Frontiers in cellular and infection microbiology · 2026
Construction of a risk prediction model for premature rupture of membranes based on vaginal microecology and systemic inflammation: a prospective cohort study.
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Xu Xiaoyan, Xu Yuance, Zhen Xuehui, Zhang Jianguang, Li Chenyang
Аннотация
OBJECTIVE: To investigate whether vaginal microecological imbalance and group B Streptococcus (GBS) colonization are correlated with premature rupture of membranes (PROM) by activating the maternal systemic inflammatory response and to construct an individualized risk prediction model.
METHOD: This study was a prospective single-center cohort study. A total of 162 singleton pregnant women at 28-37 weeks of gestation who were admitted to Jilin Provincial Maternal and Child Health Hospital from January 2023 to June 2024 were included. Among them, 81 cases were in the PROM group, and 81 cases were in the matched control group. Vaginal secretions were collected for microbiological testing (Nugent score, H2O2, and leukocyte esterase), and GBS colonization was detected by the constant temperature amplification method; serum levels of CRP, PCT, IL-6, and IL-10 were determined by electrochemiluminescence and chemiluminescence methods. LASSO-penalized multivariable logistic regression analysis was used to identify independent risk factors, and a nomogram model was constructed with internal validation by bootstrap resampling (1,000 iterations).
RESULT: The GBS colonization rate in the PROM group was significantly higher (16.0% vs. 3.7%, aOR = 4.87, 95% CI 1.89-12.56). The incidence rates of abnormal vaginal microscopic evaluation (grades III-IV), H2O2 depletion, and leukocyte esterase positivity were all significantly higher than those in the control group (P < 0.01). The ratio of IL-6/IL-10 in the PROM group was significantly increased (P < 0.001). The multivariate model showed that GBS colonization, IL-6 >12 pg/mL, and H2O2 depletion were independent risk factors. The nomogram model constructed based on these indicators had an apparent AUC of 0.89 (95% CI 0.83-0.95) and a bootstrap-corrected AUC of 0.86 (95% CI 0.80-0.92) and excellent calibration (Brier score 0.158, Hosmer-Lemeshow P = 0.423).
CONCLUSION: GBS colonization is associated with a higher incidence of PROM by inducing vaginal microecological imbalance and systemic inflammatory responses. The "microecology-inflammation" nomogram model we have developed shows potential for individualized prediction of the risk of PROM pending external validation, providing a basis for early intervention.
METHOD: This study was a prospective single-center cohort study. A total of 162 singleton pregnant women at 28-37 weeks of gestation who were admitted to Jilin Provincial Maternal and Child Health Hospital from January 2023 to June 2024 were included. Among them, 81 cases were in the PROM group, and 81 cases were in the matched control group. Vaginal secretions were collected for microbiological testing (Nugent score, H2O2, and leukocyte esterase), and GBS colonization was detected by the constant temperature amplification method; serum levels of CRP, PCT, IL-6, and IL-10 were determined by electrochemiluminescence and chemiluminescence methods. LASSO-penalized multivariable logistic regression analysis was used to identify independent risk factors, and a nomogram model was constructed with internal validation by bootstrap resampling (1,000 iterations).
RESULT: The GBS colonization rate in the PROM group was significantly higher (16.0% vs. 3.7%, aOR = 4.87, 95% CI 1.89-12.56). The incidence rates of abnormal vaginal microscopic evaluation (grades III-IV), H2O2 depletion, and leukocyte esterase positivity were all significantly higher than those in the control group (P < 0.01). The ratio of IL-6/IL-10 in the PROM group was significantly increased (P < 0.001). The multivariate model showed that GBS colonization, IL-6 >12 pg/mL, and H2O2 depletion were independent risk factors. The nomogram model constructed based on these indicators had an apparent AUC of 0.89 (95% CI 0.83-0.95) and a bootstrap-corrected AUC of 0.86 (95% CI 0.80-0.92) and excellent calibration (Brier score 0.158, Hosmer-Lemeshow P = 0.423).
CONCLUSION: GBS colonization is associated with a higher incidence of PROM by inducing vaginal microecological imbalance and systemic inflammatory responses. The "microecology-inflammation" nomogram model we have developed shows potential for individualized prediction of the risk of PROM pending external validation, providing a basis for early intervention.