Prevalence and diversity of microbes in the amniotic fluid, the fetal inflammatory response, and pregnancy outcome in women with preterm pre-labor rupture of membranes.
Prevalence and diversity of microbes in the amniotic fluid, the fetal inflammatory response, and pregnancy outcome in women with preterm pre-labor rupture of membranes.
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DOI：
10.1111/j.1600-0897.2010.00830.x
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发表时间：
2010-07-01
期刊：
影响因子：
--
通讯作者：
Relman DA
中科院分区：
文献类型：
--
作者：
DiGiulio DB;Romero R;Kusanovic JP;Gómez R;Kim CJ;Seok KS;Gotsch F;Mazaki-Tovi S;Vaisbuch E;Sanders K;Bik EM;Chaiworapongsa T;Oyarzún E;Relman DA
微生物侵入羊膜腔 (MIAC) 在早产前胎膜破裂 (pPROM) 中所起的作用尚未得到充分表征，部分原因是依赖于基于培养的方法。在一项回顾性队列研究中，通过培养和分子方法对 204 名 pPROM 受试者的羊水进行了分析。广泛和群体特异性 PCR 检测针对来自细菌、真菌和古细菌的小亚基 rDNA 或其他基因序列。结果与宿主炎症、妊娠和围产期结局的测量结果相关。培养法的 MIAC 患病率为 34% (70/204)，PCR 法的 MIAC 患病率为 45% (92/204)，两种方法相结合的 MIAC 患病率为 50% (101/204)。 PCR 揭示的细菌种类数量（46 个物种级系统型）比培养揭示的细菌种类数量（14 个物种）更多，并且包括尚未培养的分类单元。通过 PCR 检测到的一些分类群先前已被认为与胃肠道（例如粪杆菌）、口腔（例如牙齿罗氏菌）或细菌性阴道病中的阴道（例如阴道阿托博菌）有关。 PCR 阳性的组织学绒毛膜羊膜炎的相对风险为 2.1（95% 置信区间 [CI]，1.4-3.0），培养阳性的组织学绒毛膜羊膜炎的相对风险为 2.0（95% CI，1.4-2.7）。细菌rDNA丰度与分娩胎龄呈剂量关系（R2=0.26；P<0.01）。 PCR 阳性与较低的平均出生体重、较高的呼吸窘迫综合征和坏死性小肠结肠炎发生率相关（每种结果 P<0.05）。 pPROM 中的 MIAC 比之前认识到的更为常见，并且在某些情况下与未培养的分类群相关，其中一些通常与胃肠道相关。通过分子方法检测MIAC具有临床意义。
The role played by microbial invasion of the amniotic cavity (MIAC) in preterm prelabor rupture of membranes (pPROM) is inadequately characterized, in part because of reliance on cultivation-based methods. Amniotic fluid from 204 subjects with pPROM was analyzed with both cultivation and molecular methods in a retrospective cohort study. Broad-range and group-specific PCR assays targeted small subunit rDNA, or other gene sequences, from bacteria, fungi and archaea. Results were correlated with measurements of host inflammation, and pregnancy and perinatal outcomes. The prevalence of MIAC was 34% (70/204) by culture, 45% (92/204) by PCR, and 50% (101/204) by both methods combined. The number of bacterial species revealed by PCR (46 species-level phylotypes) was greater than that by culture (14 species) and included as-yet uncultivated taxa. Some taxa detected by PCR have been previously associated with the gastrointestinal tract (e.g., Coprobacillus sp.), the mouth (e.g., Rothia dentocariosa) or the vagina in the setting of bacterial vaginosis (e.g., Atopobium vaginae). The relative risk for histologic chorioamnionitis was 2.1 for a positive PCR (95% confidence interval [CI], 1.4–3.0), and 2.0 for a positive culture (95% CI, 1.4–2.7). Bacterial rDNA abundance exhibited a dose relationship with gestational age at delivery (R2=0.26; P<0.01). A positive PCR was associated with lower mean birthweight, and with higher rates of respiratory distress syndrome and necrotizing enterocolitis (P<0.05 for each outcome). MIAC in pPROM is more common than previously recognized and is associated in some cases with uncultivated taxa, some of which are typically associated with the gastrointestinal tract. The detection of MIAC by molecular methods has clinical significance.
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作者：
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