Vaginal Microbiota and Pregnancy Outcomes of Patients with Conization Histories
Vaginal Microbiota and Pregnancy Outcomes of Patients with Conization Histories
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DOI：
10.1089/jwh.2022.0440
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发表时间：
2023-01-31
影响因子：
3.5
通讯作者：
Aoki，Yoichi
中科院分区：
文献类型：
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作者：
Hashiramoto，Shin;Kinjo，Tadatsugu;Aoki，Yoichi
背景：早产的主要风险之一是锥切术史。然而，由于这种程序而引起的感染风险仍然不太清楚。使用下一代测序，我们的目的是揭示影响锥切阴道菌群在以下怀孕，和他们之间的关系自发性早产（sPTB）。方法：我们进行了一项前瞻性队列研究，包括133名孕妇，其中25人有锥切历史，108没有。在妊娠早期和分娩期间，由产科医生使用拭子收集阴道微生物组样本。结果：宫颈锥切术组的分娩周数（34周vs.36周，p= 0.003）明显低于对照组，sPTB发生率（64%vs.8.3%，p ≤ 0.001）明显高于对照组。在锥切组中，早产患者分娩期间阴道微生物群的α（Chao 1，p= 0.02;系统发育多样性全树，p= 0.04）和β多样性（排列多变量方差分析检验，p= 0.04）显著高于足月分娩患者。妊娠早期社区状态IV型与sPTB显著相关（总体优势比3.80，95%可信区间1.33- 10.8，p = 0.01）。宫颈锥切术后患者sPTB风险增加可能属于脆弱的防御机制，由于宫颈缩短和宫颈粘液减少。
Background:One of the major risks of preterm birth is a history of conization. However, the risk of infection due to this procedure is still not well known. Using next-generation sequencing, we aimed to reveal the influence of conization on vaginal microbiota in the following pregnancy, and their relationship between spontaneous preterm birth (sPTB).Methods:We conducted a prospective cohort study including 133 pregnant patients, of whom 25 had conization histories and 108 did not. Vaginal microbiome samples were collected using swabs by an obstetrician upon inclusion in the first trimester and during delivery. V1–V2 of the 16S rRNA gene were amplified and analyzed to identify the bacteria.Results:The conization group had a significantly lower delivery week (34 weeks vs. 36 weeks,p= 0.003) and higher sPTB rate (64% vs. 8.3%,p≤ 0.001) than the control group. In the conization group, alpha (Chao 1,p= 0.02; phylogenetic diversity whole tree,p= 0.04) and beta diversity (permutational multivariate analysis of variance test,p= 0.04) of the vaginal microbiota was significantly higher during delivery in patients who delivered preterm than in those who delivered term. Community-state type IV in the first trimester was significantly associated with sPTB (overall odds ratio 3.80, 95% confidence interval 1.33–10.8,p= 0.01).Conclusions:Conization is a risk factor for sPTB. Increased risk of sPTB in patients after conization may belong to the vulnerable defense mechanism, due to the shortened cervix and decreased cervical mucus.