B族链球菌核酸检测在产前筛查中可行性研究

张龙绘+李利+刘睿

[摘要] 目的 探讨B族链球菌核酸检测在产前筛查中的可行性。方法 将2012年4月～2016年8月期间于我院产检的1000例孕妇作为研究对象，于35～37孕周期间采集孕妇肛周及阴道分泌物后做PCR检测与细菌培养，分别比较两种方法对B族链球菌的阳性检出率，随后分别抽取B族链球菌阳性与阴性各100例孕妇，比较两组的分娩方式、新生儿并发症、产妇并发症发生情况。结果 PCR检测方法的阳性检出率为8%（80/1000），明显高于细菌培养检测方法的阳性检出率4%（40/1000）；阳性组产妇产后出血、早产、胎膜早破及新生儿窒息、败血症、感染等并发症发生率均高于阴性组（P<0.05）。结论 应用PCR检测方法能够提高B族链球菌的阳性检出率，尽早对B族链球菌为阳性的孕妇采取恰当的干预措施，可降低母婴并发症发生率，保证母婴健康平安。

[关键词] B族链球菌；产前筛查；可行性；研究

[中图分类号] R715.3 [文献标识码] A [文章编号] 2095-0616（2017）06-64-03

[Abstract] Objective To explore the feasibility of B-streptococcal nucleic acid detection in prenatal screening. Methods 1000 pregnant women tested in our hospital from April 2012 to August 2016 were selected as the subjects. After 35-37 gestational weeks， the perianal and vaginal secretions were collected for PCR and bacterial culture. The positive rate of B-type streptococcus was determined by the two methods. Then， 100 pregnant women with positive and negative B streptococcus were randomly selected. The delivery mode， incidence of neonatal complications and maternal complications were compared between the two groups. Results The positive detection rate of PCR was 8%（80/1000）， which was significantly higher than that of bacterial culture test （4%， 40/1000）. The positive group had postpartum hemorrhage， premature labor（P<0.05）. The incidence of neonatal asphyxia， sepsis and infection is higher than that of negative group（P<0.05）. Conclusion PCR detection method can improve the positive rate of B streptococcus， as soon as possible on the B group of streptococcus positive pregnant women to take appropriate intervention measures. It can reduce the incidence of maternal and child complications， to ensure maternal and child health and safety.

[Key words] Group B Streptococcus； Prenatal screening； Feasibility； Research

分娩過程中，引起产妇与新生儿一并出现感染的病菌主要是B族链球菌（GBS）[1]，它属于革兰阳性菌，已有研究表明[2]，B族链球菌呈阳性和母婴结局、胎膜早破等现象有密切相关，检测孕妇B族链球菌是保证母婴健康、安全的重要手段[3]。早在20世纪90年代，CDC便制订了B族链球菌的检测、筛查及处理指南[4]，AAP、ACOG提倡怀孕35～37周的孕妇进行B族链球菌的产前筛查[5]，并对阳性者及早干预，把产妇的产褥病发病率及新生儿败血症感染率控制在最低范围内[6]。

1 资料与方法

1.1 一般资料

本研究对象为2012年4月～2016年8月期间于我院产检的1000例孕妇，纳入标准：单胎妊娠、无流产、死胎病例，对本研究内容知晓且自愿参与者。排除两周内有夫妻生活者、使用抗生素者。孕妇孕周35～37周，年龄24～40岁，平均（29.3±3.2）岁；初产妇832例、经产妇168例。……