产后6～8周女性阴道炎与阴道微生态特征的相关性及其影响因素分析

Correlation and influencing factors of vaginitis in women 6 to 8 weeks postpartum and vaginal microecological characteristics

摘要:

目的 分析产后6～8周女性阴道炎与阴道微生态特征的相关性及其影响因素。方法 回顾性分析2019年5月—2021年2月武汉市第一医院就诊的127例产后6～8周阴道炎复查的女性的临床资料，根据产后6～8周是否合并阴道炎分为阴道炎组（n =19）和非阴道炎组（n =108）。比较两组的阴道微生态特征，比较两组的临床资料，比较阴式分娩中阴道炎患者与非阴道炎者的临床资料，多因素逐步Logistic回归分析探讨产后6～8周女性发生阴道炎的影响因素。结果 阴道炎组菌群多样性-～+、阴道清洁度Ⅲ、Ⅳ、革兰阴性杆菌阳性、pH值≥4.6、菌群密集度-～+、Nugent评分、过氧化氢（H₂O₂）阳性例数占比高于非阴道炎组（P <0.05），阴道炎组上皮细胞个数、乳杆菌比例、白细胞阳性例数占比低于非阴道炎组（P <0.05）；阴道炎组年龄、人工流产次数、阴道炎史例数占比、妊娠前性生活频率≥2次/周例数占比高于非阴道炎组（P <0.05）；阴式分娩中阴道炎患者与非阴道炎者产程时间，是否产中阴道壁裂伤例数占比、是否阴道壁血肿切开缝合例数占比，有无产钳助产，羊水性状比较，差异无统计学意义（P >0.05）；多因素逐步Logistic回归分析结果显示，妊娠前性生活频率≥2次/周［O^R=4.272（95%CI：1.758，10.382）］、阴道炎史［O^R=2.754（95%CI：1.133，6.693）］、人工流产次数［（O^R=3.089（95%CI：1.271，7.508）］均为产后6～8周女性发生阴道炎的影响因素（P <0.05）。结论 阴道微生态失衡在产后6～8周女性阴道炎患者中较为常见，妊娠前性生活频率较高、有阴道炎史、人工流产次数较高女性产后6～8周发生阴道炎的风险较高。

Abstract:

Objective To analyze the correlation and influencing factors of vaginitis and vaginal microecological characteristics in women 6 to 8 weeks postpartum.Methods The clinical data of 127 women who visited the hospital from May 2019 to February 2021 for reexamination at 6 to 8 weeks postpartum were retrospectively analyzed. The patients were divided into vaginitis group (n = 19) and non-vaginitis group (n = 108) according to whether there was vaginitis at 6 to 8 weeks postpartum. The vaginal microecological characteristics of the two groups were compared. The clinical data of the two groups were compared. The influence of different influencing factors in vaginal delivery on postpartum vaginitis was analyzed. Logistic multivariate regression was used to analyze the influencing factors of vaginitis in women 6 to 8 weeks postpartum.Results In the vaginitis group, the bacterial flora diversity - to +, vaginal cleanlinessⅢ and Ⅳ, gram-negative bacilli positive, pH value ≥ 4.6, bacterial flora density - to +, and hydrogen peroxide (H₂O₂) positive cases accounted for a higher proportion than non-vaginitis group (P < 0.05). The frequency of sexual life before pregnancy ≥ 2 times/week, the proportion of vaginitis cases, age, and the number of induced abortions in the vaginitis group were higher than those in the non-vaginitis group (P < 0.05). There was no significant difference in the duration of labor, whether there was vaginal wall laceration, vaginal wall hematoma incision and suture, whether there was forceps midwifery, and amniotic fluid characteristics in vaginal delivery patients with vaginitis and non-vaginitis patients during vaginal delivery (P > 0.05). Logistic multivariate regression analysis showed that the frequency of pre-pregnancy sex ≥ 2 times/week [O^R = 4.272 (95% CI: 1.758, 10.382) ], history of vaginitis [O^R= 2.754 (95% CI: 1.133, 6.693) ], and the number of induced abortion [O^R= 3.089 (95% CI: 1.271, 7.508) ] were the influencing factors of vaginitis in women 6 to 8 weeks postpartum (P < 0.05).Conclusion Vaginal microecological imbalance is more common in women with vaginitis at 6 to 8 weeks postpartum. Women who have a higher frequency of pre-pregnancy sex, a history of vaginitis, and a higher number of induced abortions have a higher risk of vaginitis at 6 to 8 weeks postpartum.