汪万军,谢莹莺

目的：研究胎膜早破（PROM）阴道微生态基因多样性及差异显著性。方法：选取2023年7月至2024年7月于青海大学附属医院产科就诊的妊娠期女性，正常组（Control组）与PROM组各30名，通过16S rRNA测序技术对比研究两组患者阴道微生态在基因组学上的多样性及差异性；分析PROM对不良妊娠结局的影响。结果：1.两样本一般资料比对结果发现PROM孕周小于Control组及pH值大于Control组均有统计学意义（P＜0.05）。2.门水平上，候选糖链菌门在PROM组丰度值较高，具有统计学意义（P＜0.05）；属水平上，加德纳菌属、范尼希氏菌属、霍伊尔氏菌属、普雷沃氏菌属、双歧杆菌属在PROM组较高，具有统计学意义（P＜0.05）。3.PROM组α多样性大于Control组，且β多样性较为显著，具有统计学意义（P＜0.05）。4.两组均以新陈代谢途径作为主要通路，而人类疾病通路在两组间在存在显差异（P＜0.05）。5.PROM组发生新生儿肺炎、黄疸、低体重儿、败血症、产褥感染及产后出血的概率高于Control组，有统计学意义(P＜0.05)。结论：发生PROM患者阴道PH值增大，菌群多样性明显增多，以加德纳菌、普雷沃菌及霍伊尔氏菌为主要差异细菌，主要以新陈代谢通路为主，而人类疾病通路是两组间的差异代谢通路。发生PROM时，其发生不良妊娠结局的概率也相对增大。

青海地区；PROM；阴道微生态；16S rRNA基因测序技术；不良妊娠结局

[1] 冉雨鑫,尹楠林,漆洪波. ACOG《胎膜早破临床实践指南(2020)》解读[J]. 中国实用妇科与产科杂志,2020,36(08):736-739. [2] Ronzoni S, Boucoiran I, Yudin MH, Coolen J, Pylypjuk C, Melamed N, Holden AC, Smith G, Barrett J. Guideline No. 430: Diagnosis and management of preterm prelabour rupture of membranes. J Obstet Gynaecol Can. 2022 Nov;44(11):1193-1208.e1. [3] Garg A, Jaiswal A. Evaluation and Management of Premature Rupture of Membranes: A Review Article. Cureus. 2023 Mar 24;15(3):e36615. [4] 米亚兵,应豪.妊娠期感染与早产[J].中国实用妇科与产科杂志,2023,39(12):1197-1200. [5] Xu H, Zhang X, Yao W, Sun Y, Zhang Y. Characterization of the vaginal microbiome during cytolytic vaginosis using high-throughput sequencing. J Clin Lab Anal. 2019 Jan;33(1):e22653. [6] Gorczyca K, Kozioł MM, Kimber-Trojnar Ż, Kępa J, Satora M, Rekowska AK, Leszczyńska-Gorzelak B. Premature rupture of membranes and changes in the vaginal microbiome - Probiotics. Reprod Biol. 2024 May 27;24(3):100899. [7] Yudin MH, van Schalkwyk J, Eyk NV; INFECTIOUS DISEASES COMMITTEE; MATERNAL FETAL MEDICINE COMMITTEE. Antibiotic therapy in preterm premature rupture of the membranes. J Obstet Gynaecol Can. 2009 Sep;31(9):863-867. English, French. [8] Bennett PR, Brown RG, MacIntyre DA. Vaginal Microbiome in Preterm Rupture of Membranes. Obstet Gynecol Clin North Am. 2020 Dec;47(4):503-521. [9] 王颖慧,张焕棕,张军能.孕晚期女性阴道菌群与妊娠结局的相关性[J].中国微生态学杂志,2022,34(12):1441-1447. [10] Baud A, Hillion KH, Plainvert C, Tessier V, Tazi A, Mandelbrot L, Poyart C, Kennedy SP. Microbial diversity in the vaginal microbiota and its link to pregnancy outcomes. Sci Rep. 2023 Jun 4;13(1):9061. [11] Fettweis JM, Serrano MG, Brooks JP, Edwards DJ, Girerd PH, Parikh HI, Huang B, Arodz TJ, Edupuganti L, Glascock AL, Xu J, Jimenez NR, Vivadelli SC, Fong SS, Sheth NU, Jean S, Lee V, Bokhari YA, Lara AM, Mistry SD, Duckworth RA 3rd, Bradley SP, Koparde VN, Orenda XV, Milton SH, Rozycki SK, Matveyev AV, Wright ML, Huzurbazar SV, Jackson EM, Smirnova E, Korlach J, Tsai YC, Dickinson MR, Brooks JL, Drake JI, Chaffin DO, Sexton AL, Gravett MG, Rubens CE, Wijesooriya NR, Hendricks-Muñoz KD, Jefferson KK, Strauss JF 3rd, Buck GA. The vaginal microbiome and preterm birth. Nat Med. 2019 Jun;25(6):1012-1021. [12] Yan C, Hong F, Xin G, Duan S, Deng X, Xu Y.Alterations in the vaginal microbiota of patients with preterm premature rupture of membranes. Front Cell Infect Microbiol. 2022 Aug 8;12:858732. [13] Serrano MG, Parikh HI, Brooks JP, Edwards DJ, Arodz TJ, Edupuganti L, Huang B, Girerd PH, Bokhari YA, Bradley SP, Brooks JL, Dickinson MR, Drake JI, Duckworth RA 3rd, Fong SS, Glascock AL, Jean S, Jimenez NR, Khoury J, Koparde VN, Lara AM, Lee V, Matveyev AV, Milton SH, Mistry SD, Rozycki SK, Sheth NU, Smirnova E, Vivadelli SC, Wijesooriya NR, Xu J, Xu P, Chaffin DO, Sexton AL, Gravett MG, Rubens CE, Hendricks-Muñoz KD, Jefferson KK, Strauss JF 3rd, Fettweis JM, Buck GA. Racioethnic diversity in the dynamics of the vaginal microbiome during pregnancy. Nat Med. 2019 Jun;25(6):1001-1011. [14] Liang X, Li Z, Tye KD, Chen Y, Luo H, Xiao X. The effect of probiotic supplementation during pregnancy on the interaction network of vaginal microbiome. J Obstet Gynaecol Res. 2021 Jan;47(1):103-113. [15] Asogwa AO, Ezugwu EC, Eleje GU, Chidinma OI, Asogwa FK, Ezugwu OC, Ezegwui HU. Association of clinical signs of chorioamnionitis with histological chorioamnionitis and neonatal outcomes in women with premature rupture of membranes. Niger J Clin Pract. 2023 Sep;26(9):1354-1360. [16] 杨增琳,杨燕.不同孕周未足月胎膜早破期待治疗对妊娠结局的影响[J].中华养生保健,2023,41(09):41-44. [17] Afolabi BB, Moses OE, Oduyebo OO. Bacterial Vaginosis and Pregnancy Outcome in Lagos, Nigeria. Open Forum Infect Dis. 2016 Feb 9;3(1):ofw030. [18] Boskabadi H, Rakhshanizadeh F, Zakerihamidi M. Evaluation of Maternal Risk Factors in Neonatal Hyperbilirubinemia. Arch Iran Med. 2020 Feb 1;23(2):128-140

点击下载PDF