支原体、衣原体感染与输卵管不孕的相关性探讨
发布时间：2018-08-25 11:02
【摘要】：目的:本研究通过对支原体、衣原体在宫颈及盆腔液中检出的阳性率做对比,探究其在不同部位被检出的敏感性;通过对输卵管不孕病人的术中输卵管损伤程度与支原体衣原体感染率情况分析,探讨支原体、衣原体感染与输卵管损伤的相关性;并根据其支原体药敏情况,进一步针对性的指导临床用药。方法:(1)本研究对2016年2月-2017年2月在广西中医药大学第一附属医院妇科门诊就诊的180例不孕症患者及孕早期要求终止妊娠的患者120例进行宫颈及阴道分泌物CT、UU、MH检查;(2)选取我院妇科住院部因输卵管不孕行腹腔镜手术治疗的88例患者作为不孕症,选取同时期我院妇科住院部因子宫肌瘤、子宫腺肌症、卵巢囊肿等行腹腔镜手术的患者62例作为对照组,对所有手术患者术前行宫颈分泌物CT、UU、MH检查,术中取盆腔液行盆腔液CT、UU、MH检查,并对不孕组术中应用输卵管评分标准对输卵管通畅程度、输卵管粘连情况、输卵管形态及伞端结构4个方向进行评分,按不同评分分为低评分组(0-7分)、中评分组(8-15分)、高评分组(16分以上),研究支原体、衣原体感染与输卵管不孕的相关性。(3)对所有行支原体检查同时进行支原体药物敏感试验,记录支原体的药物敏感结果,分析支原体耐药情况的可能原因。结果:(1)不孕组180例共检出支原体感染69例(38.33%)(其中解脲支原体(UU)65例,人型支原体(MH)14例,两者混合感染(UU+MH)10例。)沙眼衣原体(CT)感染28例(15.56%)。对照组120例共检出支原体13例(10.83%)(其中解脲支原体(UU)11例,人型支原体(MH)3例,两者混合感染(UU+MH)2例),沙眼衣原体(CT)感染4例(3.33%);不孕组宫颈分泌物支原体阳性率达38.33%,明显高于对照组10.83%,不孕组宫颈分泌物衣原体阳性率达15.56%,明显高于对照组3.33%,差异有统计学意义(P0.05;(2)88例不孕组手术患者宫颈分泌物支原体培养阳性31例,阳性率为35.23%(其中UU感染29例,MH感染5例,MH和UU同时感染3例),衣原体培养阳性9例,阳性率为10.23%;62例对照组手术患者宫颈分泌物支原体培养阳性9例,阳性率为14.52%(其中UU感染9例,MH感染0例,MH和UU同时感染0例),衣原体培养阳性0例;不孕组中盆腔液中支原体培养阳性4例,阳性率为4.55%(其中MH感染0例,UU感染4例),衣原体培养阳性6例,阳性率为6.82%;对照组中盆腔液中支原体、衣原体均未检测出;不孕组中支原体、衣原体阳性率均明显高于对照组,差异有统计学意义(P0.05);两组中支原体阳性率宫颈分泌物明显高于盆腔液,差异有统计学意义(P0.05);衣原体阳性率在宫颈分泌物与盆腔液中,差异无统计学意义(P0.05);(3)输卵管不孕组在不同等级的输卵管评分中支、衣原体感染情况分析:低、中与高评分组中支原体感染率两两比较均差异无统计学意义(P0.05);低、中与高评分组中衣原体感染率两两比较有统计学意义(P0.05):低评分组的衣原体感染率显著低于中评分组及高评分组(P0.05),中评分组的衣原体感染率显著低于高评分组(P0.05);支原体、衣原体混合感染患者中输卵管高评分组所占的比例明显高于单一感染组;(4)支原体药敏结果:总耐药性最高的是环丙沙星(58.33%),其次是可乐必妥(55.83%);单纯UU感染时,耐药性最高的是环丙沙星(63.27%),其次是可乐必妥(55.10%)。MH耐药性最高的是阿奇霉素(100%),其次是克拉霉素(85.71%)。UU合并MH感染耐药性最高的红霉素(93.33%),其次是罗红霉素和阿奇霉素,均为(73.33%)。结论:支原体、衣原体感染与不孕、输卵管损伤有一定的相关性;衣原体感染与输卵管损伤程度呈正相关性;支原体在盆腔液中检出的敏感性较高,衣原体在宫颈及盆腔液中检出的敏感性相当;支原体、衣原体混合感染对输卵管的损伤严重于支原体、衣原体单一感染。MH、UU混合感染时较MH或UU单纯感染耐药性增加。
[Abstract]:Objective: To compare the positive rates of Mycoplasma and Chlamydia in cervical and pelvic fluids, and to explore the sensitivity of different sites of Mycoplasma and Chlamydia in detection of tubal infertility. Methods: (1) CT, UU and MH examinations of cervical and vaginal secretions were performed in 180 infertility patients and 120 early pregnancy termination patients in the gynecological outpatient department of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from February 2016 to February 2017. (2) 88 cases of tubal infertility treated by laparoscopic surgery were selected as infertility, and 62 cases of gynecological factors such as uterine fibroids, adenomyosis, ovarian cysts were selected as control group. All patients underwent cervical secretion CT, UU, MH examination before operation. The pelvic fluid was taken for CT, UU and MH examination during operation, and the tubal scoring criteria were used to evaluate the degree of tubal patency, tubal adhesion, tubal morphology and umbrella tip structure in infertility group. The patients were divided into low scoring group (0-7 points), middle scoring group (8-15 points), high scoring group (over 16 points). (3) Drug susceptibility tests were carried out to record the drug susceptibility of Mycoplasma and analyze the possible causes of drug resistance of mycoplasma. Results: (1) A total of 69 cases (38.33%) of mycoplasma infection were detected in 180 cases of infertility group, including 65 cases of Ureaplasma urealyticum (UU), 65 cases of Mycoplasma hominis. There were 14 cases of Mycoplasma (MH), 10 cases of mixed infection (UU + MH), 28 cases of Chlamydia trachomatis (CT) infection (15.56%). 