Clinical And Mechanism Observation Of Group B Streptococcus In Pregnant Women With Damp Syndrome

Objective:1.To confirm the rationality and application value of the theory of " Treatment From the Dampness for Leukorrhea Disease" to the colonization of group B streptococcus in pregnancy.2.Based on the retrospective clinical data analysis,the association between the incidence of group B streptococcus colonization and pregnancy outcome in this region was preliminarily revealed.3.According to prospective clinical studies,the characteristics of intestinal flora of patients with group B streptococcus colonization during pregnancy were preliminarily grasped.4.To explore the relationship between intestinal microecological flora composition of pregnant women and maternal blood routine and neonatal blood gas analysis.5.To evaluate the clinical efficacy and safety of Yun-an lotion on group B streptococcus colonization in pregnancy and it’ s effect on the intestinal flora of related patients.6.Through the analysis of intestinal microecological microflora,the relevant mechanism of Yun-an lotion to prevent the complications related to group B streptococcus colonization in pregnancy was preliminarily revealed.Methods:1.Retrospective clinical data analysis:We collected a total of 2,343 pregnant women routinely screened for GBS in the Outpatient Department of Obstetrics and Gynecology of Nanjing BenQ Hospital from June 2017 to December 2018,and analyzed their GBS colonization and pregnancy-related outcomes.2.Prospective clinical efficacy study:(1)The 60 patients with group B streptococcus colonization during pregnancy were randomly divided into:treatment group and control group,with 30 patients in each group.The control group did not take medication during pregnancy.In the treatment group,Yun-an lotion was washed twice a day at 200ml each time for 1 week.Both groups of delivery were treated with prophylactic antibiotics,analyzed their TCM syndrome points,observed their clinical efficacy,and summarized their delivery outcomes,including adverse events such as maternal and infant complications.(2)GBS positive patient strains were screened for in vitro bacterial culture and drug sensitivity test was performed simultaneously.Maternal safety lotion was used to intervene bacterial proliferation for 24 hours,the bacteriosphere range was evaluated,and the efficacy of TCM formula was judged.3.The intestinal microecology of 26 pregnant women samples collected in clinic,which were divided into positive group,GBS positive(GBS+)and negative group(GBS negative,GBS-),including 12 cases in the positive group and 14 cases in the negative group.Using 16S rDNA sequencing technology,while detecting the above 26 patients and healthy population of blood routine,intestinal flora and delivery of neonatal cord blood blood gas analysis,observe the characteristics of pregnant group B streptococcal colonized patients and normal pregnant women,analysis of group B streptococcus colonized pregnant women intestinal microbiota composition and maternal blood routine and neonatal blood gas analysis.Results:1.A retrospective analysis of 2343 pregnant women with routine GBS screening data were collected from the obstetrics and gynecology clinic of Nanjing BenQ Hospital from June 2017 to December 2018,including 110 GBS-positive patients,which calculated that the GBS colonization rate of our hospital was 4.69%.Postpartum hemorrhage and premature rupture of membranes were associated with GBS,and were significantly different(P<0.05).Age,prematurity,vaginitis,anemia,diabetes mellitus,thyroid disease,chlamydia,and mycoplasma infection were not associated with GBS,with no significant differences(P>0.05).2.Routine analysis of maternal bloodThere was no significant difference in blood routine test between GBS positive group and GBS negative group(P>0.05),but there was a significant correlation between OTU level and inflammatory indicators.However,OTU80 was only related to neonatal blood gas,and had no significant correlation with maternal inflammatory indicators.OTU 122 level was positively correlated with monocyte count(r=0.3966,P=0.0449).The level of OTU518 was positively correlated with basophil count(r=0.6096,P=0.0009),while the proportion of monocytes was negatively correlated(r=-0.6144,P=0.0008).The level of OTU375 was negatively correlated with the level of hemoglobin(r=-4169,P=0.0341).3.Blood gas analysis of neonatal umbilical cord bloodThe umbilical artery blood gases from newborns in both groups were analyzed.There were significant correlations between OTU levels and umbilical artery blood gases.Compared with newborns born with carbon-based hemoglobin(FCOHb)from mothers without GBS,those born in GBS-positive