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目的了解未足月胎膜早破患者阴道微生态的状况,探讨未足月胎膜早破(preterm premature rupture of membranes,PPROM)孕妇阴道微生态评价的临床意义。方法选取2013年1月至2013年12月在伊犁州友谊医院常规进行产前检查,孕28~36+6周PPROM孕妇150例为PPROM组,同孕周正常孕妇150例为对照组,采集两组患者阴道分泌物,革兰染色涂片后进行阴道微生态学评价;计数资料比较采用t检验,计量资料比较采用2检验。结果 PPROM组阴道优势菌以革兰阳性球菌为主(34.67%,52/150),与对照组(12.00%,18/150)比较,2=21.54,P<0.01,差异有统计学意义;对照组以革兰阳性杆菌为主(67.33%,101/150),与PPROM组(31.33%,47/150)比较,2=38.89,P<0.01。PPROM组正常菌群密集度(Ⅱ级和Ⅲ级)的比例(63.33%,95/150),与对照组(88.00%,132/150)比较,2=17.28,P<0.01,差异有统计学意义;PPROM组正常菌群多样性(Ⅱ级和Ⅲ级)(60.00%,95/150),与对照组(90.67%,136/150)比较,2=37.96,P<0.01。PPROM组孕妇的细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)、BV+VVC及菌群失调者的发生率分别为(21.33%,32/150)、(24.00%,36/150)、(13.33%,20/150)、(32.00%,48/150)对照组分别为(10.67%,16/150)、(10.67%,16/150)、(1.33%,2/150)、(20.67%,31/150),两组比较2值分别为6.33、9.27、27.33和4.95,P值分别为=0.01、<0.01、<0.01和<0.05,差异均有统计学意义。PPROM组中无症状者有33.81%,处于微生态失调状态。结论未足月胎膜早破孕妇阴道微生态改变表现为微生态失调比例升高。
Objective To understand the status of vaginal microflora in preterm premature rupture of membranes (PPROM) and to evaluate the clinical significance of vaginal microecology evaluation. Methods From January 2013 to December 2013, Yili Friendship Hospital routinely performed prenatal examination. 150 pregnant women with PPROM at 28-36 + 6 weeks as PPROM group and 150 pregnant women with normal gestational age as control group, Group of patients with vaginal secretions, Gram stain after vaginal microbiological evaluation; count data were compared using t test, measurement data were compared using 2 test. Results The predominant vaginal bacteria in PPROM group were Gram positive cocci (34.67%, 52/150). Compared with the control group (12.00%, 18/150), ROM2 = 21.54, P <0.01, the difference was statistically significant. In the control group, gram-positive bacilli were predominant (67.33%, 101/150), compared with PPROM group (31.33%, 47/150), 2 = 38.89, P <0.01. Compared with the control group (88.00%, 132/150), the ratio of normal flora (grade Ⅱ and Ⅲ) in PPROM group (63.33%, 95/150) was 2 = 17.28, P <0.01 The mean value of normal flora in PPROM group (grade Ⅱ and Ⅲ) (60.00%, 95/150) was significantly higher than that in control group (90.67%, 136/150) (2 = 37.96, P <0.01). The incidence of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), BV + VVC and dysbacteriosis in PPROM group were (21.33%, 32/150), (24.00%, 36 (10.67%, 16/150), (10.67%, 16/150), (1.33%, 2/150) ), (20.67%, 31/150). The values of 2 in the two groups were 6.33, 9.27, 27.33 and 4.95, respectively. The P values were respectively 0.01, 0.01, 0.01 and <0.05. PPROM group asymptomatic 33.81%, in a state of micro-ecological disorders. Conclusions The vaginal microecological changes of pregnant women with premature rupture of membranes presented with a rising proportion of microecological disorders.