生殖医学杂志

目的评价实时荧光定量PCR技术检测妊娠晚期孕妇B族链球菌(GBS)感染的临床效能,探讨GBS感染与不良妊娠结局的关系。方法对3 565例妊娠35~37周孕妇的阴道分泌物和直肠分泌物,采用实时荧光定量PCR法和细菌培养法进行GBS检测;根据GBS携带者意愿将其分为干预治疗组和未干预治疗组,干预治疗组进行预防性应用抗菌素,未干预治疗组不作处理;观察各组产妇的妊娠结局。结果 3 565例孕妇中,GBS携带率为9.87%;实时荧光定量PCR法诊断GBS感染的灵敏度、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比和准确度分别为98.30%、99.50%、95.58%、99.81%、196.6、0.017和99.38%;未干预治疗组的胎膜早破、早产、宫内感染、胎儿窘迫和新生儿感染的发生率显著高于GBS阴性组和干预治疗组(P<0.05),而干预治疗组与GBS阴性组无统计学差异(P>0.05);各组新生儿均出现不同程度的GBS、金黄色葡萄球菌和表皮葡萄球菌等感染,未干预治疗组发生GBS感染数显著增高(P<0.05),而干预治疗组与GBS阴性组无统计学差异(P>0.05),其余菌种感染组间均无统计学差异(P>0.05)。结论实时荧光定量PCR是一种快速准确筛查妊娠晚期GBS的方法;妊娠晚期孕妇GBS感染会导致胎膜早破、早产、宫内感染、胎儿窘迫和新生儿感染的发生率升高,及时采取干预措施可有效降低不良妊娠结局的发生。

Objective:To evaluate clinical efficiency of real-time quantitative fluorescence polymerase chain reaction(qPCR)for screening group B Streptococcus(GBS)in third trimester pregnant women,and explore the relationship between the colonization of GBS and the adverse pregnancy outcome.Methods: A total of 3 565 pregnant women with the gestational age varying from 35 to 37 weeks were included in the study.Their secretions from 1/3 lower vagina and rectum were collected for screening GBS by qPCR and bacterial culture method.GBS carriers were classified into intervention and non-intervention groups according to subjects' wishes.Intervention group was treated with prophylactic antibiotics,and nonintervention group was not treated.The pregnancy outcomes were observed.Results:The rat of GBS carriers was 9.87% in 3 565 third trimester pregnant women.The sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and accuracy of diagnosis of GBS infection in third trimester pregnant women by qPCR were 98.30%,99.50%,95.58%,99.81%,196.6,0.017 and 99.38%respectively.Compared with GBS-negative group andnon-intervention group,the incidence of premature rupture of membranes,premature delivery,intrauterine infection,fetal distress and neonatal infection in intervention group was significantly higher(P<0.05).The incidence in non-intervention group was not significantly different with GBS-negative group(P>0.05).All groups of newborns had infection with GBS,Staphylococcus aureus and Staphylococcus epidermidis.The GBS infection was significantly increased in non-intervention group(P<0.05),but there was no significant difference between intervention group and GBS negative group(P >0.05).There was no significant difference among the other strains(P>0.05).Conclusions:qPCR is rapid and accurate method for screening GBS in third trimester pregnant women.GBS infection in third trimester perinatal women can increase the incidence of premature rupture of membranes,premature delivery,intrauterine infection,fetal distress and neonatal infection.The timely intervention can effectively reduce the incidence of adverse pregnancy outcomes.