早孕期阴道微生物组与自发性早产风险的关系：病例对照研究。
Vaginal microbiome in early pregnancy and subsequent risk of spontaneous preterm birth: a case-control study.
机构信息
Research Centre of CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
Department of Obstetrics and Gynaecology, University of Sherbrooke, Sherbrooke, QC, Canada.
出版信息
BJOG. 2019 Feb;126(3):349-358. doi: 10.1111/1471-0528.15299. Epub 2018 Jun 27.
OBJECTIVES
To explore differences in the vaginal microbiome between preterm and term deliveries.
DESIGN
Nested case-control study in 3D cohort (design, develop, discover).
SETTING
Quebec, Canada.
SAMPLE
Ninety-four women with spontaneous preterm birth as cases [17 early (<34 weeks) and 77 late (34-36 weeks) preterm birth] and 356 women as controls with term delivery (≥37 weeks).
METHODS
To assess the vaginal microbiome by sequencing the V4 region of the 16S ribosomal RNA (rRNA) gene in swabs self-collected during early pregnancy.
MAIN OUTCOME MEASURES
Comparison of relative abundance of bacterial operational taxonomic units and oligotypes and identifying vaginal community state types (CSTs) in early or late spontaneous preterm and term deliveries.
RESULTS
Lactobacillus gasseri/ Lactobacillus johnsonii (coefficient -5.36, 95% CI -8.07 to -2.65), Lactobacillus crispatus (99%)/ Lactobacillus acidophilus (99%) (-4.58, 95% CI -6.20 to -2.96), Lactobacillus iners (99%)/ Ralstonia solanacearum (99%) (-3.98, 95% CI -6.48 to -1.47) and Bifidobacterium longum/ Bifidobacterium breve (-8.84, 95% CI -12.96 to -4.73) were associated with decreased risk of early but not late preterm birth. Six vaginal CSTs were identified: four dominated by Lactobacillus; one with presence of bacterial vaginosis-associated bacteria (Gardnerella vaginalis, Atopobium vaginae and Veillonellaceae bacterium) (CST IV); and one with nondominance of Lactobacillus (CST VI). CST IV was associated with increased risk of early (4.22, 95% CI 1.24-24.85) but not late (1.63, 95% CI 0.68-5.04) preterm birth, compared with CST VI.
CONCLUSIONS
Lactobacillus gasseri/L. johnsonii, L. crispatus/L. acidophilus, L. iners/R. solanacearum and B. longum/B. breve may be associated with decreased risk of early preterm birth. A bacterial vaginosis-related vaginal CST versus a CST nondominated by Lactobacillus may be associated with increased risk of early preterm birth.
TWEETABLE ABSTRACT
Largest study of its kind finds certain species of vaginal Lactobacillus + Bifidobacterium may relate to lower risk of preterm birth.
目的
探讨早产与足月分娩之间阴道微生物组的差异。
设计
嵌套病例对照研究，纳入 3D 队列（设计、开发、发现）。
地点
加拿大魁北克。
样本
94 名自发性早产妇女为病例组（17 名早产发生在 34 周之前，77 名早产发生在 34-36 周之间），356 名足月分娩妇女为对照组（分娩孕周≥37 周）。
方法
采用自我采集的阴道拭子，通过测序 16S 核糖体 RNA（rRNA）基因的 V4 区，评估阴道微生物组。
主要观察指标
比较早产和足月分娩的阴道细菌操作分类单元和寡型的相对丰度，并鉴定早产和足月分娩的阴道群落状态类型（CSTs）。
结果
与早产发生风险降低相关的有乳杆菌属（Lactobacillus）gasseri/L. johnsonii（系数-5.36，95%置信区间-8.07 至-2.65）、Lactobacillus crispatus（99%）/Lactobacillus acidophilus（99%）（-4.58，95%置信区间-6.20 至-2.96）、Lactobacillus iners（99%）/Ralstonia solanacearum（99%）（-3.98，95%置信区间-6.48 至-1.47）和长双歧杆菌（Bifidobacterium longum）/短双歧杆菌（Bifidobacterium breve）（-8.84，95%置信区间-12.96 至-4.73），但这些关联与早产发生的时间（早或晚）无关。鉴定出 6 种阴道 CST：4 种以乳杆菌属为主；1 种与细菌性阴道病相关细菌（加德纳菌、阴道普雷沃菌和韦荣球菌科细菌）（CST IV）共存；1 种不以乳杆菌属为主（CST VI）。与 CST VI 相比，CST IV 与早产发生的风险增加（4.22，95%置信区间 1.24-24.85）相关，而与早产发生的时间无关（早或晚）。
结论
乳杆菌属（Lactobacillus）gasseri/L. johnsonii、Lactobacillus crispatus/L. acidophilus、Lactobacillus iners/R. solanacearum 和长双歧杆菌（Bifidobacterium longum）/短双歧杆菌（Bifidobacterium breve）可能与早产发生的风险降低相关。细菌性阴道病相关的 CST 与不以乳杆菌属为主的 CST 与早产发生的风险增加相关。
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