摘要目的:探讨妊娠期下生殖道无乳链球菌（group B streptococcus，GBS）定植情况以及产时抗生素预防（intrapartum antibiotic prophylaxis，IAP）的应用对围产结局的影响。方法:回顾性分析2020年1月至2021年2月于北京友谊医院通州院区及西城院区住院分娩的1 078例孕妇及其所分娩新生儿的临床资料，根据GBS定植情况分组，比较GBS阳性和阴性组孕妇的临床特征、合并症、围产结局和新生儿预后，以及应用IAP对GBS阳性孕妇临床特征、合并症、围产结局和新生儿预后的影响。呈正态分布的计量资料以 xˉ± s表示，两组间比较采用两独立样本 t检验，非正态分布的计量资料以 M（ Q1， Q3）表示，组间比较采用Mann-Whiteney U检验；计数资料以例或例（%）表示，组间比较采用χ 2检验或Fisher确切概率法。 结果:1 078名孕妇中GBS阳性93例（8.6%，GBS阳性组），选择与GBS阳性组临床资料匹配的93例作为GBS阴性组。GBS阳性组年龄、孕龄、孕次、产次、分娩方式、血压异常、血糖异常、甲状腺功能异常以及任一合并症比例比较，差异均无统计学意义（ P值分别为0.630、0.613、0.311、0.761、0.163、0.601、0.467、0.388、1.000）。GBS阳性组新生儿转儿科比例和新生儿感染、肺炎、贫血的发生率以及菌群感染率均高于GBS阴性组［57.0%（53/93）比23.7%（22/93），10.8%（10/93）比3.2%（3/93），29.0%（27/93）比14.0%（13/93），21.5%（20/93）比8.6%（8/93），22.6%（21/93）比6.5%（6/93）］（χ 2值分别为21.47、4.05、6.24、6.05、9.75， P值分别为<0.001、0.044、0.012、0.014、0.002），且新生儿的住院时间长于GBS阴性组［4（0，5）d比0（0，0）d， Z=-4.03， P<0.001］。IAP组新生儿转儿科比例和病理性黄疸、不良结局发生率均低于非IAP组［51.1%（24/47）比78.1%（25/32），44.7%（21/47）比78.1%（25/32），42.6%（20/47）比65.6%（21/32）］（χ 2值分别为5.92、8.76、4.06， P值分别为0.015、0.003、0.044），新生儿住院时间短于非IAP组［3（0，5）d比5（2，7）d， Z=-2.60， P=0.009］，两组分娩方式、破水时间，新生儿出生体质量和感染、肺炎、菌血症/败血症、贫血发生率比较差异均无统计学意义（ P值分别为0.073、0.085、0.479、0.538、0.157、0.161、0.238）。 结论:下生殖道GBS定植不增加孕妇宫内感染、胎膜早破及自发性早产发生率，但新生儿发生菌群感染和不良结局的风险更高，转儿科率更高，住院时间更长。IAP能够降低新生儿病理性黄疸发生率，缩短住院时间。

abstractsObjective:To investigate the effect of the colonization of group B streptococcus (GBS) in pregnant women and the use of intrapartum antibiotic prophylaxis (IAP) on perinatal outcomes.Methods:The clinical data of 1 078 pregnant women and their newborn babies delivered in Tongzhou and Xicheng hospital areas of Beijing Friendship Hospital from January 2020 to February 2021 were analyzed retrospectively. The clinical characteristics, complications, perinatal outcomes and neonatal prognosis of the pregnant women with positive and negative GBS were compared according to the GBS colonization, and the effects of IAP on the clinical characteristics, complications, perinatal outcomes and neonatal prognosis of the pregnant women with positive GBS was compared. The measurement data with normal distribution is expressed by x±s, two independent sample t-test was used for comparison between groups. Counting data were expressed in cases or cases (%), Inter group comparison χ 2 test. Results:Among 1 078 pregnant women, 93 were GBS positive (8.6%, GBS positive group), and 93 cases matching the clinical data of the GBS positive group were selected as the GBS negative group. There was no significant difference in age, gestational age, number of pregnancies, number of births, mode of delivery, abnormal blood pressure, abnormal blood glucose, abnormal thyroid function and the proportion of any complication in the GBS positive group (P values were 0.630, 0.613, 0.311, 0.761, 0.163, 0.601, 0.467, 0.388, 1.000, respectively). The proportion of neonates in GBS positive group transferred to pediatrics, the incidence of neonatal infection, pneumonia, anemia and bacterial infection rate were higher than those in GBS negative group (57.0%(53/93) vs 23.7%(22/93), 10.8%(10/93) vs 3.2%(3/93), 29.0%(27/93) vs 14.0%(13/93), 21.5%(20/93) vs 8.6%(8/93), 22.6%(21/93) vs 6.5%(6/93)) (χ 2 values were 21.47, 4.05, 6.24, 6.05, 9.75, respectively; the P values were <0.001, 0.044, 0.012, 0.014, 0.002, respectively). The hospitalization time of neonates transferred to pediatrics was longer than that of GBS negative group (4(0,5) d vs 0(0,0) d, Z=-4.03, P<0.001). The proportion of neonates in IAP group transferred to pediatrics and the incidence of pathological jaundice and adverse outcomes were lower than those in non IAP group (51.1% (24/47) vs 78.1% (25/32), 44.7% (21/47) vs 78.1% (25/32), 42.6% (20/47) vs 65.6% (21/32)) (χ 2 values are 5.92, 8.76 and 4.06, respectively, P values are 0.015, 0.003 and 0.044 respectively). The hospitalization time of neonates transferred to pediatrics was shorter than that of non IAP group (3(0,5) d vs 5(2,7) d, Z=-2.60, P=0.009). There was no significant difference between the two groups in terms of delivery mode, water breaking time, birth weight of neonates, infection, pneumonia, bacteremia/sepsis, and anemia ( P values were 0.073, 0.085, 0.479, 0.538, 0.157, 0.161, 0.238). Conclusions:GBS colonization in the lower genital tract does not increase the incidence of intrauterine infection, premature rupture of membranes and spontaneous preterm delivery in pregnant women, but the risk of bacterial infection and adverse outcomes in newborns is higher, the rate of paediatric transfer is higher, and the hospital stay is longer. IAP can reduce the incidence of neonatal pathological jaundice and shorten the hospital stay.