13 cases of Mycoplasma (10.83%) were detected in the control group (including 11 cases of Ureaplasma urealyticum (UU), 3 cases of Mycoplasma hominis (MH), 2 cases of mixed infection (UU + MH), 4 cases of Chlamydia trachomatis (CT) infection in the infertility group (3.33%). The positive rate of Chlamydia in cervical secretion of infertility group was 15.56%, which was significantly higher than that of control group (P 0.05); (2) The positive rate of mycoplasma culture in cervical secretion of 88 infertility patients was 35.23% (including 29 cases of UU infection, 5 cases of MH infection, 3 cases of both MH and UU infection). The positive rate of mycoplasma culture was 10.23%. The positive rate of mycoplasma culture in cervical secretion was 14.52%(9 cases of UU infection, 0 cases of MH infection, 0 cases of both MH and UU infection), 0 cases of Chlamydia culture, 4 cases of mycoplasma culture in pelvic fluid of infertility group, the positive rate was 4.55%(0 cases of MH infection, 0 cases of U infection). U infection in 4 cases, Chlamydia culture positive in 6 cases, the positive rate was 6.82%; control group in pelvic fluid mycoplasma, chlamydia were not detected; infertility group in mycoplasma, Chlamydia positive rate were significantly higher than the control group, the difference was statistically significant (P 0.05); two groups in the positive rate of Mycoplasma cervical secretion was significantly higher than pelvic fluid, the difference was statistically significant. There was no significant difference in the positive rate of Chlamydia between cervical secretion and pelvic fluid (P The infection rate of Chlamydia in low score group was significantly lower than that in middle score group and high score group (P 0.05). The infection rate of Chlamydia in middle score group was significantly lower than that in high score group (P 0.05). The proportion of high score group in mixed infection of Mycoplasma and chlamydia was significantly higher than that in single sense group. (4) Mycoplasma susceptibility test: ciprofloxacin (58.33%) was the highest total resistance, followed by clopidol (55.83%); ciprofloxacin (63.27%) was the highest resistance in UU infection alone, followed by clopidol (55.10%). Azithromycin (100%) was the highest resistance in MH infection, followed by clarithromycin (85.71%). Conclusion: Mycoplasma, Chlamydia infection and infertility, fallopian tube injury have a certain correlation; Chlamydia infection and fallopian tube injury are positively correlated; mycoplasma detection in pelvic fluid is more sensitive, chlamydia in cervical and pelvic fluid detection. Mixed infection of Mycoplasma and Chlamydia caused more serious damage to oviduct than single infection of mycoplasma. The drug resistance of mixed infection of MH and UU was higher than that of single infection of MH or UU.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.6
本文编号：2202681
[Abstract]:Objective: To compare the positive rates of Mycoplasma and Chlamydia in cervical and pelvic fluids, and to explore the sensitivity of different sites of Mycoplasma and Chlamydia in detection of tubal infertility. Methods: (1) CT, UU and MH examinations of cervical and vaginal secretions were performed in 180 infertility patients and 120 early pregnancy termination patients in the gynecological outpatient department of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from February 2016 to February 2017. (2) 88 cases of tubal infertility treated by laparoscopic surgery were selected as infertility, and 62 cases of gynecological factors such as uterine fibroids, adenomyosis, ovarian cysts were selected as control group. All patients underwent cervical secretion CT, UU, MH examination before operation. The pelvic fluid was taken for CT, UU and MH examination during operation, and the tubal scoring criteria were used to evaluate the degree of tubal patency, tubal