mothers were significantly higher than those from GBS-negative mothers,and the proportion of methemoglobin(FMetHb)was significantly lower than those in the negative group.OTU levels and umbilical arterial blood gas levels.The OTU80 levels were positively correlated with the carboxyhemoglobin content(r=0.459,P=0.021),while the methemoglobin content was negatively correlated(r=-0.51,P=0.009).The OTU518 level was negatively correlated with the PCO2(r=-0.4438,P=0.0263).OTU122 levels were positively correlated with PH values(r=0.4133,P=0.04).The OTU375 levels were negatively correlated with the ABE(r=-0.5089,P=0.0094).4.Analysis of TCM syndrome integral in Yun-an lotion treatment group(1)After 1 week of continuous of Yun-an fluid treatment,the incidence of adverse maternal and infant complications decreased in Yun-an treatment group,and the recent clinical efficacy of the treatment group was better than that of the control group(P<0.05).(2)TCM syndrome score:group B(GBS positive<GBS+)and GBS negative(GBS-)(P<0.05).5.In vitro bacterial culture and identification analysisThe K-B method analysis shows that:(1)The diameter of bacteriostatic ring of group B streptococcus standard quality control bacteria samples in the combined Chinese medicine group was larger than that in the single antibiotic control group(P>0.05);(2)The diameter of bacteriostatic ring of the standard strain in the group of single use of the combined Yun-an Chinese medicine group was smaller than that in the penicillin group,and the difference was statistically significant(P<0.05).Phellodendron amurense Rupr has a strong antibacterial ability against GBS.(3)The bacteriostatic ring of the mixed bacteria from group B streptococcus patients in the combination of Yun-an lotion and penicillin was bigger than that in the single antibiotic control group,the difference was statistically significant(P<0.05).(4)The antibacterial effect of the pregnancy TCM compound lotion group alone on the patient-derived strains was significantly lower than that of the penicillin group,and the difference was significant(P<0.05).6.Research on intestinal microecology:(1)OUT analysis showed that the number of OUT in stool samples from GBS+patients was less than that of healthy controls,the difference was significant.(2)Our results showed that Lentisphaerae,Chlorobi,Parcubacteria,Chloroflexi,Gemmatimonadetes,Acidobacteria,Fusobacteria and Fibrobacteres were only detected in GBS+paciprtiants.Actinobacteria,Tenericutes,Firmicutes,Cyanobacteria,unclassified no rank,Bacteroidetes,Verrucomicrobia,Saccharibacteria,Synergistetes,Proteobacteria were the dominant phyla in the microbiome.It indicated that the microbial composition of the samples of the two groups of subjects was similar.Especially,the abundance of Lentisphaerae,Chlorobi,Parcubacteria,Chloroflexi,Gemmatimonadetes,Acidobacteria,Fusobacteria and Fibrobacteres were only detected in participants with GBS colonization.(3)The analysis showed that the samples from the GBS-group and the GBS+group were separated in the horizontal axis direction.The aggregation of the OTU is dependent on the presence of a GBS infection.(4)The results of Wilcoxon rank-sum test showed that GBS negative and GBS positive individuals had different microbiota composition.Dorea,Holdemanella and Oscillibacter were abundant in GBS+paciprtiants.Conclusion:1.Retrospective analysis of the colonization rate of group B streptococcus during pregnancy and maternal and infant complications in this region suggests that GBS colonization is related to premature rupture of membranes and postpartum hemorrhage,and promoting and popularizing GBS screening for pregnant women in the region is conducive to the prevention and treatment of perinatal maternal and infant complications.2.There are obvious differences in the structural characteristics of intestinal flora between GBS positve and negative groups.OTU abundance was significantly reduced in GBS positive pregnant women.Especially,the abundance of Lentisphaerae,Chlorobi,Parcubacteria,Chloroflexi,Gemmatimonadetes,Acidobacteria,Fusobacteria and Fibrobacteres were only detected in participants with GBS colonization.The imbalance of intestinal microflora may be one of the pathogenesis of pregnant women colonized with Group B Streptococcus.3.There were significant correlations between OTU levels and umbilical artery blood gases.There were significant correlations between OTU levels and inflammatory indexes in pregnant women with GBS infection.4.Yun-an lotion combined with antibiotic treatment has the potential to reduce the carrier rate of group B Streptococcus,prevent and block the mother-to-child transmission of group B Streptococcus,and improve pregnancy outcomes.