不孕症患者生殖道支原体感染、Th17/Treg比值及阴道微生态情况对辅助生殖妊娠结局的影响

Impact of genital mycoplasma infection, Th17/Treg ratio, and vaginal microecology on pregnancy outcomes in infertile patients undergoing assisted reproductive technology

摘要:

目的 分析不孕症患者生殖道支原体感染、辅助型T17细胞/调节性T细胞（Th17/Treg）比值及阴道微生态情况对辅助生殖妊娠结局的影响。方法 选取2022年6月—2024年9月宝鸡市妇幼保健院收治的124例不孕症患者，采用全自动鉴定系统行菌株鉴定，结合支原体感染状况分为感染组和未感染组。比较两组临床资料、Th17/Treg比值、阴道微生态情况；分析Th17/Treg比值、阴道微生态情况对不孕症患者发生支原体感染的影响；截至2025年5月，所有患者接受辅助生殖技术助孕，比较感染组和未感染组妊娠结局。结果 124例不孕症患者，总支原体感染率为60.48%，其中解脲支原体（UU）感染36例，人型支原体感染（MH）29例，UU+MH混合感染10例。感染组Th17/Treg比值、菌群密度异常率和pH值异常率均高于未感染组（P <0.05）。多因素逐步Logistic回归分析结果显示：Th17/Treg比值高［O^R=21.355（95% CI：6.706，68.001）］、菌群密度异常［O^R=4.542（95% CI：1.579，13.069）］和pH值异常［O^R=3.058（95% CI：1.132，8.261）］是不孕症患者发生支原体感染的危险因素（P <0.05）。未感染组受精率高于感染组（P <0.05），流产率和早产率均低于感染组（P <0.05）。结论 Th17/Treg比值、阴道微生态情况是不孕症患者发生支原体感染的影响因素，而生殖道支原体感染影响辅助生殖技术效果，进而影响妊娠结局。

Abstract:

Objective To analyze the impact of genital mycoplasma infection, Th17/Treg ratio, and vaginal microecology on pregnancy outcomes following assisted reproductive technology (ART) in infertile patients.Methods A total of 124 infertile female patients admitted to Baoji Maternal and Child Health Hospital from June 2022 to September 2024 were selected. Strain identification was performed using a fully automated identification system, and patients were categorized into infected and uninfected groups based on mycoplasma infection status. Clinical data, Th17/Treg ratios, and vaginal microecology were compared between groups, and the effects of the Th17/Treg ratio and vaginal microecology on mycoplasma infection in infertile patients were analyzed. Follow-up concluded in May 2025, when all patients had undergone ART. The pregnancy outcomes were compared between infected and uninfected groups.Results Among 124 infertility patients, the overall mycoplasma infection rate was 60.48%, comprising 36 cases of Ureaplasma urealyticum (UU) infection, 29 cases of Mycoplasma hominis (MH) infection, and 10 cases of UU+MH mixed infection. Compared with the uninfected group, the infected group showed a significantly higher Th17/Treg ratio, a higher rate of abnormal vaginal microbial density, and a higher rate of abnormal vaginal pH. The multivariable stepwise logistic regression analysis revealed that elevated Th17/Treg ratios [O^R = 21.355 (95% CI: 6.706, 68.001) ], abnormal vaginal microbial density [O^R = 4.542 (95% CI: 1.579, 13.069) ] and abnormal vaginal pH [O^R = 3.058 (95% CI: 1.132, 8.261) ] were risk factors for mycoplasma infection in infertile patients (P < 0.05). The fertilization rate was higher in the uninfected group than in the infected group (P < 0.05), while the miscarriage and preterm birth rates were lower in the uninfected group (P < 0.05).Conclusion The Th17/Treg ratio and vaginal microecology are factors influencing mycoplasma infection in infertile patients. Genital mycoplasma infection adversely affects ART efficacy, ultimately leading to poorer pregnancy outcomes.