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中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (03) : 347 -354. doi: 10.3877/cma.j.issn.1673-5250.2021.03.017

论著

晚孕期孕妇生殖道B族链球菌感染对母儿结局的影响
东蓓, 周素芳†(), 张璇   
  • 收稿日期:2020-10-09 修回日期:2021-05-07 出版日期:2021-06-01
  • 通信作者: 周素芳

Effect of group B Streptococcus infection in genital tract of pregnant women in third trimester on maternal and infant outcomes

Bei Dong, Sufang Zhou†(), Xuan Zhang   

  • Received:2020-10-09 Revised:2021-05-07 Published:2021-06-01
  • Corresponding author: Sufang Zhou
  • Supported by:
    Maternal and Child Health Research Project of Jiangsu Province(F201668)
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引用本文：

东蓓, 周素芳, 张璇. 晚孕期孕妇生殖道B族链球菌感染对母儿结局的影响[J/OL]. 中华妇幼临床医学杂志(电子版), 2021, 17(03): 347-354.

Bei Dong, Sufang Zhou, Xuan Zhang. Effect of group B Streptococcus infection in genital tract of pregnant women in third trimester on maternal and infant outcomes[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(03): 347-354.

目的

探讨晚孕期孕妇生殖道B族链球菌(GBS)感染的影响因素及其对母儿结局的影响。

方法

选择2016年8月至2018年8月，在苏州高新区人民医院进行产前检查，并于35～37孕周时采取荧光定量PCR进行GBS DNA检测的1 149例晚孕期孕妇为研究对象。采用回顾性分析方法，将其分为研究组(n＝81，GBS DNA呈阳性)与对照组(n＝1 068，GBS DNA呈阴性)。对研究组GBS感染孕妇，采取产时抗菌药物预防(IAP)措施。收集2组受试者年龄、受教育程度、孕次、产次、流产史、分娩方式，分娩孕龄与人体质量指数(BMI)、血清维生素D含量，妊娠期糖尿病(GDM)、胎膜早破与产后出血发生情况，以及研究组新生儿出生后第4周GBS感染随访结果，并采用成组t检验、Mann-Whitney U检验、χ2检验等进行统计学比较。采用多因素非条件logistic回归分析，对晚孕期孕妇GBS感染影响因素进行分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求，并通过苏州高新区人民医院伦理委员会审批(审批文号：[2016]伦审批第001号)。

结果

①2组孕妇中，初产妇与经产妇构成比、流产史、GDM发生率、血清维生素D含量比较，差异均无统计学意义(P>0.05)，而2组孕妇年龄、受教育程度构成比与分娩时BMI分别比较，差异均有统计学意义(t＝-2.004、P＝0.045，χ2＝69.972、P<0.001，t＝7.054、P<0.001)。②晚孕期孕妇GBS感染影响因素的多因素非条件logistic回归分析结果显示，分娩时BMI≥25 kg/m2与受教育程度为高中及以下，均为晚孕期孕妇GBS感染的独立危险因素(OR＝2.901、6.137，95%CI：1.782～4.722、3.737～10.078，均为P<0.001)。③研究组孕妇产褥期感染、新生儿肺炎发生率分别为3.7%(3/81)与4.9%(4/81)，分别显著高于对照组的0.8%(9/1 068)与1.0%(11/1 068)，并且差异均有统计学意义(P＝0.047，χ2＝6.150、P＝0.013)。④研究组孕妇分娩的81例新生儿的出生后1周GBS阳性率为53.1 %(43/81)，早发型GBS肺炎发生率为2.5%(2/81)。

结论

分娩时孕妇BMI≥25 kg/m2与受教育程度为高中及以下，均为其GBS感染的独立危险因素。晚孕期孕妇GBS感染可导致其产褥期感染及新生儿肺炎发生率增高。

关键词: 妊娠末期, 链球菌，无乳, 危险因素, 妊娠结局, 抗菌药物预防, 孕妇
Objective

To explore influencing factors of group B Streptococcus (GBS) in genital tract of pregnant women in third trimester and its effects on outcomes of pregnant women and infants.

Methods

From August 2016 to August 2018, a total of 1 149 pregnant women in third trimester who received prenatal examination in People′s Hospital of Suzhou High-tech Zone and detection of GBS DNA by fluorescence quantitative PCR at gestational age of 35-37 weeks were selected as research subjects. By retrospective analysis method, they were divided into study group (n=81, GBS DNA+ in genital tract), and control group (n=1 068, GBS DNA- in genital tract). Measures of intrapartum antibiotic prophylaxis (IAP) was taken to subjects in study group. Clinical data of 2 groups such as age, educational background, gravidity, parity, history of abortion, mode of delivery, gestational age and body mass index (BMI) at delivery, serum vitamin D levels, rates of gestational diabetes mellitus (GDM), premature rupture of membranes, postpartum hemorrhage, and follow-up of GBS infection of neonates in study group at 4 weeks after birth were collected. Independent-samples t test, Mann-Whitney U test and chi-square test were used for statistical comparisons. Multivariate unconditional logistic regression analysis was used to analyze influencing factors of GBS infection in genital tract of pregnant women in third trimester. The procedure in this study was in line with the requirements of Helsinki Declaration of the World Medical Association revised in 2013, and has been approved by the Ethics Committee of People′s Hospital of Suzhou High-tech Zone (Approval No. 2016-001).

