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目的探讨胎膜早破患者阴道乳酸杆菌变化及粘膜免疫状况的改变。方法收集2011年1月-9月在我院就诊的正常孕妇28例,胎膜早破30例,对其阴道分泌物进行乳酸杆菌及阴道其他菌群检测,并进行细胞因子IL-2浓度、IL-6浓度、TNF-α浓度的测定。结果胎膜早破组细菌分离率由高到低依次是乳酸杆菌(13例,43.33%)、阴道加德纳氏菌(10例,33.33%)、粪肠道球菌(8例,26.67%)、溶血葡萄球菌(7例,23.33%)、粪链球菌(4例,13.33%)。胎膜早破组阴道乳酸杆菌的检出率较正常妇女和正常妊娠妇女明显降低,阴道加德纳氏菌检出率明显增高;阴道分泌物中IL-6、TNF-α水平胎膜早破妇女较正常妊娠妇女组高,差异有统计学意义。结论胎膜早破组阴道乳酸杆菌菌群分布较正常妊娠妇女组明显降低,推测乳酸杆菌失去优势后,其他细菌,包括需氧菌与厌氧菌过度生长,细胞免疫反应增强,局部炎症反应增加,可能为胎膜早破发生的机制。
Objective To investigate the changes of vaginal lactobacilli and mucosal immune status in patients with premature rupture of membranes. Methods 28 cases of normal pregnant women and 30 cases of premature rupture of membranes in our hospital were collected from January to September in 2011. The lactobacilli and other vaginal flora were tested for their vaginal discharge and the concentrations of IL-2, IL-6 concentration, TNF-α concentration determination. Results The rates of bacterial isolation in the group of premature rupture of membranes were Lactobacillus (13 cases, 43.33%), Gardnerella vaginalis (10 cases, 33.33%) and Enterococcus faecalis (8 cases, 26.67% , Staphylococcus haemolyticus (7 cases, 23.33%), Streptococcus faecalis (4 cases, 13.33%). Premature rupture of membranes group, the detection rate of vaginal Lactobacilli was significantly lower than that of normal women and normal pregnant women, and the detection rate of Gardnerella vaginalis was significantly increased. The levels of IL-6 and TNF- Women than normal pregnant women group, the difference was statistically significant. Conclusion The distribution of Lactobacillus vaginalis in premature rupture of membranes is significantly lower than that of normal pregnant women. It is speculated that after the loss of the advantage of Lactobacillus, other bacteria, including aerobic and anaerobic bacteria overgrowth, increased cellular immune response and increased local inflammatory response , May be the mechanism of premature rupture of membranes.