic antibiotics. The incidence of neonatal infection and puerperal infection was lower than that of untreated group, but the difference was not statistically significant.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.433

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