Preterm birth: associations with genital and possibly oral microflora.
Preterm birth: associations with genital and possibly oral microflora.
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DOI：
10.1902/annals.1998.3.1.222
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发表时间：
1998-07-01
期刊：
影响因子：
--
通讯作者：
Hill, G B
中科院分区：
文献类型：
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作者：
Hill, G B
机会致病微生物是女性下生殖道的固有微生物，是许多类型盆腔感染以及部分早产 (PTB) 病例的病因。细菌性阴道病（BV）是一种基于生殖器微生物群改变的临床综合征，其中阴道加德纳菌；厌氧菌种主要包括普雷沃菌属、卟啉单胞菌属、拟杆菌属、消化链球菌属和动链菌属；人型支原体；解脲脲原体在阴道分泌物中占主导地位。与以兼性乳杆菌为主的正常阴道微生物群相比，这种 BV 微生物复合体与早产、早产胎膜早破、PTB 和其他围产期感染并发症的风险显着增加相关。发病机制包括由于微生物产物和母体和/或胎儿产生前列腺素和细胞因子的反应而导致的感染和/或炎症过程的上升途径。在存在牙周病的情况下，口腔机会性病原体和/或其炎症产物也可能通过血行途径在早产中发挥作用。具核梭杆菌是一种常见的口腔菌种，是早产且胎膜完整的女性羊水培养物中最常见的分离菌种。此外，与从下生殖道鉴定出的菌株相比，从羊水中鉴定出的梭杆菌属和亚种与健康和患病龈下部位报告的梭杆菌属最接近，即 F. nucleatum subspecies vincentii 和 F. nucleatum subspecies nucleatum。尽管这些梭杆菌也可以通过伴侣的舔阴获得，但通过从羊水中分离具核梭杆菌、二氧化碳嗜纤维菌和其他口腔物种而获得的将母体牙周病与早产低出生体重相关的新数据支持进一步研究可能的其他途径（口腔血源性）至 PTB。
Opportunistic pathogenic microbes are indigenous to the female lower genital tract and etiologic in many types of pelvic infections and, apparently, a portion of preterm birth (PTB) cases. Bacterial vaginosis (BV) is a clinical syndrome based on an altered genital microflora in which Gardnerella vaginalis; anaerobic species primarily among Prevotella, Porphyromonas, Bacteroides, Peptostreptococcus, and Mobiluncus; Mycoplasma hominis; and Ureaplasma urealyticum become predominant in vaginal secretions. This BV complex of microbes, compared to a normal vaginal microflora dominated by facultative lactobacilli, is associated with significantly increased risks for preterm labor, preterm premature rupture of membranes, PTB, and other perinatal infectious complications. Pathogenetic mechanisms include an ascending route of infection and/or inflammatory process due to microbial products and maternal and/or fetal response(s) with production of prostaglandins and cytokines. In the presence of periodontal disease, oral opportunistic pathogens and/or their inflammatory products also may have a role in prematurity via a hematogenous route. Fusobacterium nucleatum, a common oral species, is the most frequently isolated species from amniotic fluid cultures among women with preterm labor and intact membranes. Also, the species and subspecies of fusobacteria identified from amniotic fluid most closely match those reported from healthy and diseased subgingival sites, namely F. nucleatum subspecies vincentii and F. nucleatum subspecies nucleatum, compared to strains identified from the lower genital tract. Although these fusobacteria also could be acquired through cunnilingus from a partner, new data associating maternal periodontal disease with preterm low birth weight taken with the isolation of F. nucleatum, Capnocytophaga, and other oral species from amniotic fluid support further study of a possible additional route, oral-hematogenous, to PTB.