摘要
近年研究发现,引起阴道细菌感染的疾病有两类,一类由厌氧菌和兼性厌氧菌引起,临床上称为细菌性阴道病(BV),另一类由需氧菌引起,临床上称需氧菌性阴道炎(AV)。关于BV的研究很多,而关于AV的研究国内报道较少,妊娠期AV以及对妊娠结局的影响国内尚未见报道,国外报道不多。B族链球菌(GBS)是AV常见致病菌,妊娠期GBS感染可导致严重的不良妊娠结局,但母婴GBS的血清型及基因型配对研究国内报道较少。因此,我们选取在我院产科门诊建册常规产检、诊断为需氧菌性阴道炎(AV)的孕妇150例为研究对象,分析阴道菌群分布情况及其与妊娠结局相关性,并对其母婴配对GBS菌株血清型及基因型进行了相关性分析。
第一部分妊娠期需氧菌性阴道炎对妊娠结局的影响
目的探讨AV孕妇妊娠不同时期阴道菌群分布情况及其与妊娠结局相关性。
方法选取2010年7月～2012年7月在深圳市南山人民医院产科门诊建册常规产检、诊断为AV的孕妇150例为研究对象,分为三组,其中早孕组50例(孕周<13周),中孕组50例(13周≤孕周<28周),晚孕组50例(孕周≥28周),并选取同期在我院产科门诊行健康检查的正常孕妇100例为对照组。取阴道分泌物,部分镜检,部分送微生物培养,AV阳性者根据患者意愿给予治疗。分析AV孕妇阴道菌群分布,并随访阴道分泌物、妊娠结局包括分娩孕周、分娩方式、胎膜破裂、绒毛膜羊膜炎、胎儿窘迫、产褥感染、产后出血、新生儿评分、新生儿体重及新生儿感染情况。
结果
1.AV孕妇以阴道分泌物性状改变就诊者占31.3%(47/150),分泌物一般为黄色或黄绿色、稀薄、脓性。阴道菌群主要以GBS、大肠埃希氏菌、金黄色葡萄球菌及粪肠球菌为主,其中GBS检出率为28.6%(43/150),早孕组32%,中孕组28%,晚孕组26%。
2.150例AV孕妇胎膜早破(26%)、绒毛膜羊膜炎(10.7%)、产后出血(9.3%)的发生率均明显高于对照组的发生率(分别为13.0%、2.0%、3.0%)(P<0.05)；各个孕期AV孕妇胎膜早破、绒毛膜羊膜炎、产后出血发生率差异无统计学意义(P>0.05)。
3.AV孕妇所分娩的新生儿中,新生儿感染率为11.3%,高于对照组的2%(P<0.05)；而新生儿体重、Apgar评分明显低于对照组(P<0.05)；共发生新生儿肺炎4例,其中AV孕妇分娩新生儿3例,均为GBS感染。
4.应用克林霉素磷酸酯阴道泡腾片治疗后,治疗组胎膜早破(20.6%)、绒毛膜羊膜炎(4.9%)、产后出血(5.9%)的发生率明显低于未治疗组孕妇的发生率(分别为37.5%、22.9%、14.6%)(P<0.05)。而分娩方式、胎儿窘迫、早产、产褥感染发生率两组比较,差异均无统计学意义(P>0.05)。
5.治疗组新生儿感染率为8.9%,明显低于未治疗组的16.7%(P<0.05)；而新生儿体重、Apgar评分明显高于未治疗组(P<0.05)。
结论AV感染孕妇主要症状为阴道分泌物呈黄色、黄绿色、稀薄、脓性,感染菌群主要以GBS、大肠埃希氏菌、金黄色葡萄球菌及粪肠球菌为主,AV感染可导致胎膜早破、绒毛膜羊膜炎、产后出血、新生儿感染、窒息、低出生体重等不良妊娠结局,经治疗可改善妊娠结局。
第二部分母婴感染GBS血清型及基因型分析
目的探讨母婴配对GBS菌株血清型和DNA指纹图谱是否一致。
方法选取第一部分AV中为GBS感染者及其新生儿口咽部分泌物培养G1BS阳性者为研究对象,随机选取GBS菌株72株利用免疫双扩散法进行血清学分型,并将母婴菌株配对,研究其血清型是否一致,应用RAPD技术对18株不同血清型的菌株进行DNA指纹图谱研究,比较G1BS菌株血清型和基因型是否一致。
结果
1.对43例GBS感染者进行药敏试验,GBS对青霉素G、氨苄青霉素、头孢唑啉、头孢替安及克林霉素敏感,敏感率均为97.7%,红霉素和头孢哌酮的耐药率较高,红霉素耐药率高达23.3%。
2.对72株GBS菌株进行了血清型分析,共分离出9个血清型,包括Type Ⅰ。、Ⅰb、IⅡ、Ⅲ、Ⅳ、Ⅴ、Ⅵ、Ⅶ、Ⅷ,其中Ⅱ型占23.6%,Ⅲ型占25%,是主要血清型,另外发现3株GBS为不可分型。
3.利用免疫双扩散法将12例新生儿GBS供试抗原与其母亲GBS抗血清进行配对检测,12例均产生沉淀线,相应的沉淀线完全融合,形成平滑的曲线。
4.应用RAPD技术对18株GBS基因型进行研究,所用7条随机引物中有4条呈现良好的多态性和稳定性,可产生差异显著的指纹图谱。18株GBS间的遗传距离为0.082～0.531,平均距离为0.35,其中第4株和第13株同为血清型TypeⅢ,但遗传距离最大,为0.358；第1株和第7株为不同血清型,而遗传距离最小,为0.011。不同血清型的GBS菌株具有相似的指纹图,而同一血清型的菌株指纹图存在差异。
结论1.我们共分离出9个血清型,其中Ⅱ型和Ⅲ是主要血清型,另外发现3株GBS为不可分型,孕妇及其产婴儿GBS菌株具较高的相似性。
2.不同血清型的GBS菌株具有相似的指纹图,同一血清型的菌株指纹图存在差异。
Aerobic vaginitis is common vaginitis of women.Aerobic vaginitis in pregnant women can seriously affect the quality of perinatal care, cause many adverse effects on pregnancy. Studies have found that group B streptococcus is common vaginitis pathogen of aerobic vaginitis, but aerobic bacteria during pregnancy on pregnancy outcome and gene effects and maternal and child group B Streptococcus serotype type is not reported in China. Therefore, we collected150cases of different maternal during the2010-2012in our hospital of vaginal secretions, analysis of flora distribution and pregnancy outcome and correlation, and the mother-baby pairs and gene of GBS strain serotype type.
