宫颈机能不全孕妇阴道微生物菌群特征及其与早产的相关性研究

Characteristics of vaginal microbiota in pregnant women with cervical insufficiency and its correlation with preterm birth

摘要:

目的 探讨宫颈机能不全孕妇阴道微生物菌群特征及其与早产的关系。方法 选取2017年1月—2022年1月电子科技大学医学院附属妇女儿童医院收治的249例宫颈机能不全孕妇作为研究组，另选取同期该院97例健康孕妇作为对照组。检测并比较两组孕妇孕晚期阴道微生物菌群。多因素Logistic逐步回归分析宫颈机能不全孕妇阴道微生物菌群特征与早产的关系。结果 研究组的厚壁菌门相对丰度低于对照组（P <0.05），研究组与对照组的放线菌门、拟杆菌门相对丰度比较，差异无统计学意义（P >0.05）。研究组的乳酸菌属相对丰度低于对照组（P <0.05），阴道加德纳菌属、普雷沃菌属相对丰度高于对照组（P <0.05）；研究组与对照组的奇异菌属、巨球型菌属相对丰度比较，差异无统计学意义（P >0.05）。研究组的卷曲乳酸菌、惰性乳酸菌、半格/格氏乳酸菌相对丰度低于对照组（P <0.05），加德纳菌相对丰度高于对照组（P <0.05）；研究组与对照组的阴道阿托普菌相对丰度比较，差异无统计学意义（P >0.05）。多因素Logistic逐步回归分析结果显示：阴道pH［O^R =5.414（95% CI：2.228，13.158）］、Chaol指数［O^R =7.745（95% CI：3.187，18.822）］、Shannon指数［O^R =7.523（95% CI：3.096，18.284）］、乳酸菌属相对丰度［O^R =6.495（95% CI：2.672，15.784）、卷曲乳酸菌相对丰度［O^R =6.841（95% CI：2.815，16.627）］、惰性乳酸菌相对丰度［O^R =5.430（95% CI：2.234，13.197）］是影响宫颈机能不全孕妇早产的独立因素（P <0.05）。结论 宫颈机能不全孕妇阴道微生物菌群失调，其阴道pH、Chaol指数、Shannon指数、乳酸菌属、卷曲乳酸菌、惰性乳酸菌与早产风险有关。

Abstract:

Objective To investigate the characteristics of vaginal microbiota in pregnant women with cervical insufficiency and its relationship with premature delivery.Methods From January 2017 to January 2022, 249 pregnant women with cervical insufficiency admitted to the hospital (study group) were selected, and 97 healthy pregnant women admitted to the hospital during the same period were selected as clinical control group (control group). Vaginal microbiota was measured in the third trimester of pregnancy. The vaginal microbiota was compared between the two groups, and the relationship between the characteristics of vaginal microbiota and preterm birth in pregnant women with cervical insufficiency was analyzed by multivariate Logistic regression.Results The relative abundance of Firmicutes in the study group was lower than that in the control group (P < 0.05), there was no significant difference in the relative abundance of Actinobacteria and Bacteroidetes between the study group and the control group (P > 0.05). The relative abundance of Lactobacillus in the study group was lower than that in the control group (P < 0.05), and the relative abundance of Gardnerella and Prevotella in the study group was higher than that in the control group (P < 0.05). There was no significant difference in the relative abundance of Mirabilis and Macroglobulae between the study group and the control group (P > 0.05). The relative abundance of Lactobacillus crimped, Lactobacillus indolent, and Lactobacillus semiglesteri/Lactobacillus grigni in the study group was lower than that in the control group (P < 0.05), and the relative abundance of Gardnerella vaginalis was higher than that in the control group (P < 0.05). There was no significant difference in the relative abundance of Atopsiella vaginalis between the study group and the control group (P > 0.05). Multivariate stepwise Logistic regression analysis showed that vaginal pH [O^R = 5.414 (95% CI: 2.228, 13.158) ], Chaol index [O^R = 7.745 (95% CI: 3.187, 18.822) ], Shannon index [O^R = 7.523 (95% CI: 3.096, 18.284) ], lactic acid bacteria [O^R = 6.495 (95% CI: 2.672, 15.784) ], curly lactic acid bacteria [O^R = 6.841(95% CI: 2.815, 16.627) ], inert lactic acid bacteria [O^R = 5.430 (95% CI: 2.234, 13.197) ] relative abundance was an independent factor affecting preterm birth in pregnant women with cervical insufficiency (P < 0.05).Conclusion Vaginal microbiota is dysregulated in pregnant women with cervical insufficiency, and the risk of preterm birth is related to vaginal pH, Chaol index, Shannon index, Lactobacillus, curly Lactobacillus, and indolent Lactobacillus expression.