乳酸菌阴道胶囊联合甲硝唑栓对妊娠晚期BV患者阴道乳酸菌及妊娠结局的影响

目的 探讨乳酸菌阴道胶囊联合甲硝唑栓对妊娠晚期细菌性阴道病（BV）患者阴道乳酸菌数量及妊娠结局的影响。方法 选取产科门诊治疗的妊娠晚期BV妇女110例,随机分为观察组和对照组各55例。观察组予以乳酸菌阴道胶囊（1粒/晨,1次/d）联合甲硝唑栓（1粒/晚,1次/d）阴道给药,对照组予以单纯甲硝唑栓阴道给药治疗,用法与用量同观察组,两组疗程均为10 d。治疗结束后1周复诊观察阴道乳酸菌数量,并比较其临床疗效、妊娠结局及阴道假丝酵母菌病（VVC）的发生率。结果 1周后复诊,观察组患者阴道乳酸菌数量多于对照组（χ2=24.44,P0.05）。观察组和对照组分别诱发VVC 2例（3.64%）和8例（14.55 %）,观察组VVC发生率低于对照组（χ2=3.96,P<0.05）。结论 妊娠晚期BV患者予以乳酸菌阴道胶囊和甲硝唑栓联合治疗的疗效确切,能增加阴道乳酸菌数量,纠正阴道菌群紊乱,减少VVC的发生率,从而减少早产发生率,改善妊娠结局。     

咪康唑栓联合乳酸菌阴道胶囊对妊娠期外阴阴道假丝酵母菌病患者阴道微生态的影响

目的 探讨咪康唑栓联合乳酸菌阴道胶囊对妊娠期外阴阴道假丝酵母菌病（VVC）患者阴道微生态的影响及疗效观察。方法 选取产科门诊就诊的妊娠期VVC患者120例,随机分为观察组和对照组各60例。对照组患者予以咪康唑栓400 mg/晚,1次/d,阴道给药。观察组在对照组基础上加用乳酸菌阴道胶囊0.25 g/晨,1次/d,阴道给药,两组疗程均为10 d。治疗结束后2周复诊观察并记录两组治疗后的疗效及阴道乳酸菌数量的变化,并比较其母婴结局。结果 2周后复诊,观察组临床总有效率较对照组高（χ2=4.23,P0.05）。结论 咪康唑栓联合乳酸菌阴道胶囊治疗妊娠期VVC患者的效果好,能增加阴道乳酸菌数量,恢复阴道微生态平衡,并可改善母婴结局,降低其早产、胎膜早破和产褥感染发生率。     

乳酸菌阴道胶囊对早产患者阴道菌群及分娩结局的影响

目的探讨乳酸菌阴道胶囊对菌群失调早产患者阴道菌群及分娩结局的影响。方法 2018年9月-2019年12月在龙华区人民医院接受治疗及分娩的菌群失调先兆早产患者80例,参照随机数表法分为对照组、研究组各40例。对照组患者接受硝呋太尔制霉素软胶囊治疗,研究组患者接受乳酸菌阴道胶囊治疗6 d。停药1周后,比较两组患者的pH值、乳酸菌菌落数、H_2O_2检出率,记录两组患者分娩结局。结果研究组用药后pH值明显降低(P0.05),研究组和对照组用药后pH值差异有统计学意义(P0.05);治疗后两组病原菌检出率差异无统计学意义(χ~2=0.556,P0.05);阴道乳酸菌菌落1/2面积检出阳性研究组明显增多,差异有统计学意义(χ~2=26.600,P0.05);产H_2O_2阳性率研究组明显高于对照组,差异有统计学意义(χ~2=9.141,P0.05);分娩时对照组复发率高(χ~2=20.093,P0.05);研究组不良妊娠结局发生率低于对照组患者(χ~2=6.263,P0.05)。结论乳酸菌阴道胶囊对菌群失调的早产患者阴道菌群、改善妊娠结局具有一定积极作用。     

