人乳头状瘤病毒与妇科其他常见病原微生物感染关系的调查

Association of human papillomavirus infection with other microbial pathogens in gynecology

目的 探讨人乳头状瘤病毒（HPV）感染与妇科其他常见病原微生物感染的关系.方法 收集2007年6月至2008年12月在浙江省温岭市第一人民医院妇科门诊就医的857例妇女的宫颈和阴道拭子标本,采用PCR技术检查HPV DNA及其基因分型,采用链替代扩增方法检测沙眼衣原体,其他妇科病原微生物的检测按照常规方法进行,统计分析结果资料.结果 本研究收集的857例妇女中检测出HPV阳性266例,阳性率为31.0%（266/857）.在266例HPV阳性妇女中,除4例为混合基因型,其余262例共检测出35种HPV的不同亚型,各亚型按所出现频率〉5%排列,分另是HPVl6（14.5%,38/262）、HPV58（9.2%,24/262）、HPV53（8.0%,21/262）、HPV42（6.1%,16/262）;HPV高危型和可能高危型占58.8%（154/262）,HPV低危型占27.9%（73/262）,HPV未知危险型占13.4%（35/262）.宫颈脱落细胞检测结果显示,63.2%（168/266）的HPV阳性妇女未见异常细胞,3.8%（10/266）是高度鳞状上皮内病变（HSIL）,29.7%（79/266）是低度鳞状上皮内病变（LSIL）,3.0%（8/266）是未明确诊断意义的不典型鳞状上皮细胞（ASCUS）.在所有研究对象中未检测出淋病奈瑟菌,人型支原体在所有研究对象中仅检测出2例.logistic回归分析显示,HPV感染与沙眼衣原体和解脲支原体[〉10000颜色变化单位（CCU）/ml]感染具有显著相关性（P均〈0.01）,而细菌性阴道病、无乳链球菌、假丝酵母菌、阴道毛滴虫和解脲支原体（≤l0000 CCU/ml）与HPV感染无相关性（P均〉0.05）;但患细菌性阴道病妇女的HPV阳性率为42.6%.沙眼衣原体是HPV感染的高危因素（OR=2.82,95%CI为1.74～4.57）.结论 细菌性阴道病与HPV感染虽不具有相关性,但其在HPV阳性妇女中普遍存在.HPV感染与沙眼衣原体和解脲支原体感染具有相关性;

Objective To Investigate correlation between screening assay of human papillomavirus （HPV） and microbial pathogens in gynecology. Methods Cervical samples were collected to search for HPV, bacteria and yeast infections in gynecologic outpatients. HPV typing was carried out by PCR and sequencing on cervical brush specimens. Chlamydia trachomatis was identified by strand displacement amplification （SDA） and the other microorganisms were detected by conventional methods. All data were analyzed to investigate the correlation among them. Results In this cross-sectional study, among 857 enrolled outpatients, there were 266 cases with positive HPV DNA, and the rate of infection was 31.0%（266/857）. HPV genotype showed that thirty-five different HPV types were identified, of which HPV16 was the most prevalent （ 14.5%, 38/262）, followed by HPV58 （9.2%, 24/262）, HPV53 （8.0%, 21/262）and HPV42 （6.1%, 16/262）; while other genotypes were present in less than 5% of HPV positive women.According to the reclassification, the aggregated percentage （high-risk and probably high-risk） of detected HPV was 58.8% （ 154/262）, 27.9% （73/262） for low-risk and 13.4% （35/262） for unknown-risk HPV types. Among HPV positive women, cervical brush specimens results showed that more than 60% cases with normal cytology, 3.8% （10/266） with high-grade squamous intraepithelial lesions （HSIL）, 29. 7% （79/266） with low-grade squamous intraepithelial lesions （LSIL） and 3.0% （8/266） with atypical squamous cells of undetermined significance （ASCUS）, respectively. Statistical analyses revealed there was a significant association between the infected HPV and Chlamydia trachomatis or Ureaplasma urealyticum （ 〉10000 CCU/ml; all P 〈0.01）, while no correlation was found between HPV infection and bacterial vaginosis, streptococcus agalactiae, candida, Trichomonas vaginalis or Ureaplasma urealyticum （ ≤ 10000CCU/ml; all P 〉 0.05 ）. Among the cases with bacterial vaginosis, the positive rate of HPV infected was42.6%. Chlamydia trachomatis was one of the high-risk factors for the infection of HPV （ OR = 2.82, 95%CI： 1.74 -4.57）. Mycoplasma hominis was isolated only in 2 cases, no patient was infected with Neisseria gonorrhocae. Conclusions Although bacterial vaginosis was not significantly associated with HPV, it was more common among the HPV positive women. There is the significant association between HPV and Chlamydia trachomatis or Ureaplasma urealyticum which may be increase the infection of HPV. These data suggest that it may be important to screen for the simultaneous presence of different microorganisms which may have synergistic pathological effects.