【摘要】：目的:本研究通過對支原體、衣原體在宮頸及盆腔液中檢出的陽性率做對比,探究其在不同部位被檢出的敏感性;通過對輸卵管不孕病人的術中輸卵管損傷程度與支原體衣原體感染率情況分析,探討支原體、衣原體感染與輸卵管損傷的相關性;并根據(jù)其支原體藥敏情況,進一步針對性的指導臨床用藥。方法:(1)本研究對2016年2月-2017年2月在廣西中醫(yī)藥大學第一附屬醫(yī)院婦科門診就診的180例不孕癥患者及孕早期要求終止妊娠的患者120例進行宮頸及陰道分泌物CT、UU、MH檢查;(2)選取我院婦科住院部因輸卵管不孕行腹腔鏡手術治療的88例患者作為不孕癥,選取同時期我院婦科住院部因子宮肌瘤、子宮腺肌癥、卵巢囊腫等行腹腔鏡手術的患者62例作為對照組,對所有手術患者術前行宮頸分泌物CT、UU、MH檢查,術中取盆腔液行盆腔液CT、UU、MH檢查,并對不孕組術中應用輸卵管評分標準對輸卵管通暢程度、輸卵管粘連情況、輸卵管形態(tài)及傘端結構4個方向進行評分,按不同評分分為低評分組(0-7分)、中評分組(8-15分)、高評分組(16分以上),研究支原體、衣原體感染與輸卵管不孕的相關性。(3)對所有行支原體檢查同時進行支原體藥物敏感試驗,記錄支原體的藥物敏感結果,分析支原體耐藥情況的可能原因。結果:(1)不孕組180例共檢出支原體感染69例(38.33%)(其中解脲支原體(UU)65例,人型支原體(MH)14例,兩者混合感染(UU+MH)10例。)沙眼衣原體(CT)感染28例(15.56%)。對照組120例共檢出支原體13例(10.83%)(其中解脲支原體(UU)11例,人型支原體(MH)3例,兩者混合感染(UU+MH)2例),沙眼衣原體(CT)感染4例(3.33%);不孕組宮頸分泌物支原體陽性率達38.33%,明顯高于對照組10.83%,不孕組宮頸分泌物衣原體陽性率達15.56%,明顯高于對照組3.33%,差異有統(tǒng)計學意義(P0.05;(2)88例不孕組手術患者宮頸分泌物支原體培養(yǎng)陽性31例,陽性率為35.23%(其中UU感染29例,MH感染5例,MH和UU同時感染3例),衣原體培養(yǎng)陽性9例,陽性率為10.23%;62例對照組手術患者宮頸分泌物支原體培養(yǎng)陽性9例,陽性率為14.52%(其中UU感染9例,MH感染0例,MH和UU同時感染0例),衣原體培養(yǎng)陽性0例;不孕組中盆腔液中支原體培養(yǎng)陽性4例,陽性率為4.55%(其中MH感染0例,UU感染4例),衣原體培養(yǎng)陽性6例,陽性率為6.82%;對照組中盆腔液中支原體、衣原體均未檢測出;不孕組中支原體、衣原體陽性率均明顯高于對照組,差異有統(tǒng)計學意義(P0.05);兩組中支原體陽性率宮頸分泌物明顯高于盆腔液,差異有統(tǒng)計學意義(P0.05);衣原體陽性率在宮頸分泌物與盆腔液中,差異無統(tǒng)計學意義(P0.05);(3)輸卵管不孕組在不同等級的輸卵管評分中支、衣原體感染情況分析:低、中與高評分組中支原體感染率兩兩比較均差異無統(tǒng)計學意義(P0.05);低、中與高評分組中衣原體感染率兩兩比較有統(tǒng)計學意義(P0.05):低評分組的衣原體感染率顯著低于中評分組及高評分組(P0.05),中評分組的衣原體感染率顯著低于高評分組(P0.05);支原體、衣原體混合感染患者中輸卵管高評分組所占的比例明顯高于單一感染組;(4)支原體藥敏結果:總耐藥性最高的是環(huán)丙沙星(58.33%),其次是可樂必妥(55.83%);單純UU感染時,耐藥性最高的是環(huán)丙沙星(63.27%),其次是可樂必妥(55.10%)。MH耐藥性最高的是阿奇霉素(100%),其次是克拉霉素(85.71%)。UU合并MH感染耐藥性最高的紅霉素(93.33%),其次是羅紅霉素和阿奇霉素,均為(73.33%)。結論:支原體、衣原體感染與不孕、輸卵管損傷有一定的相關性;衣原體感染與輸卵管損傷程度呈正相關性;支原體在盆腔液中檢出的敏感性較高,衣原體在宮頸及盆腔液中檢出的敏感性相當;支原體、衣原體混合感染對輸卵管的損傷嚴重于支原體、衣原體單一感染。MH、UU混合感染時較MH或UU單純感染耐藥性增加。
[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.
【學位授予單位】：廣西中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R711.6

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