乳酸菌阴道胶囊辅助治疗对未足月胎膜早破的疗效及对其阴道微生态的影响

目的 观察乳酸菌阴道胶囊辅助治疗对未足月胎膜早破的治疗效果,并探讨其对阴道微生态的影响。 方法 86例未足月胎膜早破患者采用随机数表分为常规组与研究组,各43例。常规组予以常规治疗,研究组予以乳酸菌阴道胶囊联合常规治疗。比较治疗后两组阴道微生态、胎儿宫内感染率和分娩方式、母体和胎儿不良妊娠结局发生情况。 结果 治疗后研究组Chao1指数和Shannon指数均高于常规组(均P结论 乳酸菌阴道胶囊辅助治疗未足月胎膜早破相较于常规治疗可改善阴道微生态,还可降低胎儿宫内感染率、剖宫产率,减少母体和围产儿不良妊娠结局的发生。     

妊娠中晚期孕妇阴道菌群紊乱的改变对不良妊娠结局的影响

目的探讨妊娠中晚期孕妇阴道菌群紊乱的改变对不良妊娠结局的影响。方法选取产科门诊就诊的妊娠28-34周的患者150例。根据检查结果将其分为菌群正常组48例和菌群失常组102例。观察并对比两组患者的不良妊娠结局。结果 102例菌群失常患者中滴虫6例,假丝酵母菌67例,衣原体17例,淋菌2例,细菌性阴道病10例。假丝酵母菌感染率明显高于其他致病菌(P0.05)。菌群失常组患者早产、胎膜早破、剖宫产、产褥感染发生率分别为15.69%、22.55%、35.29%和18.63%,均明显高于菌群正常组的4.17%、8.33%、18.75%和6.25%(P0.05)。菌群失常组患者新生儿黄疽、新生儿感染和低出生体重儿发生率分别为24.51%、21.57%、16.67%,均明显高于菌群正常组的10.42%、8.33%、4.17%(P0.05),在胎儿窘迫的发生率方面两组比较差异无统计学意义(P0.05)。结论妊娠中晚期阴道菌群紊乱中以假丝酵母菌感染发生率最多,与不良妊娠结局密切相关,增加了早产、胎膜早破、剖宫产、产褥感染、新生儿黄疸、新生儿感染和低出生体重儿等与不良妊娠结局的发生率。     

妊娠中晚期阴道微生态失调及乳酸菌胶囊干预对不良妊娠结局的作用

目的 观察妊娠中晚期妇女阴道微生态状况,探讨应用乳杆菌活菌胶囊纠正阴道微生态失调对不良妊娠结局的预防价值。方法 选择孕13~36周单胎妊娠期妇女560例,取其阴道分泌物,经革兰染色后油镜下观察,进行阴道微生态（阴道菌群的密集度、多样性、优势菌、炎症反应等）状况评价,检测阴道分泌物成分、阴道病原菌类型。对阴道微生态失调孕妇,根据是否接受乳杆菌活菌胶囊治疗分为治疗组和对照组,治疗组给予乳杆菌活菌胶囊,对照组不采用药物干预。追踪随访所有孕妇的妊娠情况,比较阴道微生态正常组、微生态失调治疗组及微生态失调对照组的不良妊娠结局。结果 560例研究对象中,阴道微生态正常 335 例（59.82%）,微生态失调225例（40.18%）。225例微生态失调孕妇中,细菌性阴道病（bacterial vaginosis,BV）32例（14.22%）,阴道假丝酵母菌病（vulvovaginal candidiasis,VVC）56例（24.89%）,滴虫性阴道炎（triehomonal vaginitis,TV）11例（4.89%）,BV和VVC混合感染4例（1.78%）,BV和TV混合感染3例（1.33%）,菌群增殖过度75例（33.33%）,菌群抑制44例（19.56%）。微生态失调组pH值>4.5、过氧化氢、白细胞酯酶、唾液酸苷酶、脯氨酸氨基肽酶、乙酰氨基葡萄糖苷酶阳性比例均明显高于微生态正常组（χ2=55.59~340.06,Ps0.05）。结论 妊娠中晚期容易导致阴道微生态失调,造成不良妊娠结局,乳杆菌活菌胶囊纠正阴道微生态失调对于改善不良妊娠结局有较好的预防作用。     

