血清IFN-γ、HBD-2水平与妊娠合并霉菌性阴道炎患者阴道微生态及妊娠结局的相关性-现代医学

血清IFN-γ、HBD-2水平与妊娠合并霉菌性阴道炎患者阴道微生态及妊娠结局的相关性

单位：1. 成都医学院第一附属医院, 四川成都 610500;
2. 成都市新津区人民医院, 四川成都 611430

分类号：R714.2

出版年·卷·期（页码）：2023·51·第十一期（1611-1616）

摘要：

目的：探讨血清γ-干扰素(IFN-γ)、β-防御素-2(HBD-2)与妊娠合并霉菌性阴道炎(VVC)患者阴道微生态及妊娠结局的相关性。方法：选取2020年6月至2022年6月在成都医学院第一附属医院产科住院并分娩的妊娠合并VVC患者83例为研究对象(VCC组)，统计VVC患者妊娠结局，分为不良妊娠结局组51例、正常妊娠结局组32例；另选取同期住院并分娩的非VVC妊娠妇女90例作为对照(非VVC组)，ELISA法检测血清IFN-γ、HBD-2水平；Pearson法分析血清IFN-γ、HBD-2水平与阴道微生态各指标的相关性；Logistic回归分析妊娠合并VVC患者发生妊娠不良结局的影响因素。结果：VVC组血清IFN-γ、HBD-2水平均显著高于非VVC组(P＜0.05)；VVC组阴道菌群密集度为Ⅱ～Ⅲ级、菌群多样性为Ⅱ～Ⅲ级、清洁度为Ⅰ~Ⅱ度、pH为3.8~4.5占比显著低于非VVC组(P＜0.05)，VVC组过氧化氢酶为阳性、白细胞脂酶为阳性占比显著高于非VVC组(P＜0.05)；阴道菌群密集度为Ⅱ～Ⅲ级、菌群多样性为Ⅱ～Ⅲ级、清洁度为Ⅰ~Ⅱ度、pH在3.8~4.5之间、过氧化氢酶为阴性、白细胞脂酶为阴性的VVC患者血清IFN-γ、HBD-2显著低于阴道菌群密集度为Ⅰ或Ⅳ级、菌群多样性为Ⅰ或Ⅳ级、清洁度为Ⅲ～Ⅳ度、pH>4.5、过氧化氢酶为阳性、白细胞脂酶为阳性的VVC患者(P＜0.05)；VVC组不良妊娠结局(产后出血、过期产、低体重儿、新生儿窒息、宫内生长受限)的发生率显著高于非VVC组(P＜0.05)；不良妊娠结局组血清IFN-γ、HBD-2水平均显著高于正常妊娠结局组(均P＜0.05)；IFN-γ、HBD-2均是妊娠合并VVC患者发生妊娠不良结局的危险因素(P＜0.05)。结论：血清IFN-γ、HBD-2水平在妊娠合并VVC患者体内上升，阴道微生态指标异常者血清IFN-γ、HBD-2水平较高，且血清IFN-γ、HBD-2升高与妊娠不良结局的发生有关。

Objective: To investigate the correlation between the serum γ-interferon(IFN-γ), human β-defensin-2(HBD-2) levels and the vaginal microecology and pregnancy outcome in pregnant women with mycotic vaginitis(VVC). Methods: A total of 83 pregnant women with VVC who were hospitalized and delivered in the obstetrics department of our hospital from June 2020 to June 2022 were selected as our research subjects(VCC group), and 90 pregnant women without VVC who were hospitalized and delivered in our hospital during the same period were selected as controls(non VVC group).The pregnancy outcomes of VVC patients were calculated and they were divided into an adverse pregnancy outcome group(51 cases) and a normal pregnancy outcome group(32 cases). ELISAwas applied to detect serum IFN-γ and HBD-2 levels and Pearsonwas employed to analyze the correlation between the serum IFN-γ, HBD-2 levels and the various indicators of vaginal microbiota. Logistic regression analysis was used to analyze the influencing factors of adverse pregnancy outcomes in pregnant women with VVC. Results: The serum IFN-γ and HBD-2 levels in the VVC group were obviously higher than those in the non VVC group(P<0.05). The proportions of vaginal microbiota density of grade II-III, bacterial diversity of grade II-III, vaginal cleanliness of grade I-II, and vaginal pH of 3.8-4.5 in the VVC group were obviously lower than those in the non VVC group(P<0.05). The proportions of catalase positive and leukocyte lipase positive in the VVC group were obviously higher than those in the non VVC group(P<0.05). The serum IFN-γ and HBD-2 of VVC patients with vaginal microbiota density of grade II-III, bacterial diversity of grade II-III, vaginal cleanliness of grade I-II, vaginal pH of 3.8-4.5, catalase negative, and leukocyte lipase negative were obviously lower than those with vaginal microbiota density of grade I or IV, bacterial diversity of grade I or IV, vaginal cleanliness of grade III-IV, vaginal pH greater than 3.8-4.5, catalase positive, and leukocyte lipase positive(P<0.05). The incidence of adverse pregnancy outcomes(postpartum hemorrhage, post-term birth, low birth weight, neonatal asphyxia, intrauterine growth restriction) in the VVC group was significantly higher than that in the non VVC group(P<0.05).The levels of serum IFN-γ and HBD-2 in the adverse pregnancy outcome group were obviously higher than those in the normal pregnancy outcome group(P<0.05). IFN-γ and HBD-2 were both the risk factors for adverse pregnancy outcomes in pregnant women with VVC(P<0.05). Conclusion: The levels of serum IFN-γ and HBD-2 increase in pregnant women with VVC, while those with abnormal vaginal microecological indicators have higher levels of serum IFN-γ and HBD-2. The increases in serum IFN-γ and HBD-2 are related to the occurrence of adverse pregnancy outcomes.

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