Part I The relationship between aerobic vaginitis in pregnant women and pregnant outcome
Objective To investigate the vaginal flora distribution and its correlation with pregnancy outcomes of aerobic vaginitis women of pregnancy in different periods.
Methods We choiced150cases of aerobic vaginitis in pregnant women from July2010to July2012in our hospital routine prenatal obstetric outpatient service.50cases of first trimester group (gestational age<13weeks),50cases of second trimester group (13weeks Results
1. The mainly bacteria in aerobic bacterium vaginitis infection of pregnant women were group B streptococcus, e. coli bacteria, staphylococcus ball bacteria and enterococcus. There was no statistically significant difference between each pregnancy group(P>0.05).
2.There was statistically significant difference between aerobic bacterium vaginitis women and normal pregnant women in incidence of premature rupture of membrances(P<0.05);There was no statistically significant difference among different aerobic bacterium vaginitis pregnant women in the incidence of premature rupture of membranes(P>0.05). There was statistically significant difference between aerobic bacterium vaginitis women and normal pregnant women in incidence of chorioamnionitis (P<0.05); There was no statistically significant difference among different aerobic bacterium vaginitis pregnant women in incidence of chorioamnionitis (P>0.05). There was statistically significant difference between aerobic bacterium vaginitis women and normal pregnant women in the incidence of postpartum hemorrhage(P<0.05); There was no statistically significant difference among different aerobic bacterium vaginitis pregnant women in incidence of postpartum hemorrhage (P>0.05).
3. There was statistically significant difference between aerobic bacterium vaginitis women and normal pregnant women in the incidence of and infection in neonates(P<0.05);. neonatal weight, Apgar score of newborn of aerobic bacterium vaginitis women were lower than normal pregnant women(P<0.05).
4. After treatment,There was statistically significant difference between the treatment group and non-treatment group in incidence of premature rupture of membranes(P<0.05).In pregnant women, The bacterial culture of aerobe incidence of chorioamnionitis of102cases of treatment group was4.9%, lower than incidence of chorioamnionitis of non-treatment pregnant women and the difference was statistically significant (P<0.05). The non-treatment pregnant women had significantly higher incidence of postpartum hemorrhage than treatment women(P<0.05). while the incidence of fetal distress and preterm birth and puerperal infection in the two groups, there were no statistically significant difference (P>0.05).
