基于孕周分层的阴道微生态特征与胎膜早破的相关性及对母儿结局的影响

王同; 王倩; 柏妍槟; 田玲; 张公镇; 钱程

基于孕周分层的阴道微生态特征与胎膜早破的相关性及对母儿结局的影响

Correlation between vaginal microecological characteristics based on gestational age and premature rupture of membranes and its impact on maternal and fetal outcomes

摘要

摘要:
目的： 探讨不同孕周胎膜早破（PROM）孕妇的阴道微生态特征差异，分析其对母儿结局的影响，并构建基于独立危险因素的列线图及母儿不良结局的预测模型。
方法： 回顾性收559例单胎孕妇，根据是否发生PROM及破膜孕周进行分组：28～33⁺⁶周PROM孕妇为A组（n = 50），34～36⁺⁶周PROM孕妇为B组（n = 67），≥ 37周PROM孕妇为C组（n = 152），同期无PROM的足月孕妇为D组（n = 290）。比较各组资料，分析不同孕周阴道微生态特征及其对母儿结局的影响。
结果： 病例组与对照组在年龄、孕次及产次方面差异均有统计学意义（P ＜ 0.05）。4组B族链球菌感染（GBS）感染率分别为48.0%、37.3%、42.8%和31.0%（P ＜ 0.05），阴道清洁度异常率分别为70.0%、62.7%、53.3%和40.3%（P ＜ 0.01）。新生儿低出生体质量发生率分别为74.0%、23.9%、0.7%和0.3%（P ＜ 0.01）。多因素logistic回归分析显示，高龄（OR = 1.930）、肥胖（OR = 4.676）、PROM（OR = 2.416）、GBS感染（OR = 2.747）、霉菌感染（OR = 1.913）及阴道微生态失衡（OR = 1.894）等为母儿不良结局的独立危险因素（P ＜ 0.05）。列线图模型AUC为0.762。
结论： 不同孕周PROM孕妇阴道微生态特征存在明显异质性，母儿不良结局发生风险存在孕周差异。基于独立危险因素构建的列线图模型具有较好的预测能力，可为临床风险评估提供参考。

Abstract:
Objective To investigate the differences in vaginal microecological characteristics among pregnant women with premature rupture of membranes (PROM) at different gestational ages, analyze their impact on maternal and fetal outcomes, and construct a nomogram based on independent risk factors and a predictive model for adverse maternal and fetal outcomes.
Methods A retrospective study was conducted on 559 singleton pregnant women. They were grouped according to the occurrence of PROM and the gestational age at membrane rupture: Group A (n = 50) had PROM at 28–33⁺⁶ weeks, Group B (n = 67) had PROM at 34–36⁺⁶ weeks, Group C (n = 152) had PROM at ≥ 37 weeks, and Group D (n = 290) had full-term pregnant women without PROM during the same period. Data from each group were compared to analyze the vaginal microecological characteristics at different gestational ages and their impact on maternal and fetal outcomes.
Results There were statistically significant differences between the case group and the control group in terms of age, gravidity, and parity (P ＜ 0.05). The infection rates of group B streptococcus (GBS) in the four groups were 48.0%, 37.3%, 42.8%, and 31.0%, respectively (P ＜ 0.05), and the rates of abnormal vaginal cleanliness were 70.0%, 62.7%, 53.3%, and 40.3%, respectively (P ＜ 0.01). The incidence of low birth weight in newborns was 74.0%, 23.9%, 0.7%, and 0.3%, respectively (P ＜ 0.01). Multivariate logistic regression analysis showed that advanced maternal age (OR = 1.930), obesity (OR = 4.676), PROM (OR = 2.416), GBS infection (OR = 2.747), fungal infection (OR = 1.913), and vaginal microecological imbalance (OR = 1.894) were independent risk factors for adverse maternal and fetal outcomes (P ＜ 0.05). The AUC of the nomogram model is 0.762.
Conclusions Significant heterogeneity exists in the vaginal microecological characteristics of pregnant women with PROM at different gestational weeks, leading to gestational differences in the risk of adverse maternal and fetal outcomes. Nomogram models based on independent risk factors demonstrate good predictive ability and can provide a reference for clinical risk assessment.

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