胎膜早破孕妇羊水中微生物的流行情况和多样性、胎儿炎症反应与妊娠结局。
Prevalence and diversity of microbes in the amniotic fluid, the fetal inflammatory response, and pregnancy outcome in women with preterm pre-labor rupture of membranes.
机构信息
Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
出版信息
Am J Reprod Immunol. 2010 Jul 1;64(1):38-57. doi: 10.1111/j.1600-0897.2010.00830.x. Epub 2010 Mar 21.
PROBLEM
The role played by microbial invasion of the amniotic cavity (MIAC) in preterm pre-labor rupture of membranes (pPROM) is inadequately characterized, in part because of reliance on cultivation-based methods.
METHOD OF STUDY
Amniotic fluid from 204 subjects with pPROM was analyzed with both cultivation and molecular methods in a retrospective cohort study. Broad-range and group-specific polymerase chain reaction (PCR) assays targeted small subunit ribosomal DNA (rDNA), or other gene sequences, from bacteria, fungi, and archaea. Results were correlated with measurements of host inflammation, as well as pregnancy and perinatal outcomes.
RESULTS
The prevalence of MIAC was 34% (70/204) by culture, 45% (92/204) by PCR, and 50% (101/204) by both methods combined. The number of bacterial species revealed by PCR (44 species-level phylotypes) was greater than that by culture (14 species) and included as-yet uncultivated taxa. Some taxa detected by PCR have been previously associated with the gastrointestinal tract (e.g., Coprobacillus sp.), the mouth (e.g., Rothia dentocariosa), or the vagina in the setting of bacterial vaginosis (e.g., Atopobium vaginae). The relative risk for histologic chorioamnionitis was 2.1 for a positive PCR [95% confidence interval (CI), 1.4-3.0] and 2.0 for a positive culture (95% CI, 1.4-2.7). Bacterial rDNA abundance exhibited a dose relationship with gestational age at delivery (R(2) = 0.26; P < 0.01). A positive PCR was associated with lower mean birthweight, and with higher rates of respiratory distress syndrome and necrotizing enterocolitis (P < 0.05 for each outcome).
CONCLUSION
MIAC in pPROM is more common than previously recognized and is associated in some cases with uncultivated taxa, some of which are typically associated with the gastrointestinal tract. The detection of MIAC by molecular methods has clinical significance.
问题
微生物侵袭羊膜腔（MIAC）在早产胎膜早破（pPROM）中的作用尚未充分描述，部分原因是依赖于培养为基础的方法。
方法
在一项回顾性队列研究中，对 204 例 pPROM 患者的羊水进行了培养和分子分析。广谱和组特异性聚合酶链反应（PCR）检测靶向细菌、真菌和古菌的小亚基核糖体 DNA（rDNA）或其他基因序列。结果与宿主炎症以及妊娠和围产儿结局的测量相关。
结果
通过培养，MIAC 的患病率为 34%（70/204），通过 PCR 为 45%（92/204），通过两种方法联合检测为 50%（101/204）。通过 PCR 检测到的细菌种类（44 个种水平的分类群）多于培养方法（14 种），并包括尚未培养的分类群。通过 PCR 检测到的一些分类群以前与胃肠道（例如，Coprobacillus sp.）、口腔（例如，Rothia dentocariosa）或细菌性阴道病（例如，Atopobium vaginae）中的阴道有关。组织学绒毛膜羊膜炎的相对风险为 PCR 阳性（95%置信区间（CI），1.4-3.0）和培养阳性（95%CI，1.4-2.7）的 2.1。细菌 rDNA 丰度与分娩时的胎龄呈剂量关系（R(2) = 0.26；P < 0.01）。PCR 阳性与平均出生体重较低有关，与呼吸窘迫综合征和坏死性小肠结肠炎的发生率较高有关（每种结局 P < 0.05）。
结论
pPROM 中的 MIAC 比以前认识到的更为常见，并且在某些情况下与未培养的分类群有关，其中一些通常与胃肠道有关。通过分子方法检测 MIAC 具有临床意义。
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