5. There was statistically significant difference between untreated pregnant women and treatment group in the incidence of infection in neonates(P<0.05); neonatal weight, Apgar score of newborn of untreated pregnant women were lower than treatment group (P<0.05).
Conclusion
1. The mainly bacteria in aerobic bacterium vaginitis infection of pregnant women were group B streptococcus, e. coli bacteria, staphylococcus ball bacteria and enterococcus. There was no statistically significant difference between each pregnancy group.
2. Aerobic bacterium vaginitis can cause many adverse effects such as:premature rupture of fetal membrane,chorioamnionitis,postpartum hemorrhage. After treatment, Pregnant outcome woulde be improved.
Part Ⅱ:Analysis of serotype and Genotype of Group B streptococcus in pregnant women and their newborns
Objective To investigate mother son paired GBS serotype strains, and DNA fingerprint are consistent, in order to be early prevention, early treatment, improve the outcome.
Methods We selected of vaginal secretion culture for group B streptococcus of pregnant women and their newborns oropharyngeal secretions training GBS as the research object, in selecting strains, used immune double diffusion method and compare serum type of credits and mother son paired GBS serotype strains. Through RAPD, We studied GBS genotype.
Results
1. We used immune double diffusion method to analyze serotype GBS bacteria of72strains.9serotype were isolated, including Ⅱ and Ⅲ main serotype, another three GBS inseparable type strains.
2.12cases of neonatal GBS antigen and its matching mother GBS antiserum precipitation line corresponding to precipitate line total integration formed a smooth curve. It showed that they had the same both GBS main antigen components, a quite close relationship, namely the strains with high similarity.
3. Through RAPD, We studied of18kinds of GBS genotype.7random primers can be used in four of the article presents good polymorphism and stability, and can produce significant difference of the fingerprint. To analysis the genetic distance between the different strains.18strains of GBS genetic distance were frome0.082to0.531, the average distance of0.35,18strains of group B streptococcus4strains and13strains of genetic distance, the biggest0.358.1and7of the smallest genetic distance was0.011. GBS of different serotype strains had similar fingerprint, the same serotype strains had different fingerprint.
Conclusion
1. A total of nine serotype was isolated, of which Ⅱ and Ⅲ were main serum types. We also found that three strains of GBS were inseparable type. GBS production strains between pregnant women and their babies were high similarity.
2. GBS of the same serotype strains had different fingerprint,different serotype strains had similar fingerprint.
引文
[1]刘朝晖,廖秦平.妇科及计划生育门诊外阴阴道假丝酵母菌病流行病学调研[J].中国实用妇科与产科杂志,2005,21(4)：223-224.
[2]吴文湘,廖秦平.阴道炎的诊治进展[J].中国实用妇科与产科杂志,2009,25(12)：949-952.
[3]樊璐,吴佳聪,任慕兰.妊娠期女性阴道微生态状况的分析[J].江苏医药,2011,37(2)：205-207.
[4]Donders GG, Vereecken A, Bosmans E et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis:aerobic vaginitis[J]. Br J Obstet Gynaecol,2002,109:34-43.
[5]Tempera G, Bonfiglio G, Cammarata E,et al. Microbiological/clinical characteristics and validation of topical therapy with kanamycin in aerobic vaginitis: a pilot study [J]. International Journal of Antimicrobial Agents,2004,24:85-88.
[6]Tempera G, Abbadessa G, Bonfiglio G, et al. Topical kanamycin:an effective therapeutic option in erobicVaginitis[J]JounalofChemotherapy,2006,18(4):409-414.
[7]Donders G, Bellen G, Rezeberga D. Aerobic vaginitis in pregnancy [J]. International Journal of Obstetics and Gynaecology.2011,118(10):1163-70.
[8]Zodzika J, Rezeberga D, Jermakova I,et al. Factors related to elevated vaginal pH in the first trimester of pregnancy [J]. Acta Obstet Gynecol Scand.2011,90(1):41-6.
[9]Piper JM, Newton ER, Berkus MD,et al. Meconium:a marker for peripartum infection[J]. Obstet Gynecol.1998,91(5):741-5.
[10]Curzik D, Drazancic A, Hrgovic Z.Nonspecific aerobic vaginitis and regnancy[J]. Fetal Diagn Ther.2001,16(3):187-92.
