本文選題：不孕　切入點：不良妊娠結(jié)局　出處：《泰山醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的分析支原體、衣原體在不孕和不良妊娠結(jié)局患者的感染情況,進一步探討支原體、衣原體感染與不孕和不良妊娠結(jié)局的相關(guān)性；對不孕組支原體陽性者進行培養(yǎng)鑒定計數(shù)藥敏試驗,通過分析藥敏結(jié)果,了解本地區(qū)支原體的藥物敏感情況,為臨床治療支原體感染提供可靠的依據(jù)。方法采用實時熒光定量PCR法,檢測708例不孕患者以及188例不良妊娠結(jié)局患者支原體、衣原體感染情況,同時檢測100例正常早孕婦女支原體、衣原體感染情況；用液體培養(yǎng)法檢測不孕患者核酸檢測支原體陽性者的支原體分型鑒定和藥物敏感情況。結(jié)果一、實時熒光定量PCR方法檢測不孕、不良妊娠結(jié)局患者支原體、衣原體感染率1.不孕組708例,其中單獨支原體感染者438例,陽性率61.9%；單獨衣原體感染者68例,陽性率9.6%；混合感染者72例,陽性率10.2%。2.不良妊娠組188例,其中單獨支原體感染者56例,陽性率29.8%；單獨衣原體感染者32例,陽性率17.0%；混合感染者21例,陽性率11.2%。3.100例正常早孕婦女生殖道單獨支原體感染者12例,陽性率12.0%；單獨衣原體感染者2例,陽性率2.0%；混合感染者3例,感染率3.0%。二、支原體核酸檢測陽性不孕患者支原體分型及藥敏結(jié)果1.支原體陽性者培養(yǎng)結(jié)果為解脲支原體陽性376例,占78.3%,人型支原體陽性12例,占2.5%,解脲支原體和人型支原體雙陽性92例,占19.2%。2.單獨解脲支原體感染的藥物敏感率最高的是強力霉素97.9%,其次敏感率較高的為美滿霉索、交沙霉素、克拉霉素、阿奇霉素、加替沙星和紅霉素,敏感率依次為97.3%、97.3%、96.3%、94.1%、84.6%和80.9%。耐藥率最高的是司帕沙星42.0%,其次為甲砜霉素和克林霉素,耐藥率都為33.3%。3.12例單獨人型支原體培養(yǎng)陽性的藥敏結(jié)果顯示：單獨人型支原體感染藥物敏感率較高的依次為強力霉素100.0%、交沙霉素100.0%、克林霉素100.0%、美滿霉素83.3%。耐藥率較高的由高到低依次為阿奇霉素100.0%、紅霉素100.0%、司帕沙星66.7%。4.92例解脲支原體和人型支原體培養(yǎng)陽性的藥敏結(jié)果顯示：藥物敏感率較高的為美滿霉素和強力霉素,敏感率分別為95.7%。耐藥率由高到低依次為羅紅霉素93.5%、紅霉素89.1%、司帕沙星87.0%、克拉霉素80.4%、阿奇霉素78.3%。結(jié)論1.支原體、衣原體感染與不孕和不良妊娠結(jié)局有密切的關(guān)系,是導(dǎo)致不孕及不良妊娠結(jié)局的重要原因之一。2.單獨解脲支原體感染的標本藥物敏感率較高,敏感藥物種類也多,而耐藥的藥物種類少,而且耐藥率很低。敏感率最高的是強力霉素,其次為美滿霉素、交沙霉素、克拉霉素、阿奇霉素,耐藥率都很低�？蓪⒋蟓h(huán)內(nèi)酯類藥物交沙霉素、克拉霉素和阿奇霉素作為治療單獨解脲支原體感染的一線用藥。3.單純?nèi)诵椭гw感染的標本中,四環(huán)素類的強力霉素和大環(huán)內(nèi)酯類的交沙霉素、克林霉素敏感率最高；紅霉素和阿奇霉素的耐藥率最高。4.在解脲支原體和人型支原體復(fù)合感染的藥敏試驗中,屬于四環(huán)素類的美滿霉素和強力霉素的敏感率最高；耐藥率普遍較高,耐藥率由高到低依次為羅紅霉素、紅霉素、司帕沙星、克拉霉素、阿奇霉素。5.單獨解脲支原體感染者在0-5種藥物耐藥組中所占比例最高,6-11種藥物耐藥組中所占比例最低,解脲支原體和人型支原體感染12種藥物耐受組中所占比例最高。雖然人型支原體感染數(shù)量少,但多重耐藥情況比較嚴重,治療難度較大。
[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.

【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.6

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