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。

Vaginal microecology imbalance in mid- and late-term pregnancy and the effect of Lactobacillus capsule intervention on adverse pregnancy outcomes

Objective To observe the vaginal microecology of pregnant women in mid- and late-term pregnancy and explore the preventive value of Lactobacillus capsule for adverse pregnancy outcomes in correcting vaginal microecological imbalance．Methods 560 singleton pregnant women during 13 to 36 weeks of gestation were selected．The vaginal secretions were examined after Gram staining for inspection of vaginal microecology（vaginal flora density and diversity，dominant bacteria，inflammatory response），vaginal secretion composition and pathogenic bacteria．The patients with vaginal microecological imbalance were divided into treatment group and control group according to whether they received Lactobacillus capsule therapy．The treatment group was treated with Lactobacillus capsule，while the control group did not receive drug intervention．All the pregnant women were followed up．The rates of adverse pregnancy outcomes were compared between the normal control group，microecological imbalance treatment group and microecological imbalance control group．Results The rate of normal vaginal microecology was 59.82%（335/560），while that of microecological imbalance was 40.18%（225/560）．Among the 225 cases of vaginal microecological imbalance，bacterial vaginosis（BV），vulvovaginal candidiasis（VVC）and aerobe vaginosis（AV）accounted for 32 cases（14.22%），56 cases（24.89%）and 11 cases（4.89%）respectively；mixed infection of BV and VVC，mixed infection of BV and TV，excessive proliferation of bacteria and bacterial growth inhibition accounted for 4 cases（1.78%），3 cases（1.33%），75 cases（33.33%）and 44 cases（19.56%）respectively．The positive rates of pH>4.5，catalase，leukocyte esterase，sialidase，proline aminopeptidase and acetyl glucosidase in the microecological imbalance group were significantly higher than those in the normal microecology group（χ2=55.59~340.06，Ps0.05）．Conclusion Women in mid- and late-term pregnancy are prone to vaginal microecological imbalance which can cause adverse pregnancy outcomes．Lactobacillus capsule has satisfactory preventive effect on adverse pregnancy outcomes by correcting vaginal microecological imbalance．