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目的探讨胎膜早破患者阴道微生态及黏膜免疫状况的改变。方法收集2006年10月至2007年4月在广州市番禺区人民医院就诊的正常妇女46例,正常孕妇23例,胎膜早破31例,对其阴道分泌物细菌进行检测,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(15例,占48.39%)、大肠埃希氏菌(13例,占41.94%)、表皮葡萄球菌(8例,占25.81%)、溶血葡萄球菌(7例,占22.58%)、粪链球菌(4例,占12.90%)、阴沟肠杆菌(4例,占12.90%)和白色假丝酵母菌(4例,占12.90%)。胎膜早破组乳酸杆菌的检出率较正常妇女和正常妊娠妇女明显降低,大肠埃希菌检出率明显增高;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。结论胎膜早破组菌群分布与正常妇女、正常妊娠妇女组均不同,阴道的微环境发生改变,推测菌群失调和免疫微环境改变可能为胎膜早破发生的机制。
Objective To investigate the changes of vaginal microflora and mucosal immune status in patients with premature rupture of membranes. Methods A total of 46 normal women, 23 normal pregnant women and 31 premature rupture of membranes were collected from Panyu People’s Hospital of Guangzhou from October 2006 to April 2007 to detect the vaginal secretions of bacteria and cytokines IL-2 concentration, IL-6 concentration, TNF-α concentration. Results The rate of bacterial isolation in the group of premature rupture of membranes was Lactobacillus (15 cases, 48.39%), Escherichia coli (13 cases, 41.94%), Staphylococcus epidermidis (8 cases, accounting for 25.81% , Staphylococcus haemolyticus (7 cases, accounting for 22.58%), Streptococcus faecalis (4 cases, accounting for 12.90%), Enterobacter cloacae (4 cases, accounting for 12.90%) and Candida albicans (4 cases, accounting for 12.90% ). The detection rate of Lactobacillus in premature rupture of membranes was significantly lower than that in normal women and normal pregnant women, and the detection rate of Escherichia coli was significantly higher. The levels of IL-6 and TNF-α in vaginal secretions were significantly higher than those in normal premature rupture of membranes Pregnant women group was higher, the difference was statistically significant. Conclusion The premature rupture of membranes in patients with premature rupture of the flora distribution and normal women, normal pregnant women are different, vaginal microenvironment changes, speculated that flora and immune microenvironment changes may be the mechanism of premature rupture of membranes.