调整阴道菌群失调在预防妊娠晚期未足月胎膜早破中的价值

目的探讨调整阴道菌群失调在预防妊娠晚期未足月胎膜早破(PPROM)中的价值。方法选取产科门诊进行产前检查无症状单胎妊娠晚期孕妇450例。根据检查结果将其分为菌群失常组138例和菌群正常组312例。菌群失常组根据患者的自愿行乳酸菌阴道胶囊治疗112例(治疗组),未行乳酸菌阴道胶囊治疗26例(对照组)。观察并比较菌群正常组和菌群失常组、治疗组与对照组PPROM发生率。结果菌群失常组孕妇138例中发生PPROM 8例(5.80%),菌群正常组孕妇312例中发生PPROM 3例(0.96%),菌群失常组孕妇PPROM发生率明显高于菌群正常组(χ2=7.46,P0.05)。治疗组孕妇112例中发生PPROM 3例(2.68%),对照组孕妇26例中发生PPROM 5例(19.23%),治疗组孕妇PPROM发生率明显低于对照组(χ2=7.77,P0.05)。结论妊娠晚期孕妇阴道菌群失调与PPROM发生关系密切,予以乳酸菌阴道胶囊调整阴道菌群失调可有利于预防和治疗妊娠妇女发生生殖道感染,降低PPROM发生率,减少其对母婴造成的不良结局。     

乳酸菌阴道胶囊联合小剂量甲硝唑对中晚期妊娠滴虫性阴道炎妇女阴道菌群的调节作用

目的 探讨乳酸菌阴道胶囊联合小剂量甲硝唑对中晚期妊娠滴虫性阴道炎妇女阴道菌群的调节作用。方法 选择中晚期妊娠滴虫性阴道炎妇女140例,随机分为观察组和对照组各70例。对照组妇女予以甲硝唑片0.2 g/次,3次/d,口服,连用1周。观察组在采用对照组治疗方法结束后再加用乳酸菌活菌胶囊0.25 g/次,1次/d,阴道放置,连用1周。治疗结束后2周复诊,比较两组妇女的临床疗效、阴道乳酸菌检出率及产H2O2阳性率。结果 观察组妇女临床总有效率明显高于对照组（χ2=4.52,P<0.05）;观察组妇女阴道乳酸菌检出菌落≥1/2面积率明显高于对照组（χ2=60.51,P<0.01）;观察组妇女产H2O2阳性率明显高于对照组（χ2=14.12,P<0.01）。结论 乳酸菌阴道胶囊联合小剂量甲硝唑治疗中晚期妊娠滴虫性阴道炎妇女的疗效确切,能明显升高阴道乳酸菌数量及活性,纠正阴道菌群紊乱。     

乳酸菌阴道胶囊对妊娠晚期未足月胎膜早破的预防价值

目的探讨乳酸菌阴道胶囊对妊娠晚期未足月胎膜早破(PPROM)的预防价值。方法选取产科门诊进行产前检查的妊娠晚期单胎孕妇,筛查出阴道微生态失调180例。根据是否接受乳酸菌阴道胶囊治疗分为观察组132例与对照组48例。观察组孕妇睡前温开水冲洗外阴后于阴道后穹窿处放置乳酸菌阴道胶囊2粒,连用10d。10d后行阴道微生态检查,仍异常者再治疗10d。对照组未进行用药干预治疗。观察并评估观察组治疗后阴道pH、乳酸菌阳性率及阴道分泌物清洁度的变化,并比较两组PPROM发生率。结果观察组治疗后阴道pH(3.84±0.14)较前(4.72±0.16)明显下降,乳酸菌阳性率(90.15%)较前(0.00%)明显上升,阴道分泌物清洁度较前明显好转(χ2=2.35、P0.05;t=216.66、t=210.12,P0.01);观察组孕妇132例中发生PPROM 3例(2.27%),对照组孕妇48例中发生PPROM 6例(12.50%),观察组孕妇PPROM发生率明显低于对照组(χ2=5.75,P0.05)。结论妊娠晚期孕妇阴道微生态失调与PPROM发生关系密切,乳酸菌阴道胶囊可恢复正常的阴道微生态环境,降低PPROM发生率,对预防PPROM有较好的价值。     

