2018 年第 9 期 第 13 卷

妊娠晚期无症状无乳链球菌感染的高危因素及对母婴的影响

Risk factors of asymptomatic group B Streptococcus infection in late pregnancy and the impact on mothers and neonates

作者：翟青枝高原付晓琳关铮高志英游艳琴

英文作者：

单位：100853北京，解放军总医院妇产科

英文单位：

关键词：无乳链球菌感染;妊娠结局;新生儿疾病

英文关键词：

• 摘要：

• 【摘要】目的    探讨妊娠晚期无症状无乳链球菌(GBS)感染的高危因素及对母婴的影响。方法    选取2016年7月至2017年6月在解放军总医院分娩的孕妇2 027例，根据妊娠晚期GBS检测结果分为GBS阳性组和GBS阴性组，收集2组孕妇的一般资料、孕期情况以及分娩新生儿转新生儿重症监护病房（NICU）率和并发症的发生情况。分析GBS阳性组孕妇临产后或胎膜早破后接受与未接受抗菌药物预防性治疗对新生儿GBS带菌率和患病率的影响。结果    GBS阳性组136例，GBS阴性组1 891例。GBS阳性组年龄≥35岁、体重指数＞26 kg/m2比例均高于GBS阴性组［36.8%(50/136）比25.2%（476/1 891），49.3%（67/136）比38.3%（725/1 891）］（均P<0.05）；2组剖宫产、产后出血、胎膜早破、羊水污染、早产发生率比较差异均无统计学意义（均P＞0.05）。因存在双胎分娩，GBS阳性组分娩新生儿137例，GBS阴性组分娩新生儿1 938例。GBS阳性组新生儿转NICU率和新生儿肺炎、新生儿高胆红素血症发生率均高于GBS阴性组［55.5%（76/137）比18.9%（366/1 938），24.8%（34/137）比11.0%（214/1 938），35.8%（49/137）比13.5%（262/1 938）］（均P<0.01）。GBS阳性组孕妇临产后或胎膜早破后共88例接受抗菌药物预防性治疗，48例未使用抗菌药物者中1例为双胎。接受抗菌药物预防性治疗组新生儿肺炎发生率低于未接受抗菌药物预防性治疗组［13.6%（12/88）比44.9%（22/49）］（P＜0.01），但2组新生儿GBS带菌率、新生儿高胆红素血症发生率比较差异均无统计学意义（均P＞0.05）。结论    高龄妊娠（年龄≥35岁）及超重（体重指数＞26 kg/m2）是妊娠晚期无症状GBS感染的高危因素，无症状感染对孕妇分娩无明确影响，且不增加新生儿早发型GBS感染风险，但新生儿疾病发生率明显升高。临产后预防性使用抗菌药物可明显降低新生儿肺炎的发生率。

• 【Abstract】Objective    To investigate the susceptible factors of asymptomatic group B Streptococcus(GBS) infection during the third trimester of pregnancy and to observe the impact on mothers and newborns. Methods    From July 2016 to June 2017, 2 027 pregnant women in Chinese PLA General Hospital were divided into GBS-positive group and GBS-negative group according to the detection results during the third trimester of pregnancy. General data of mothers, maternal complications, neonatal intensive care unit(NICU) admission rate and neonatal complications were analyzed. In GBS-positive pregnant women, neonatal GBS-carrying rate and infection rate were analyzed between patients with and without prophylactic antibiotic therapy. Results    There were 136 cases in the GBS-positive group and 1 891 cases in the GBS-negative group. Rates of age≥35 years and body mass index＞26 kg/m2 in the GBS-positive group were significantly higher than those in the GBS-negative group［36.8%(50/136） vs 25.2%（476/1 891）， 49.3%（67/136） vs 38.3%（725/1 891）］（P<0.05）. Rates of cesarean section, postpartum hemorrhage, premature rupture of membranes, amniotic fluid turbidity and preterm birth showed no significant differences between groups（P＞0.05）. The GBS-positive group had 137 neonates and the GBS-negative group had 1 938 neonates. Rates of NICU admission, neonatal pneumonia and hyperbilirubinemia in the GBS-positive group were significantly higher than those in the GBS-negative group［55.5%（76/137） vs 18.9%（366/1 938）， 24.8%（34/137） vs 11.0%（214/1 938）， 35.8%（49/137） vs 13.5%（262/1 938）］（P<0.01）. In the GBS-positive group, 88 women had prophylactic antibiotic therapy. Incidence of neonatal pneumonia in the prophylactic antibiotic therapy group was significantly lower than that in the non-prophylactic antibiotic therapy group（with 1 case of twins）［13.6%（12/88） vs 44.9%（22/49）］（P＜0.01）. Neonatal GBS-carrying rate and hyperbilirubinemia rate showed no significant difference between prophylactic antibiotic therapy group and non-prophylactic antibiotic therapy group（P＞0.05）. Conclusions    Advanced maternal age (≥35 years old) and overweight（body mass index＞26 kg/m2） are risk factors of maternal GBS colonization in the third trimester. Asymptomatic GBS infection has no adverse effect on delivery and it does not increase the risk of early-onset GBS infection in newborns; but the neonatal disease rate is significantly higher. Preventive use of antibiotics after delivery can reduce the risk of neonatal pneumonia.