adhesion, tubal morphology and umbrella tip structure in infertility group. The patients were divided into low scoring group (0-7 points), middle scoring group (8-15 points), high scoring group (over 16 points). (3) Drug susceptibility tests were carried out to record the drug susceptibility of Mycoplasma and analyze the possible causes of drug resistance of mycoplasma. Results: (1) A total of 69 cases (38.33%) of mycoplasma infection were detected in 180 cases of infertility group, including 65 cases of Ureaplasma urealyticum (UU), 65 cases of Mycoplasma hominis. There were 14 cases of Mycoplasma (MH), 10 cases of mixed infection (UU + MH), 28 cases of Chlamydia trachomatis (CT) infection (15.56%). 13 cases of Mycoplasma (10.83%) were detected in the control group (including 11 cases of Ureaplasma urealyticum (UU), 3 cases of Mycoplasma hominis (MH), 2 cases of mixed infection (UU + MH), 4 cases of Chlamydia trachomatis (CT) infection in the infertility group (3.33%). The positive rate of Chlamydia in cervical secretion of infertility group was 15.56%, which was significantly higher than that of control group (P 0.05); (2) The positive rate of mycoplasma culture in cervical secretion of 88 infertility patients was 35.23% (including 29 cases of UU infection, 5 cases of MH infection, 3 cases of both MH and UU infection). The positive rate of mycoplasma culture was 10.23%. The positive rate of mycoplasma culture in cervical secretion was 14.52%(9 cases of UU infection, 0 cases of MH infection, 0 cases of both MH and UU infection), 0 cases of Chlamydia culture, 4 cases of mycoplasma culture in pelvic fluid of infertility group, the positive rate was 4.55%(0 cases of MH infection, 0 cases of U infection). U infection in 4 cases, Chlamydia culture positive in 6 cases, the positive rate was 6.82%; control group in pelvic fluid mycoplasma, chlamydia were not detected; infertility group in mycoplasma, Chlamydia positive rate were significantly higher than the control group, the difference was statistically significant (P 0.05); two groups in the positive rate of Mycoplasma cervical secretion was significantly higher than pelvic fluid, the difference was statistically significant. There was no significant difference in the positive rate of Chlamydia between cervical secretion and pelvic fluid (P The infection rate of Chlamydia in low score group was significantly lower than that in middle score group and high score group (P 0.05). The infection rate of Chlamydia in middle score group was significantly lower than that in high score group (P 0.05). The proportion of high score group in mixed infection of Mycoplasma and chlamydia was significantly higher than that in single sense group. (4) Mycoplasma susceptibility test: ciprofloxacin (58.33%) was the highest total resistance, followed by clopidol (55.83%); ciprofloxacin (63.27%) was the highest resistance in UU infection alone, followed by clopidol (55.10%). Azithromycin (100%) was the highest resistance in MH infection, followed by clarithromycin (85.71%). Conclusion: Mycoplasma, Chlamydia infection and infertility, fallopian tube injury have a certain correlation; Chlamydia infection and fallopian tube injury are positively correlated; mycoplasma detection in pelvic fluid is more sensitive, chlamydia in cervical and pelvic fluid detection. Mixed infection of Mycoplasma and Chlamydia caused more serious damage to oviduct than single infection of mycoplasma. The drug resistance of mixed infection of MH and UU was higher than that of single infection of MH or UU.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.6
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