From the Department of Obstetrics and Gynecology, Marseille Public Hospital System (APHM); Unité des rickettsies, IFR 48, CNRS-IRD UMR 6236, Faculté de Médecine, Université de la Méditerranée; and Centre d'investigation clinique 9502, Marseille, France.
Obstet Gynecol. 2010 Jan;115(1):134-140. doi: 10.1097/AOG.0b013e3181c391d7.
To estimate the relationship between vaginal quantification of the main microorganisms related with bacterial vaginosis and the risk of preterm delivery among women with preterm labor.
Molecular methods were used to prospectively quantify Lactobacillus species, Gardnerella vaginalis, Atopobium vaginae, and Mycoplasma hominis in vaginal fluid samples from women admitted for spontaneous preterm labor with intact membranes from July 2007 through July 2008. The primary outcome measure was the relationship between bacterial concentration at admission and preterm delivery, before 37 weeks of gestation. Sensitivity and specificity of molecular cutoff values and 95% confidence intervals (CIs) were calculated using the University of British Columbia Bayesian Calculator type 2.
Of the 90 women included, 36 delivered before 37 weeks of gestation (40%). Preterm delivery was not associated with the presence of Lactobacillus species, G vaginalis, A vaginae, or M hominis. In contrast, molecular quantification detected high concentrations of A vaginae (10(6)/mL or more: 25.0% in the preterm group and 9.3% in the term group, P=.04) and G vaginalis (10(7)/mL or more: 16.7% and 3.7%, P=.03) more often in women with preterm deliveries compared with term deliveries. Moreover, high vaginal concentrations of these two microorganisms together were associated with a significantly (P=.03) shorter interval between preterm labor and delivery (46 days, 95% CI 30-61) than were lower concentrations (85 days, 95% CI 75-95). The hazard ratio for a short preterm labor-to-delivery interval was three times higher for high vaginal fluid concentrations of A vaginae and G vaginalis than for lower concentrations (hazard ratio 3.3, 95% CI 1.1-9.5, P=.03).
The risk of preterm delivery is significantly associated with high vaginal concentrations of A vaginae and G vaginalis in women with preterm labor.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00484653.
III.
评估细菌性阴道病相关主要微生物阴道定量与早产胎膜早破孕妇早产风险之间的关系。
采用分子方法对 2007 年 7 月至 2008 年 7 月因胎膜早破接受自发性早产治疗的孕妇阴道液样本中的乳杆菌属、阴道加德纳菌、阴道阿托波菌和人型支原体进行定量。主要结局指标为入院时细菌浓度与妊娠 37 周前早产的关系。使用不列颠哥伦比亚大学贝叶斯计算器 2 型计算分子截止值的灵敏度和特异性及 95%置信区间（CI）。
90 例孕妇中，36 例（40%）在妊娠 37 周前分娩。早产与乳杆菌属、阴道加德纳菌、阴道阿托波菌或人型支原体的存在无关。相比之下，分子定量检测到早产组中阴道阿托波菌（10^6/ml 或更多：25.0%和足月组 9.3%，P=0.04）和阴道加德纳菌（10^7/ml 或更多：16.7%和 3.7%，P=0.03）的高浓度更为常见。此外，这两种微生物阴道高浓度与早产至分娩的间隔时间显著缩短相关（P=0.03，95%CI 30-61 天），而低浓度则无相关性（85 天，95%CI 75-95 天）。与低浓度相比，阴道阿托波菌和阴道加德纳菌高浓度与早产至分娩的短间隔时间的风险比（HR）高 3 倍（HR 3.3，95%CI 1.1-9.5，P=0.03）。
细菌性阴道病相关主要微生物阴道高浓度与早产胎膜早破孕妇早产风险显著相关。
ClinicalTrials.gov，www.clinicaltrials.gov，NCT00484653。
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