[11]Donders GG, Van Calsteren K, Bellen G,et al. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy [J]. International Journal of Obstetics and Gynaecology. 2009,116(10):1315-24.
[12]贺晶,梁峰冰.炎症与早产[J].中国实用妇科与产科杂志,2008,24(5)：331-333.
[13]朱敏,范建霞,程利南.围产期B族链球菌感染的研究进展[J].中华妇产科杂志,2005,40(2)：137-141.
[14]姬香莲,霍建刚,李红英.新生儿无乳链球菌引起败血症1例[J].现代中西医结合杂志,2003,12(19)：2100.
[15]Centers for Disease Control and Prevention, The Division of Bacterial and Mycotic Diseases National Center for Infectious Diseases Centers for Disease Control and Prevention. Available at:http://wonder.cdc.gov/wonder/prevguid/p0000422.asp. Publication date:01/01/1996.
[16]陈慧慧,范建霞,陆庭嫣.孕妇B族溶血性链球菌感染对母婴的影响[J].上海医学,2009,32(2)：128-130.
[17]马延敏,吴连方,黄醒华,等.孕妇B族溶血性链球菌带菌与母婴预后的关系[J].中华妇产科杂志,2000,35：32-35.
[18]马延敏,吴连方,黄醒华,等.孕妇B族溶血性链球菌带菌与母婴预后的探讨[J].北京医学,2005,27：516-518.
[19]汤红芳,裴美兰,乔微.对B族溶血性链球菌带菌者早期干预与胎膜早破、晚期流产、早产关系探讨[J].交通医学,2008,22(2)：189-191.
[20]沈定树,周雪艳.无乳链球菌表面蛋白的研究进展[J].中国微生态学杂志,2007,19(5)：472-473.
[21]申阿东,斯悦,钟雁,等.新生儿B族链球菌感染传播途径的研究[J].中华儿科杂志,2000,38(8)：501-502.
[22]李莉,叶鸿瑁,杨永弘,等.孕妇及新生儿体内B族链球菌Ⅲ型特异性IgG抗体水平的研究[J].中华围产医学杂志,2002,5(4)：269-272.
[23]尹万贵,张秋桂,刘双全.铜绿假单胞菌医院感染流行病学分子研究及基因分型[J].湘南学院学报(医学版)2011,13(3)：14-16.
[24]徐鸿绪,黄健宇,赖在真,等.产ESBLs肺炎克雷伯菌的RAPD基因分型研究[J].中国卫生检验杂志,2010,20(12)：3305-3307.
[25]朱成宾,高应东.RAPD在金黄色葡萄球菌分型中的应用研究进展[J].临床输血与检验杂志,2009,11(3)：283-285.
[26]白文生,范惠玲RAPD标记技术及其应用进展[J].河西学院学报.2008,24(2)：52-54.
[27]董彦亮.细菌性宫内感染对妊娠的影响[J].中国实用妇科与产科杂志,2009,25(11)：818-820.
[28]蔡德燕,罗媛.不同年龄段阴道炎病原检测与分析[J].医学信息,2011,11：10-11.
[29]马蔡昀,童明庆,王美莲,等.女性阴道微生态变化与年龄、妊娠及4种阴道疾病关系的探讨[J].南京医科大学学报(自然科学版),2005,25(10)：722-724.
[30]刘朝晖,张岱,赵敏,等.5275例健康妇女阴道微生态状况的分析[J].现代妇产科进展,2009,18：129-131.
[31]李兰娟.感染微生态学[M].北京：人民卫生出版社,2002,425.
[32]肖冰冰, 张岱, 廖秦平,等.妊娠期阴道菌群的微生态评价.中国妇产科临床杂志,2007,8(6)：812-814.
[33]薛凤霞.需氧菌性阴道炎的诊治进展[J].实用妇产科杂志,2010,26(2)：83-84.
[34]Sobel JD. Desquamative inflammatory vaginitis:a new subgroup of purulent vaginitis responsive to topical 2% clindamycin therapy[J]. Am J Obstet Gynecol, 1994,171:1215-1220.
[35]Tempera G, Bonfiglio G, Cammarata E,et al. Microbiological/clinical characteristics and validation of topical therapy with kanamycin in aerobic vaginitis: a pilot stud[J]y. International Journal of Antimicrobial Agents,2004,24:85-88.
[36]Tempera G, Abbadessa G, Bonfiglio G, et al. Topical kanamycin:an effective therapeutic option in Aerobic Vaginitis. Jounal ofChemotherapy,2006,18(4):409-414.
