妊娠期阴道菌群多样性的动态变化及对早产的预测价值

目的 探究妊娠期阴道菌群多样性的动态变化及对早产的预测价值。方法 选取2018年1月至2019年1月拟在我院生产的具有早产危险因素的孕妇71例，根据是否发生早产分为早产组与对照组，比较两组一般资料，测定及对比其不同孕期阴道菌群多样性指标，包括：丰富度、Shannon-Wiener指数及均匀度，应用Logistic回归分析早产发生的独立危险因素；应用ROC曲线评估不同多样性指标对早产的预测效能。结果 本研究共发生18例（25.35%）早产，早产组在合并妊娠期内感染及妊娠期糖尿病的人数显著高于对照组（χ2=13.169，5.565；均P<0.05），两组阴道菌群丰富度及Shannon-Wiener指数均在不同孕期差异具有显著性，且随孕期增加而增加（P＜0.05）。早产组孕晚期丰富度显著高于对照组（t=5.681，P<0.01），孕中期、孕晚期Shannon-Wiener指数显著高于对照组（t=2.683，7.367；均P＜0.05）。不同孕期两组阴道菌群在多个微生物层次的表达具有一定差异。多因素Logistic回归分析显示，高水平孕晚期丰富度、孕晚期和孕中期Shannon-Wiener指数是早产发生的独立危险因素（P=0.037，0.006，0.018），孕晚期丰富度、Shannon-Wiener指数、孕中期Shannon-Wiener指数预测早产发生的最佳截点分别为11.28、2.54、2.94，其AUC分别为0.792、0.948、0.645，孕晚期Shannon-Wiener指数显著优于其他两指标（均P＜0.05）。孕晚期丰富度、Shannon-Wiener指数具有较好的灵敏度，孕中期Shannon-Wiener指数具有较好的特异度（均P＜0.05）。结论 妊娠期阴道菌群多样性对早产的发生具有一定预测效能。

Dynamics of vaginal microflora diversity during pregnancy and its predictive value for preterm delivery

Objective To investigate the dynamics of vaginal microflora diversity during pregnancy and its predictive value for preterm delivery．Methods From January 2018 to January 2019，Seventy-one pregnant women with risk factors of preterm birth who were to be delivered in our hospital were selected and divided into the preterm group and the control group according to whether preterm birth occurred．General data of the two groups were compared，the diversity indexes of vaginal flora in different pregnancy were determined and compared，including richness，shannon-wiener index and evenness．Logistic regression was used to analyze the independent risk factors of preterm birth．ROC curve was used to evaluate the predictive efficacy of different diversity indexes for preterm labor．Results In this study，a total of 18 cases（25.35%）of preterm labor occurred．The number of preterm infants with gestational infection and gestational diabetes were significantly higher in the preterm group than control group（χ2=13.169，5.565，all P＜0.05）．The richness of vaginal flora and shannon-wiener index of the two groups were significantly different in different pregnancies and increased with the increase of pregnancy（P<0.05）．The richness of the preterm group in the third trimester was significantly higher than control group（t=5.681，P<0.01）， Shannon-wiener index of the premature delivery group in the second and third trimester was significantly higher than control group（t=2.683，7.367，all P<0.05）．Tere were some differences in the expression of vaginal flora between the two groups during the same period of pregnancy．Multivariate Logistic regression analysis showed that high levels of late pregnancy richness，shannon-wiener index in the third trimester，and shannon-wiener index in the second trimester were independent risk factors for premature delivery（OR=3.002，5.399，15.068，P=0.037，0.006，0.018）．The best cut-off points for predicting the occurrence of richness at the third trimester，shannon-wiener index at the third trimester，shannon-wiener index in the second trimester were11.28，2.54，2.94，the AUC were 0.792，0.948，0.645，Shannon-wiener index in the third trimester was significantly better than the other two indicators（P<0.05），the richness and shannon-wiener index in the third trimester had good sensitivity and shannon-wiener index in the second trimester had good specificity（all P<0.05）．Conclusions The diversity of vaginal microflora during pregnancy can predict the occurrence of preterm birth．