妊娠晚期HPV潜伏感染对妊娠结局的影响

HPV latent infection during the third trimester of pregnancy and its influence to pregnancy outcome.

目的:探讨妊娠晚期HPV潜伏感染是否改变了阴道内酸性环境及阴道菌群,进而对妊娠结局产生不良影响;了解妊娠晚期HPV潜伏感染的高危因素。方法:选取我院产检的孕妇312例,孕28～30周。进行问卷调查,取阴道分泌物及宫颈分泌物检测滴虫、念珠菌性阴道炎、细菌性阴道病及HPV;检测阴道pH值,按照HPV DNA是否阳性分研究组与对照组,追踪孕妇不良妊娠结局的发生情况。结果:妊娠晚期HPV DNA阳性发生率45.51%(142/312),感染高危型23.08%(72/312),低危型16.67%(52/312),高危型与低危型混合感染18例,发生率5.77%(18/312);妊娠合并念珠菌性阴道炎患病率15.06%(47/312);妊娠合并滴虫性阴道炎患病率1.28%(4/312);妊娠合并细菌性阴道病患病率29.81%(93/312)。研究组孕妇阴道pH值明显高于对照组,差异有显著性(P<0.05);研究组与对照组细菌性阴道病发生率有显著差异(P<0.05);而两组间念珠菌性阴道炎、滴虫性阴道炎的发生率无显著差异(P>0.05);妊娠晚期HPV潜伏感染与低文化水平、吸烟因素及首次性生活年龄小有关(P<0.05);研究组与对照组间分娩方式相似。结论:妊娠晚期HPV潜伏感染与阴道内酸性环境改变相关,增加了妊娠合并细菌性阴道病的发生率且可增加胎膜早破发生。对围生期妇女行生殖道感染筛查,尤其是HPV、BV检测很有必要。

Objective：To investigate the HPV latent infection rate in pregnant women. To explore alterations in the vaginal flora and pH of pregnant women in association with the presence of cervical HPV infection,which may lead to the adverse outcome of pregnancy. To study the factors predisposing towards the acquisition of this infection. Methods：312 voluntary pregnancy women regularly examined in our hospital were asked about predisposing factors of HPV and evaluated by questionnaire face to face. The measurement of vaginal pH was done by using accurate pH test paper. Vaginal secretions were tested and cultivated for cleaning degree, trichomonas vaginalis,BV and Candida sp. The expression of HPV DNA was explored by real-time PCR in cervical secretions and exfoliated cell. Women with HPV infection were in the case group, women without HPV infection were in the control group. The pregnant outcome was observed. Results：There were 142 pregnant women with HPV infection（45.51% ） ,23.08% （72 cases） presented high-risk HPV,16.67% （52 cases） presented low-risk HPV and 5.77% （ 18 cases） presented an association of low and high-risk HPV. The prevalence of candidiasis was 15.06% （47 cases）. The prevalence of trichomonas vaginalis was 1.28% （4 cases）. The preva- lence of BV was 29.81% （93 cases）. The vaginal pH was higher in the HPV-positive group than that in the HPV-negative group （ P〈0.05 ）. The prevalence of BV was higher in HPV infection group than that in control group（P〈0.05）. But the infection rates of Candida sp and trichomonas vagnalis were similiar in two groups（P〉0.05 ）. HPV latent infection had correlations with educational background, smoking, the age of first sexual life. There was no statistically difference in the mode of delivery between two group. Conclusion：The research shows that HPV infection is associated with variations in vaginal pH. The lower reproductive tract infection during the third trimester of pregnancy increases the incidence of adverse outcome of pregnant. Genital tract infection should be tested and treated actively.