[37]刘朝晖.董悦.需氧菌阴道炎菌群及治疗效果的临床研究[J].现代妇产科进展,2019,18：832-835.
[38]Peacocke M, Djurkinak E, Thys-Jacobs S. Treatment of desquamative inflammatory vaginitis with Vitamin D:a case report[J]. Cutis,2008,81:75-78
[39]范爱萍,薛凤霞.需氧菌性阴道炎及其混合感染的临床特征分析[J].中华妇产科杂志,2010,45(12)904-908.
[40]Berek JS,Novak's Gynecology. Thirteenth Edition [M]. Philadelphia: Lipp incottWilliams and wilkins,2002:459-460.
[41]Barcaite E, Bartusevicius A, Tameliene R, et al. Prevalence of maternal group B streptococcal colonisation in Europeancountries[J].Acta Obstet Gynecol Scand,2008,87:260-271.
[42]崔爱民,裴美兰,刘霞,等.B族溶血性链球菌与胎膜早破关系的研究[J].交通医学,2007,21(5)：578-580.
[43]Osrin D, Vergnano S, Costello A-Serious bacterial infections in new- born in developing countries[J]·Cury Opin Infect Dis,2004,17(3):217-229.
[44]江敏,汪伟山.孕妇B族溶血性链球菌带菌状况与母婴预后的研究[J].中华全科医学,2012,10(4)：506-508.
[45]时春艳,杨慧霞.B族溶血性链球菌围产期感染的预防和处理策略[J].中华围产医学杂志,2008,11(5)：315-318.
[46]叶蓉华,赵阳玉.严重宫内感染导致多脏器功能障碍1例J].中国妇产科临床杂志,2008,9(1)：63-64.
[47]时春艳,曲首辉,杨磊,等.妊娠晚期孕妇B族链球菌带菌状况的检测及带菌对妊娠结局的影响J].中华妇产科杂志,2010,45(1)：12-16.
[48]邓江红,姚开虎,胡惠丽,等.新生儿肺炎死亡病例中B族链球菌的检[J].中华儿科杂志,2006,44(11)：850-854.
[49]Arad I, Ergaz Z. The fetal inflammatory response syndrome and associated infant morbidity[J].Isr Med ASSOC J,2004,6:766-769.
[50]李鹤梅,孟伟莉.流动人口孕产妇B族溶血性链球菌感染监测与母婴传播干预结果分析[J].现代医院,2010.10(4)：28.30.
[1]朱敏,范建霞,程利南.围产期B族链球菌感染的研究进展[J].中华妇产科杂志,2005,40：137-141.
[2]Barcaite E,Bartusevicius A,Tameliene R,et al.Prevalence of maternal group B streptococcal colonisation in European countries [J].Acta Obstet Gynecol Scand,2008,87:260-271.
[3]应群华,严文卫,丁金龙.围产期生殖道菌群检测和B群链球菌筛查[J].中国微生态学杂志,2006,18(6)：491-492.
[4]Bergeron MK,Ke D,Menard C,et al.Rapid detection of group B streptococci in pregnancy women at delivery[J].N Engl J Med,2000,343:175-179.
[5]Sweet RL,Gibbs RS.Infectious diseases of the female genital trael 15th.Wohers Kluwer:Lippincott Williams & Wilkim.2009:1-9.
[6]邓江红,姚开虎,胡惠丽,等.新生儿肺炎死亡病例中B族链球菌的检测[J].中华儿科杂志,2006,44：850-854.
[7]Brgeron MK,Ke D,Menard C,et al.Rapid detection of group B streptococci in pregnancy women at delivery[J].N Engl J Med,2000,343:175-179.
[8]Davies HD.Miller MA,Faro S,et al.Multicenter study of a rapid molecular-based assay for the diagnosis of group B streptococcal edonization in pregnancy women[J].Clin Infect Dis,2004.39:1129-1135.
[9]姚开虎,陆权,邓力等.2000-2002年三家儿童医院分离的肺炎链球菌血清型分布及其对β内酰胺类抗生素敏感性的变化[J].中华儿科杂志,2006,12：928-932.
[10]聂妍,何芳,刘凯波等.北京市围产期妇女生殖道感染监测与分析[J].中华围产医学杂志,2004,7(5)：259.
[11]范爱萍,薛凤霞.需氧菌性阴道炎及其混合感染的临床特征分析[J].中华妇产科杂志,2010,45,12；904-908.
