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目的探讨隐匿性绒毛膜羊膜炎产妇胎膜组织中B族链球菌(GBS)的存在状况及对新生儿的影响。方法收集2013年6月-2014年12月在该院妇产科分娩时无宫内感染的临床表现,但胎盘、胎膜娩出后肉眼观符合典型组织学绒毛膜羊膜炎的病例共210例(最终病检证实196例)作为实验组;另收集同期分娩的无宫内感染临床表现,也无组织学绒毛膜羊膜炎表现的病例共267例作为对照组;于胎盘、胎膜娩出后立即采取双份新鲜胎膜组织棉拭子,一份应用荧光PCR探针定性的方法检测其GBS的存在状况,另一份用选择性培养基培养GBS;并追观新生儿临床感染情况。结果实验组PCR法检出GBS阳性21例(10.71%),培养法检出GBS阳性13例(6.63%);对照组PCR法检出GBS阳性2例(0.75%),培养法检出GBS阳性0例;两组比较差异有统计学意义(P<0.05)。实验组中有32例新生儿感染(16.33%);对照组中有5例新生儿感染(1.87%),两组比较差异有统计学意义(P<0.05)。结论隐匿性绒毛膜羊膜炎是新生儿GBS感染的危险因素,由于其在临床上缺乏典型的阳性指征,仅靠生后胎盘病理检查才能发现,易漏诊而延误治疗,对新生儿的危害巨大。荧光PCR法结合新鲜胎膜拭子是一种快速、准确检测GBS感染的方法,有利于临床高危产妇的筛查以及指导临床预防性应用抗生素,对新生儿感染的诊断和治疗也意义重大。
Objective To investigate the presence of Streptococcus mutans (GBS) and its effect on newborn infants in concealed chorioamnionitis maternal fetal membranes. Methods The clinical manifestations of intrauterine infection during obstetrics and gynecology were collected from June 2013 to December 2014 in our hospital. However, there were 210 cases of typical histological chorioamnion after placenta and fetal membranes were delivered The final pathology confirmed 196 cases) as the experimental group; the other collection of simultaneous clinical manifestations of intrauterine infection without delivery, there were no histological chorioamnion cases of 267 cases as a control group; in the placenta, immediately after delivery of fetal membranes Double fresh fetal tissue cotton swab, a method of using fluorescent PCR probe to detect the presence of GBS, and the other with selective culture medium GBS; and to observe the clinical status of neonatal infection. Results In the experimental group, 21 cases (10.71%) were positive for GBS by PCR and 13 cases (6.63%) were GBS positive by culture, 2 cases (0.75%) were GBS positive by PCR, and GBS was positive by culture 0 cases; the difference between the two groups was statistically significant (P <0.05). There were 32 cases of neonatal infection (16.33%) in the experimental group and 5 cases of neonatal infection (1.87%) in the control group. The difference between the two groups was statistically significant (P <0.05). Conclusions Occult chorioamnionitis is a risk factor for neonatal GBS infection. Due to its lack of typical positive indications in clinic, it can be found only by placenta pathological examination after birth, it is easy to misdiagnosis and delay treatment, which is harmful to the newborn . Fluorescent PCR combined with fresh fetal membrane swab is a rapid and accurate method for the detection of GBS infection, is conducive to clinical screening of high-risk maternal and guidance of clinical prophylactic antibiotics, neonatal infection diagnosis and treatment is also significant.