Results

①There were no statistically significant differences in composition ratio of primipara and multipara, history of abortion, incidence of GDM and serum vitamin D levels between two groups (P>0.05). While there were statistically significant differences in age, composition ratio of educational background and BMI at delivery between two groups (t=-2.004, P=0.045; χ2=69.972, P<0.001; t=7.054, P<0.001). ②Multivariate unconditional logistic regression analysis showed that BMI≥25 kg/m2 at delivery and high school education level or below were independent risk factors for GBS infection in genital tract of pregnant women in third trimester (OR=2.901, 6.137, 95%CI: 1.782-4.722, 3.737-10.078, all P<0.001). ③The incidence of puerperium infection and neonatal pneumonia in study group were 3.7% (3/81) and 4.9% (4/81), which were significantly higher than those in control group 0.8% (9/1 068) and 1.0% (11/1 068), respectively, and both differences were statistically significant (P=0.047; χ2=6.150, P=0.013). ④Among 81 neonates of study group, positive rate of GBS at 1 week after birth was 53.1% (43/81). The incidence of early onset GBS pneumonia in neonates was 2.5% (2/81).

Conclusions

BMI≥25 kg/m2 at delivery and high school education level or below are independent risk factors for GBS infection in genital tract of pregnant women in third trimester, and may lead to increased incidence of puerperium infection and neonatal pneumonia.

Key words: Pregnancy trimester, third, Streptococcus, agalactia, Risk factors, Pregnancy outcome, Antibiotic prophylaxis, Pregnant women
表1 晚孕期孕妇发生生殖道GBS感染影响因素的单因素分析
组别 例数 年龄(岁，±s) 受教育程度[例数(%)] 分娩时BMI (kg/m2，±s) 产妇类型[例数(%)] 流产史[例数(%)] GDM [例数(%)] 维生素D含量[ng/mL， M(P25～P75)]
本科及以上 高中及以下 初产妇 经产妇
研究组 81 29.6±4.0 24(29.6) 57(70.4) 27.5±4.7 42(51.9) 39(48.1) 43(53.1) 10(12.3) 14.2(10.4～20.6)
对照组 1 068 28.6±4.2 786(73.6) 282(26.4) 24.6±3.1 548(51.3) 520(48.7) 596(55.8) 98(9.2) 15.6(11.1～22.2)
检验值   t＝-2.004 χ2＝69.972 t＝7.054 χ2＝0.009 χ2＝0.225 χ2＝0.888 Z＝-1.802
P值   0.045 <0.001 <0.001 0.925 0.635 0.346 0.072
表2 晚孕期孕妇发生生殖道GBS感染影响因素的多因素非条件logistic回归分析变量的含义及其赋值情况
自变量/因变量 变量名 赋值
孕妇是否发生GBS感染 y y＝0表示孕妇未发生GBS感染，y＝1表示孕妇发生GBS感染
产妇类型 x1 x1＝0表示初产妇，x1＝1表示经产妇
孕妇流产史 x2 x2＝0表示孕妇无流产史，x2＝1表示孕妇有流产史
孕妇是否发生GDM x3 x3＝0表示孕妇未发生GDM，x3＝1表示孕妇发生GDM
孕妇分娩时BMI x4 x4＝0表示孕妇分娩时BMI<25 kg/m2(孕期体重正常及偏低)，x4＝1表示孕妇分娩时BMI≥25 kg/m2(孕期超重及肥胖)
孕妇受教育程度 x5 x5＝0表示孕妇受教育程度为本科及以上，x5＝1表示孕妇受教育程度为高中及以下
孕妇年龄 x6 x6＝0表示孕妇年龄<35岁，x6＝1表示孕妇年龄≥35岁
表3 晚孕期孕妇发生生殖道GBS感染影响因素的多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
产妇类型 -0.053 0.246 0.047 0.829 0.948 0.585～1.536
孕妇流产史 -0.201 0.245 0.674 0.412 0.818 0.506～1.321
孕妇是否发生GDM 0.484 0.379 1.633 0.201 1.622 0.772～3.407
孕妇分娩时BMI 1.065 0.249 18.348 <0.001 2.901 1.782～4.722
孕妇受教育程度 1.814 0.253 51.400 <0.001 6.137 3.737～10.078
孕妇年龄 0.478 0.417 1.317 0.251 1.614 0.713～3.654
表4 2组孕妇及其分娩新生儿结局比较[例数(%)]
组别 例数 分娩方式 分娩孕龄 胎膜早破 产后出血
自然分娩 剖宫产术分娩 ≥37周 <37周
研究组 81 62(76.5) 19(23.5) 78(96.3) 3(3.7) 16(19.8) 4(4.9)
对照组 1 068 762(71.3) 306(28.7) 1 045(97.8) 22(2.1) 180(16.9) 25(2.3)
χ2值   1.002 0.338 0.406 1.144
P值   0.317 0.561 0.524 0.285
组别 例数 产褥期感染 新生儿窒息 新生儿出生体重 新生儿肺炎
正常 巨大儿 低出生体重儿
研究组 81 3(3.7) 2(2.5) 77(95.1) 3(3.7) 1(1.2) 4(4.9)
对照组 1 068 9(0.8) 8(0.7) 1 002(93.8) 53(5.0) 13(1.2) 11(1.0)
χ2值   — — 1.426 6.150
P值   0.047 0.153 0.450 0.013
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