[12]周庭银.临床微生物学诊断与图解[M].第2版.上海科学技术出版社2007,6：93-95.
[13]白文生,范惠玲RAPD标记技术及其应用进展[J].河研学报,2008,24(2)：52-54.
[14]黄爱华,李君文,王新为.军团菌RAPD基因分型研究[J].中国卫生检验杂志,2002,12(6)：648-649.
[15]马延敏,吴连方,黄醒华,等.孕妇B组溶血性链球菌带菌与母婴预后的探讨[J].北京医学,2005,27：516-518.
[16]Scahrag S,Gorwitz R,Fultz-Butts K,et al. Prevention of perinatal Group B streptococcus disease.Revised guidelines from CDC[J].MMWR Recomm Rep,2002,51:1-22.
[17]王辉,徐英春,陈民钧.简要介绍美国NCCLS药敏试验纸片扩散法法规(1993年12月版).中华医学检验杂志,1995,18(1)：60-62.
[18]Nakarnura PA,Sclmab RB,Neves FP,et al.Antimicrobial resistance profiles and genctie characterisation of macrolide resist&hi isolates of Streptococcus agalactiae[J].Mem Inst Oswaldo Cruz,2011,106(2):119-122.
[19]段纯,李素丽,王宏,等.妇幼医院无乳链球菌临床分布情况及药敏结果分析[J].热带医学杂志,2009,9(3)：301-303.
[20]郭素芳,张迎华,周敏,等泌尿生殖道分离无乳链球菌药物敏感件分析[J].检验医学,2008,23(6)：612-614.
[21]Verani JR.McGee L,Schrag SJ,et al.Prevention of perinatal group B streptocoecal disease-revise guidelines from CDC,2010[J].MMWR Recomm Rep.2010,59(RR.10): 31-36.
[22]张景华,袁林,杨永弘.600名妊娠妇女及其所娩新生儿GBS带菌情况的研究[J].中华流行病学杂志,1995,16：36.
[23]俞桑洁,王槿芳,李洁,等.肺炎链球菌耐药性和血清型分布及隐匿性耐药克隆株的研究[J].中华儿科杂志,2000,38(7)：424-427.
[24]李莉,叶鸿瑁,杨永弘,等.孕妇及新生儿体内B组链球菌Ⅲ型特异性IgG抗体水平的研究[J].中华围产医学杂志,2002,5(4)：269-272.
[25]尹万贵,张秋桂,刘双全.铜绿假单胞菌医院感染流行病学分子研究及基因分型[J]。湘南学院学报(医学版)2011,13(3)：14-16.
[26]E.哈洛,D.莱恩编著.抗体技术实验指南[M].科学出版社,2002：157-186.
[27]Ronald S. Gibbs,Stephanie Schrag, Anne Schuchat.Perinatal Infections Due to Group B Streptococci [J]. Obstet Gynecol 2004,104:1062-1076.
[28]罗小铭,古有婵,梁建平,等.肺炎链球菌的耐药性及其血清型分布调查[J].实用预防医学,2003,10(6)：835-837.
[29]赵根明,BLACK Steve,SHINEFIELD Henry,等.儿童肺炎链球菌的血清型及对抗生素的耐药性[J].复旦学报(医学版),2004,31(4)；387-390.
[30]Renee D S, Jeremy M K, Laura E E, et al.Risk factors for group B streptococcal genitourinary tract colonization in pregnant women[J].Obstet Gynecol,2005,106 (6):1246-1252.
[31]Colbourn T, Gilbert R. An overview of the natural history of early onset group B streptococcal disease in the UK[J].Early Hum Dev,2007,83(3):149-156.
[32]Centers for Disease Control.Descreasing incidence of perinatal group B streptococcus disease-United States[J].MMWR,1997,46:473-477.
[33]Ogunmodede F,Vimig BA,Danila R,et al.Prevention of perinatal group B streptococcal disease in Minnesota result from a retrospective cohort study and new prevention guidelines[J].Minn Med,2003,86:40-45.
[34]马延敏,申阿东,张桂荣.B族溶血性链球菌抗体对母婴预后的影响[J].中华围产医学杂志,2002,5：266-268.
[35]麻慧芳,王宙,黄晋玲.分子标记的类型与RAPD技术本身存在的问题及对策[J].山西师范大学学报,2007,21(3)：64-66.
[36]姜白锋,林乃铨,徐梅RAPD技术及其应用中的一些问题[J].福建农林大学学报(自然科学版),2002,31(3)：356-360.
