B 族链球菌产前筛查在母婴感染防控中的应用

摘要

Objective To establish a screen method for group B Streptococcus(GBS)in prenatal period,to investigate the significance of GBS screen among pregnant women in late pregnancy,to take interventions to GBS carriers,and to observe prevention and control of maternal and neonatal infection. Methods A total of 1 000 cases with more than 35-week pregnancy for prenatal care and delivery were enrolled,and their samples from vaginal orifice 1/3 and perianal secretions were collected for GBS screen. GBS was detected by bacterial culture method. GBS-positive subjects were classified into intervention and non-intervention groups according to subjects′wishes. Intervention group was treated with prophylactic antibiotics in delivery or rupture of membranes,and non-intervention group was not treated. Maternal pregnancy outcomes were compared. Results A total of 97 cases had GBS infection,and the infection rate was 9.7%. Compared with GBS-negative group,premature rupture of membranes,premature delivery, intrauterine infection,fetal distress,neonatal low quality,Apgar score and infection incidence in intervention group had no statistical significance(P>0.05). The difference of Apgar score in intervention group had no statistical significance compared with non-intervention group(P>0.05),and other indices had statistical significance(P<0.05). Conclusions The screen method for GBS in pregnant women′s vaginal and perianal secretions is rapid,sensitive and specific. It is important to carry out GBS screen among pregnant women in late pregnancy. It can effectively reduce the incidence of adverse maternal and neonatal pregnancy outcomes and infection.%目的：建立产前筛查 B 族链球菌（GBS）检验方法，将其应用于孕晚期 GBS 携带的筛查，探讨妊娠晚期对孕妇进行 GBS 感染筛查的临床意义，并对 GBS 带菌者采取干预措施，观察其对母婴感染的防控作用。方法选取产科进行产前检查及分娩的35周以上的孕妇1000例为研究对象，采集孕妇阴道口1/3处及肛周分泌物进行 GBS 筛查，采用已建立的细菌培养法检测 GBS，将 GBS 阳性者根据其意愿分为干预治疗组和不干预治疗组，干预治疗组在临产后或破膜后预防性应用抗菌药物，不干预治疗组不作处理。对比各组产妇的妊娠结局。结果1000例受检孕妇经检测共发生 GBS 感染97例，感染率为9.7%；与 GBS 阴性组相比，干预治疗组胎膜早破、早产、宫内感染、胎儿窘迫、新生儿低体质量、Apgar 评分及感染发生率差异均无统计学意义（P>0.05）；而与不干预治疗组相比，干预治疗组 Apgar 评分差异无统计学意义（P>0.05），其他指标差异均有统计学意义（P<0.05）。结论建立的筛查 GBS 方法可快速、敏感、特异地筛查出孕妇阴道及肛周样本中的 GBS。孕晚期对孕妇进行 GBS 感染的筛查非常重要，及时采取干预措施可有效减少不良妊娠结局及母婴感染的发生率。