定君生治疗妊娠期及产褥期细菌性阴道病的临床研究

目的观察阴道用乳杆菌活菌胶囊(定君生)治疗妊娠中晚期和产褥期细菌性阴道病的临床疗效以及妊娠中晚期干预细菌性阴道病对围产结局的影响。方法选取2014年1月-12月在我院门诊就诊的妊娠中晚期BV患者160例,根据患者自愿将其分为治疗组96例和未治疗组64例,治疗组给予定君生处理,观察治疗效果并随访治疗组与未治疗组的围产结局。选取2014年1月-12月在我院门诊就诊的产褥期BV患者100例,随机分为观察组50例和对照组50例,观察组给予定君生处理,对照组给予甲硝唑栓处理,比较两组临床疗效、过氧化氢浓度及复发情况。结果妊娠中晚期BV治疗组治愈56例,有效30例,总有效率89.6%,BV治疗组孕妇流产、早产、胎膜早破、低出生体质量儿、新生儿感染和产褥感染的发生率低于BV未治疗组,差异有统计学意义(χ2=14.127,P0.05)。产褥期BV观察组总有效率为88%,对照组总有效率82.0%,差异没有统计学意义(χ2=0.706,P0.05);观察组和对照组乳杆菌定植成功率分别为86.0%和68.0%,差异有统计学意义(χ2=4.574,P0.05);30d后随访观察组复发率为11.4%,对照组复发率为31.7%,差异有统计学意义(χ2=5.262,P0.05)。结论妊娠中晚期BV经过定君生治疗后能改善围产结局,定君生治疗妊娠中晚期及产褥期BV,安全有效并能减少复发。     

Early pregnancy azathioprine use and pregnancy outcomes

BACKGROUND: Azathioprine (AZA) is used during pregnancy by women with inflammatory bowel disease (IBD), other autoimmune disorders, malignancy, and organ transplantation. Previous studies have demonstrated potential risks. METHODS: The Swedish Medical Birth Register was used to identify 476 women who reported the use of AZA in early pregnancy. The effect of AZA exposure on pregnancy outcomes was studied after adjustment for maternal characteristics that could act as confounders. RESULTS: The most common indication for AZA use was IBD. The rate of congenital malformations was 6.2% in the AZA group and 4.7% among all infants born (adjusted OR: 1.41, 95% CI: 0.98–2.04). An association between early pregnancy AZA exposure and ventricular/atrial septal defects was found (adjusted OR: 3.18, 95% CI: 1.45–6.04). Exposed infants were also more likely to be preterm, to weigh <2500 gm, and to be small for gestational age compared to all infants born. This effect remained for preterm birth and low birth weight when infants of women with IBD but without AZA exposure were used as a comparison group. A trend toward an increased risk of congenital malformations was found among infants of women with IBD using AZA compared to women with IBD not using AZA (adjusted OR: 1.42, 95% CI: 0.93–2.18). CONCLUSIONS: Infants exposed to AZA in early pregnancy may be at a moderately increased risk of congenital malformations, specifically ventricular/atrial septal defects. There is also an increased risk of growth restriction and preterm delivery. These associations may be confounded by the severity of maternal illness. Birth Defects Research (Part A), 2009. © 2009 Wiley‐Liss, Inc.     

Oxidative stress early in pregnancy and pregnancy outcome

The objectives of this study were to determine whether oxidative stress early in pregnancy influenced pregnancy outcome. A combination of assays were used for exogenous and endogenous anti-oxidants together with two well accepted biomarkers for oxidative stress, the urinary excretion of 8-iso-PGF_2α (a biomarker marker for lipid oxidation, n=508) and 8-oxo-7,8 dihydro-2 deoxyguanosine (8-OHdG, a biomarker for DNA oxidation, n=487). The two biomarkers tracked different pregnancy outcomes. Isoprostanes were associated with an increased risk of pre-eclampsia and a decreased proportion of female births. In contrast, 8-OHdG tracked lower infant birthweight and shortened gestation duration. Birth defects were associated with low levels of 8-OHdG.     

Oxidative stress early in pregnancy and pregnancy outcome

The objectives of this study were to determine whether oxidative stress early in pregnancy influenced pregnancy outcome. A combination of assays were used for exogenous and endogenous anti-oxidants together with two well accepted biomarkers for oxidative stress, the urinary excretion of 8-iso-PGF(2alpha) (a biomarker marker for lipid oxidation, n=508) and 8-oxo-7,8 dihydro-2 deoxyguanosine (8-OHdG, a biomarker for DNA oxidation, n=487). The two biomarkers tracked different pregnancy outcomes. Isoprostanes were associated with an increased risk of pre-eclampsia and a decreased proportion of female births. In contrast, 8-OHdG tracked lower infant birthweight and shortened gestation duration. Birth defects were associated with low levels of 8-OHdG.