【摘要】 目的探究妊娠晚期孕妇生殖道多耐药B族链球菌(GBS)基因型鉴定及GBS阳性与母婴结局的相关性。方法选取2017年1月至2020年6月聊城市东昌府区妇幼保健院诊治的1 300例32～37周孕妇作为研究对象。入院时取阴道及直肠分泌物进行细菌培养,对127株菌株GBS基因型分析,比较GBS阳性(GBS阳性组)和GBS阴性(GBS阴性组)孕妇的基线资料、母婴结局,Pearson分析GBS阳性与母婴结局的相关性,受试者工作特征(ROC)曲线分析风险评分模型对不良母婴结局的评估效能。结果 1 300例妊娠晚期孕妇GBS阳性感染率为9.77%(127/1 300)。两组的分娩方式、妊娠糖尿病、妊娠高血压、妊娠贫血、阴道炎比较,差异具有统计学意义(P<0.01)。127株GBS菌株排名前3的耐药基因型为ermB、ermTR、mef,分别占52.75%、11.81%和10.24%。GBS阳性孕妇早产、胎膜早破、宫内感染、羊水污染、新生儿黄疸、新生儿肺炎、新生儿窒息的发生率明显高于GBS阴性孕妇,差异具有统计学意义(P<0.01)。ermB、ermTR、mef与产后出血、早产、胎膜早破、宫内感染、羊水污染、新生儿黄疸、胎儿窘迫、新生儿肺炎和新生儿窒息呈正相关,ROC曲线显示不良评分模型的预测准确性良好。结论 GBS感染是造成不良母婴结局发生的影响因素,通过鉴定多耐药GBS基因型,了解GBS感染的流行病学特征,可为临床预防和治疗提供重要的指导价值。更多还原

【Abstract】 Objective To explore the genotype identification of multidrug-resistant group B streptococcus(GBS) in the reproductive tract of pregnant women in the third trimester and the correlation between GBS positive and maternal and fetal outcome. Methods 1,300 pregnant women with gestation age from 32 to 37 weeks enrolled in the Dongchangfu Maternal and Child Health Hospital from January 2017 to June 2020 were selected. The vaginal and rectal secretions were collected for bacterial culture on admission, and the GBS genotypes of 127 strains were analyzed. The baseline data and maternal and fetus outcomes of GBS positive(GBS positive group) and GBS negative(GBS negative group) of pregnant women were compared. Pearson was used to analyze the correlation between GBS positive and maternal and fetus outcomes. Receiver operating characteristic(ROC) curve was used to evaluate the efficacy of risk scoring model for adverse maternal and fetus outcomes. Results The positive rate of GBS in 1,300 pregnant women in the third trimester was 9.77%(127/1,300). There were statistically significant differences in delivery mode, gestational diabetes mellitus, gestational hypertension, gestational anemia and vaginitis between the two groups(P<0.01). The top 3 drug resistance genotypes of 127 GBS strains were ermB,ermTR,mef, accounting for 52.75%, 11.81% and 10.24%, respectively. The incidences of premature delivery, premature rupture of membranes, intrauterine infection, amniotic fluid contamination, neonatal jaundice, neonatal pneumonia and neonatal asphyxia in GBS positive pregnant women were significantly higher than those in GBS negative pregnant women(P<0.01). ErmB,ermTR,mef were positively correlated with postpartum hemorrhage, premature delivery, premature rupture of membranes, intrauterine infection, amniotic fluid contamination, neonatal jaundice, fetal distress, neonatal pneumonia and neonatal asphyxia. ROC curve showed that the prediction accuracy of poor scoring model was good. Conclusions GBS infection is the influential factor causing adverse maternal and fetus outcomes. Identifying multidrug-resistant GBS genotypes and understanding the epidemiological characteristics of GBS infection can provide important guidance for clinical prevention and treatment.更多还原