[37]Bojesen A M,Christensen H,Nielsen O L,et al.Detection of Gallibacterium spp.in chickens by fluorescent 16S rRNA in situ hybridization[J].Journal of Clinical Microbiology,2003,41(11):5167-5172.
[38]Edwards RK,Novak-Weekley SM,Koty PP,et al.Rapid group B streptococci screening using a Real-Time polymerase chain rBaction assay [J].Obstet Gynecol,2008,111:1335-1341.
[39]Dieter KL.Quantification using real-time PCR technology:applications and 1 imitations[J].Trends in Molecular Medicine 2002.8:257-260.
[40]Silvester ME,Dicks LM.Identification of lactic acid bacteria isolated from human vaginal secretions[J].Antonie Van Leeuwenhoek,2003; 83(2):117-23.
[1]Donder G,Jlbert G G, Vereecken AE, et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis:aerobic vaginitis[J]. Int JObste Gyna,2002,109(1):34-43.
[2]马蔡昀,童明庆,王美莲,等.女性阴道微生态变化与年龄、妊娠及4种阴道疾病关系的探讨[J].南京医科大学学报(自然科学版),2005,25(10)：722-724.
[3]刘朝晖,张岱,赵敏,等.5 275例健康妇女阴道微生态状况的分析[J].现代妇产科进展,2009,18：129-131.
[4]Mac Dermott RU.Bacterial vaginisis[J].Br J Obstet Gynecol,1995,902 (1): 92.
[5]Yen S, Shafer MA, Moncada J, et al. Bacterial vaginisism sexually experienced and nonsexually experienced young women entering the military[J].Obstet Gynecol, 2003,102 (5ptl):927-933。
[6]刘朝晖,董悦.需氧菌阴道炎菌群及治疗效果的临床研究[J].现代妇产科进展,2009,18(11)：832-835.
[7]戴婉波,杨芬红.妊娠期合并细菌性阴道病患者120例妊娠结局临床分析[J].中国社区医师·医学专业,2010,12(17)：104-105.
[8]黄绮涛,郭跃文,谭惠民,等。细菌性阴道病对不良妊娠结局的影响[J].基层医学论坛,2010,14：394-396。
[9]尹玉竹,李小毛,李国梁,等.细菌性阴道病和早产者宫颈分泌物IL-1 β IL-6含量变化的相关性[J].中国实用妇科与产科杂志,2000,16(6)：361-362.
[10]Bradshaw CS, Morton AN, Garland SM, et al.Evaluation of a point-of-care test, BV Blue, and clinical and laboratory criteria for diagnosis of bacterial vaginosis [J]. Clin Microbiol,2001,39:3197-3199.
[11]CDC. Management of Patients Who Have Vaginal Infections[J].MMWR,2006: 55.
[12]ACOG Practice Bulletin. Clinicalmanagement guidelines for obstetrician-gynecologists [J]. Obstet Gynecol,2006,107 (5):1195-1206.
[13]田志红,黄醒华,范玲.妊娠期细菌性阴道病的治疗[J].中国妇产科临床,2005,6(2)：98.
[14]Donder G, Vereecken A,Bosmans E, et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis:desquamative inflammatory vaginitis [J].BJOG,2002,109:342-43.
[15]Mumtaz S, Ahmad M, Aftab I, et al. Aerobic vaginal pathogens and their sensitivity pattern.[J] Ayub Med Coll Abbottabad.2008,20(1):113-7.
[16]Donders GG, Van Calsteren K, Bellen G, et al. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy [J]. BJOG.2009 Sep;116(10):1315-24.
[17]翁秀琴,秦洁,丁香翠,等。B-组溶血链球菌与胎膜早破[J].中国妇幼保健,2010,25(9)：1250-1251.
[18]Tempera G, Bonfiglil G, Cammarata E, et al. Microbiological/Clincal characteristics and validation of topical therapy with kannmycin in aerobic vaginitis: a Pilot study[J]. Int J Antimiero Agents,2004,24 (1):85-88.
[19]Tempera G, Abbadessa G, Bonfiglio G, et al. Topical kanamycin:an effective therapeutic option in aerobic vaginitis[J].Chemother.2006 Aug; 18(4):409-14.
