妊娠初期妇女阴道微生态研究分析

目的 研究妊娠早期妇女阴道微生态状况，分析不同类型阴道炎在妊娠早期的发病率，比较Nugent评分和Claeys评级两种标准在诊断阴道炎方面的一致性。方法 选择2017年7月至2017年10月在上海市第一妇婴保健院产科门诊就诊的妊娠早期妇女726例（孕周≤12周），采集阴道分泌物进行外阴阴道假丝酵母菌性阴道炎（vulvovaginal candidiasis，VVC）、滴虫性阴道炎（trichomonas vaginitis，TV）、需氧性阴道炎（aerobic vaginitis，AV）、细菌性阴道病（bacterial vaginosis，BV）检测，AV和（或）VVC阳性的分泌物进行培养鉴定；对革兰染色涂片进行Nugent评分和Claeys评级，以Nugent标准为金标准，评价Claeys评级在诊断阴道炎方面的性能。结果 726例标本中共检出异常标本153例（21.07%），AV、BV、TV、VVC的发生率分别为5.23%、11.02%、0.13%、11.71%，混合感染占异常标本28.76%（44/153），最常见的混合感染类型是BV合并VVC，AV最常见的致病菌是无乳链球菌、大肠杆菌、粪肠球菌。以Nugent方法为金标准，Claeys评级的敏感性、特异性、阳性预测值、阴性预测值、Kappa值分别为96.2%、88.1%、85.4%、97.1%、≥0.880。结论 妊娠早期阴道微生态失衡发生率较高且混合感染存在较高的比例，湿片和革兰染色结合分析可以提高阴道炎诊断的准确性。Claeys评级在阴道菌群分析上更全面、更简便，可作为Nugent标准的替代方法用于临床和科研。

Vaginal microecology in the first trimester of pregnancy

Objective To observe vaginal microflora，analyze the prevalence of different types of vaginitis in the first trimester of pregnancy，and evaluate the consistency of the Nugent scoring and Claeys criterion in the diagnosis of vaginitis．Methods 726 pregnant women（gestational age≤12 weeks）who visited the obstetrics department of our hospital during July and October 2017 were selected．The specimens of vaginal discharge were collected to diagnose vulvovaginal candidiasis（VVC），trichomonas vaginitis（TV），aerobic vaginitis（AV）and bacterial vaginosis（BV）．The AV- and/or VVC-positive specimens were cultured to identify the pathogens．The results of Gram staining were analyzed using Nugent scoring and Claeys criterion．The ability of Claeys criterion for diagnosis of vaginitis was evaluated by using Nugent scoring as the gold standard．Results Among the 726 samples，153 ones（21.07%）were abnormal．The incidence rates of AV，BV，TV and VVC were 5.23%，11.02%，0.13% and 11.71% respectively．The rate of mixed infections was 28.76%（44/153）．The most common type of mixed infection was BV combined with VVC．Streptococcus agalactiae，Escherichia coli and Enterococcus faecalis were the most frequently isolated pathogens in AV．The sensitivity，specificity，positive predictive value，negative predictive value and Kappa value of Claeys criterion when using Nugent scoring as the gold standard were 96.2%，88.1%，85.4%，97.1% and ≥0.880，respectively．Conclusion The incidence of vaginal microflora imbalance is high in early pregnancy，with a high proportion of mixed infections．Therefore，combined analysis of wet mount and Gram staining can improve the accuracy of vaginitis diagnosis．Claeys criterion is more comprehensive and simple in the analysis of vaginal flora，and can be used as an alternative to the Nugent scoring for clinical testing and research．