QUANTITATIVE MICROBIOLOGIC MODEL FOR PRETERM DELIVERY

描述（由申请人提供）：早产（PTD）是主要的 美国婴儿发病率和死亡率的原因，预防是 围产期保健的主要目标。最近的证据表明， 怀孕期间阴道菌群的改变 以及PTD的发生。然而，特定微生物在PTD中的作用 并没有得到很好的理解。该实验室最近的研究是针对 确定与PTD相关的特定微生物风险因素。我们有 在此基础上建立了PTD的预测统计模型， 微生物危险因素。我们的研究确定了两个关键人群 与PTD的发生有关。已显示 细菌磷脂酶PLA2的水平在20 孕37周以下分娩的妇女孕30周。 PLA2的这种增加与作为细菌的一部分的普雷沃氏菌属的存在相关。 阴道微生物群落也有人指出，两者的存在 产生过氧化氢（H2O2）的乳酸杆菌和不产生H2O2的乳酸杆菌 乳酸杆菌同时作为阴道微生物区系的一部分是一个危险因素 对于PTD，与任一菌株本身的存在分开。 这一观察结果表明，菌株的组合可能具有不利的生物学特性。 对妊娠结局的影响。拟议项目的目标是 前瞻性收集定量和定性微生物学数据， PTD高危女性和PTD无可识别风险的女性， 基于以下确定所述统计模型是否能够预测PTD： 微生物学数据，为随后的研究做准备， 将对通过该模型确定为有PTD风险的患者进行治疗。此外该 将评价细菌引起PTD的实际机制， 确定任何干预性研究的微生物靶点。具体目标 1）完善从以下来源得出的预测模型： 对前三年收集的数据进行初步分析， 研究并验证该模型用于预测PID在前瞻性 临床试验，2）提高我们对特定作用的认识 PTD中的细菌物种，特别是普雷沃氏菌，3）使用分子分型 确定特定乳酸杆菌菌株是否更常见的方法 妊娠37周以下分娩的妇女比妊娠37周以下分娩的妇女 妊娠37周以上，以及此类菌株是否在妊娠期间获得，以及 4)以确定乳酸杆菌菌株之间的相互作用 使用培养的阴道上皮细胞， 在体外暴露于体内发现的乳酸杆菌的组合。

DESCRIPTION (provided by applicant): Preterm delivery (PTD) is the leading cause of infant morbidity and mortality in the United States, and prevention is a primary goal for perinatal health care. Recent evidence indicates that there is a strong association between an altered vaginal microflora during pregnancy and the occurrence of PTD. However, the role of specific microorganisms in PTD is not well understood. Recent studies in this laboratory have been directed at identifying specific microbial risk factors associated with PTD. We have established a predictive statistical model for PTD, based on these microbiologic risk factors. Our studies have identified two key populations that are associated with the occurrence of PTD. It has been shown that the levels of a bacterial phospholipase, PLA2, increase in concentration between 20 and 30 weeks of gestation in women who deliver at less than 37 weeks gestation. This increase in PLA2 correlates with the presence of Prevotella sp. as part of the vaginal microflora. It has also been noted that the presence of both hydrogen peroxide (H2O2) producing lactobacilli and non-H2O2 producing lactobacilli simultaneously as part of the vaginal microflora is a risk factor for PTD, separate from the presence of either strain by itself. This observation suggests that combinations of strains may have a detrimental effect on pregnancy outcome. The goal of the proposed project is to prospectively collect quantitative and qualitative microbiologic data from women at high risk for PTD and those with no identifiable risk for PTD, to determine whether the statistical model is capable of predicting PTD based on microbiologic data, in preparation for a subsequent study in which women identified as at risk for PTD by this model will be treated. In addition, the actual mechanism(s) by which bacteria cause PTD will be evaluated in order to identify microbiologic targets for any interventional study. The specific aims for this proposal are to 1) refine the predictive model derived from the initial analysis of the data collected during the first three years of this study and to validate this model for predicting PID during a prospective clinical trial, 2) to improve out understanding of the role of specific bacterial species in PTD particularly Prevotella sp, 3) to use molecular typing methods to determine whether specific strains of lactobacilli are more common in women delivering at less than 37 weeks gestation than those delivering at 37+ weeks gestation and whether such strains are acquired during pregnancy, and 4) to determine whether interactions between strains of lactobacilli deleterious to pregnant women occur by using cultured vaginal epithelial cells in vitro exposed to combinations of lactobacilli found in vivo.