[1]Edwards MS,Baker CJ. Group B Streptococcal infections.In:Remington JS,Klein JO,editors.Infections diseases of the fetus and newborn infant(P).5th ed,Philadelphia W.B.Saunders,2001:1091-1156
[2]Ronald S. Gibbs, MD, Stephanie Schrag, PhD, and Anne Schuchat, MD.Perinatal Infections Due to Group B Streptococci[J]. Obstet Gynecol 2004,104:1062-1076
[3]Renee D. Stapleton,Jeremy M. Kahn, Laura E. Evans, et al.Risk Factors for Group B Streptococcal Genitourinary Tract Colonization in Pregnant Women[J]. Obstet Gynecol,2005,106:1246-1252
[4]Hickman ME, Rench MA, Ferrieri P,et al. Changing epidemiology of group B streptococcal colonization[J]. Pediatrics.1999,104:203-209
[5]朱敏,范建霞,程利南.围产期B族链球菌感染的研究进展[J].中华妇产科杂志,2005,40：137-141
[6]Chaisilwattana P,Monif GRG,In vitro ability of Group B streptococcal to inhibit gram-positive and gram-variable constituens of the bacterial floro of the female genital tract[J].Infec Dis Obstet Gynecol,1995,3:91-97
[7]马延敏,吴连芳,黄醒华.孕妇B族溶血性链球菌带菌与母婴预后的探讨[J].北京医学,2005,27：516-618
[8]Pinto, Nelangi M, Soskolne et al. Neonatal Early-Onset Group B Residual Problems[J]. J Perinatal,2003,23:265-271
[9]Alonso JM, Guiyoule A, Zarantonelli ML, et al. A model of meningococcal bacteremia after respiratory superinfection in 2003,222:99-106
[10]Josette Raymond,Jean Baptiste Armengaud, Ce'cile Lambe,et al. Late-onset Neonatal Infections Caused by Group B Streptococcus Associated with viral Infection[J]. The Pediatric Infectious Disease Journal,2007.26:963-965
[11]马延敏,吴连方,黄醒华,等.孕妇B族溶血性链球菌带菌与母婴预后的关系[J].中华妇产科杂志,2000,35(1)：32-35
[12]Bergeron MG, Menard C, Picard FJ, et al. Rapid detection of group B streptococci in pregnant women at delivery[J]. N Engl J Med,2000,343:175-179
[13]Natarajan G, Johnson YR, Zhang F, et al. Real-time polymerase chain reaction for the rapid detection of group B streptococcal colonization in neonates[J].Pediatrics, 2006,118:14-22
[14]David D. Kim, McKenna, Lt Catherine M. Kim.Neonatal Group B Streptococcus Sepsis After Negative Screen in a Patient Taking Oral Antibiotics[J]. Obstet Gynecol 2005,105:1259-1261
[15]Stoll BJ, Hansen N, Fanaroff AA, et al. Changes in pathogens causing earlyonset sepsis in very-low-birth-weight infants[J]. N Engl J Med,2002,347:240-247
[16]Andrew J. Daley, MBBS, FRACP,et al. Ten-Year Study on the Effect of Intrapartum Antibiotic Prophylaxis on Early Onset Group B Streptococcal and Escherichia coli Neonatal Sepsis in Australasia[J]. Pediatr Infect Dis,2004,23: 630-634
[17]Curtis J, Kim G, Wehr NB, et al. Group B streptococcal phospholipids causes pulmonary hypertension [J]. PNAS,2003,100:5087-5090
[18]Feng Ying C. Lin, James F. Troendle.Hypothesis Neonatal Respiratory Distress May Be Related to Asymptomatic Colonization With Group B Streptococci [J]. Pediatr Infect Dis,2006,25:884-888
[19]Boyer KM, Gadzala CA, Kelly PD,et al. Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. III. Interruption of mother-to-infant transmission[J]. Infect Dis,1983,148:810-816
[20]Lin FY, Brenner RA, Johnson YR, et al. The effectiveness of risk-based intrapartum chemoprophylaxis for the prevention of early-onset neonatal group B streptococcal disease[J]. Obstet Gynecol,2001,184:1204-1210
[21]贺晶韩秀君,B族链球菌感染的母婴传播及其预后[J].中国实用妇科及产科杂志,2005,21：343-345
[22]李莉,叶鸿瑁,沈叙庄,等.Ⅲ型B族链球菌结合疫苗对新生小鼠致死性感染的保护作用[J].中华儿科杂志,2002,40：28-31
[23]Gilbert GL. Vaccines for other neonatal infections:are group B streptococcal infections vaccine-preventable [J]? Expert Rev Vaccines,2004,3:371-3