基于列线图探讨妊娠期阴道菌群特征与自发性早产发生的关系OA

Objective To explore relationship between characteristics of vaginal flora during pregnancy and spontaneous preterm delivery based on a nomogram.Methods In case-control design,79 pregnant women with spontaneous preterm delivery(preterm delivery group)and 156 full-term pregnant women(control group)who admitted to Department of Obstetrics in our hospital from January 2020 to December 2023 were selected as study subjects.Vaginal swab samples were taken for all participants in the third trimester of pregnancy to analyze microbiota in the vagina.Logistic regression analysis was used to analyze independent risk factors of preterm delivery in the pregnant women.Using R package"rms"in version R4.4.0,a prediction nomogram for preterm delivery in the pregnant women was established.Receiver operating characteristic(ROC)curve was drawn and area under the curve(AUC)was employed to analyze predictive values of risk factors for preterm delivery.Results Compared with the control group,the serum white blood cell(WBC)level of the pregnant women in the preterm delivery group was higher,the difference was significant(t=3.875,P<0.05).The proportions of abnormal microflora,coccoid microbiota and fungi infections in the pregnant women in the preterm delivery group were higher than those in the control group,the differences were significant(χ2=10.459-13.045,all P<0.05).Also,the infection rates of Candida spp.,Haemophilus vaginalis,Mycoplasma hominis and Ureaplasma urealyticum in the preterm delivery group were higher,while the proportion of Lactobacillus spp.was lower,with statistically significant differences compared with the control group(χ2=14.774-20.490,all P<0.05).Logistic regression analysis showed that high WBC level,high Nugent score,and infections of coccoid microbiota,fungi,Candida spp.,Haemophilus vaginalis,Mycoplasma hominis and Ureaplasma urealyticum were independent risk factors for preterm delivery in the pregnant women(OR=1.086-11.095,all P<0.05).ROC curve analysis showed that AUC of the nomogram for predicting preterm delivery was 0.88(95%CI:0.81-0.94),with an accuracy of 0.79,a sensitivity of 0.76 and a specificity of 0.85.The Hosmer-Lemeshow calibration curve revealed that the model had high goodness of fit(P=0.491).Conclusion The elevated WBC in plasma and presence of specific bacteria,such as fungi,Candida species,Haemophilus vaginalis,Mycoplasma hominis and Ureaplasma urealyticum in vaginal discharge are closely associated with higher incidence of spontaneous preterm delivery in pregnant women.The nomogram model constructed by these factors has good discrimination,consistency and clinical practicability,and is helpful for screening preterm delivery in pregnant women.