B族鏈球菌感染與胎膜早破的相關(guān)性研究
發(fā)布時(shí)間：2018-08-04 14:31
【摘要】：胎膜早破(premature rupture of membrane,PROM)是指臨產(chǎn)前胎膜破裂,其常見(jiàn)原因包括:生殖道感染、羊膜腔壓力增高、胎膜受力不均、營(yíng)養(yǎng)因素缺乏等。其中感染是胎膜早破的重要致病因素,在引起感染的病原體中,以B族溶血性鏈球菌(GBS)穿透力最強(qiáng),致病率最高。GBS正常寄居于陰道和直腸,是一種條件致病菌,對(duì)絨毛膜有較強(qiáng)吸附能力和穿透能力,接種2小時(shí)內(nèi)即可吸附于母體組織,繼而侵入絨毛膜,通過(guò)炎癥細(xì)胞的吞噬作用及細(xì)菌產(chǎn)生的蛋白水解酶的直接侵襲,使胎膜局部張力減低,從而導(dǎo)致胎膜早破。目前,國(guó)內(nèi)外對(duì)于GBS的預(yù)防方案主要采用抗生素預(yù)防。但近年來(lái),全球GBS的耐藥性逐年上升。對(duì)于是否應(yīng)常規(guī)對(duì)GBS陽(yáng)性孕婦進(jìn)行預(yù)防性抗生素治療,目前尚存在爭(zhēng)議。目的探討孕婦生殖道B族鏈球菌(GBS)感染與胎膜早破的關(guān)系。分析對(duì)于B族鏈球菌陽(yáng)性患者在產(chǎn)前給予抗生素治療是否能預(yù)防胎膜早破的發(fā)生及改善母嬰結(jié)局。方法搜集于2015年8月至2016年3月青島大學(xué)附屬醫(yī)院產(chǎn)科門診病人1121例,以148例因胎膜早破住院、或住院后發(fā)生胎膜早破的孕婦為研究組,隨機(jī)抽取150例相同孕周的正常孕婦為對(duì)照組,比較兩組陰道分泌物B族鏈球菌陽(yáng)性率;將62例門診篩查陰道分泌物B族鏈球菌陽(yáng)性的35-37周孕婦分為治療組和未治療組,其中接受產(chǎn)前24小時(shí)內(nèi)給予抗生素治療的20例為治療組,未接受任何藥物干預(yù)治療的42例為未治療組。分別比較治療組與非治療組之間的胎膜早破、早產(chǎn)、宮內(nèi)感染、新生兒感染、產(chǎn)褥感染情況,分析抗B族鏈球菌感染對(duì)母嬰預(yù)后的影響。結(jié)果148例胎膜早破孕婦的生殖道分泌物中,GBS培養(yǎng)陽(yáng)性38例,占25.68%。而150名無(wú)胎膜早破早產(chǎn)孕婦中GBS培養(yǎng)陽(yáng)性12例,占8.00%。兩組經(jīng)統(tǒng)計(jì)學(xué)分析,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。以62例妊娠晚期GBS檢測(cè)陽(yáng)性者作為研究對(duì)象,接受產(chǎn)前24小時(shí)內(nèi)給予抗生素治療的20例,發(fā)生胎膜早破4例,占20.00%,未接受任何藥物干預(yù)治療的42例,發(fā)生胎膜早破14例,占33.33%,治療組和非治療組的胎膜早破發(fā)生率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),治療組發(fā)生早產(chǎn)的有3例,占15.00%,對(duì)照組的發(fā)生早產(chǎn)8例,占19.05%,兩者比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療組發(fā)生宮內(nèi)感染的有0例,占00.00%,對(duì)照組發(fā)生宮內(nèi)感染0例,占00.00%,兩者比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療組發(fā)生新生兒感染的有0例,占0.00%,對(duì)照組的發(fā)生新生兒感染3例,占7.14%,兩者比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療組無(wú)產(chǎn)褥感染發(fā)生,未治療組有5例產(chǎn)婦發(fā)生了產(chǎn)褥感染,占11.90%,兩者比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論(1)胎膜早破與B族鏈球菌的感染密切相關(guān),其產(chǎn)前感染的發(fā)生明顯高于非胎膜早破組。(2)接受預(yù)防性抗生素治療患者胎膜早破、早產(chǎn)、新生兒感染及產(chǎn)褥感染發(fā)生率較未治療者低,但差異無(wú)統(tǒng)計(jì)學(xué)意義,對(duì)母嬰結(jié)局無(wú)顯著改善。
[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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.433
本文編號(hào)：2164175
[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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.433
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