宫颈癌合并生殖道感染的主要致病菌与耐药性

Pathogenic bacterium and drug resistance in cervical cancer patients complicated with reproductive tract infection

目的：分析宫颈癌患者合并生殖道感染的主要病原菌及其耐药性，初步了解生殖道细菌感染是否能协同高危HPV感染增加宫颈癌发生的危险。方法：选择216例新疆肿瘤医院经病理证实为宫颈癌的新发病例作为研究组，另选择同期53例排除其他恶性肿瘤的慢性宫颈炎患者作为对照组。两组在诊断治疗前均采集阴道分泌物进行HPVD瞄染检测、常规细菌培养及药敏检测，了解两组HPv感染情况及阴道分泌物细菌分布和耐药特点。结果：研究组革兰阴性菌占74．38％，对氨苄西林和哌拉西林耐药率最高（75％～100％）；革兰阳性菌占21．49％，对青霉素和红霉素耐药率最高（87％～100％）。对照组革兰阴性菌占42．31％，对氨苄西林和哌拉西林耐药率高（50％～100％）；革兰阳性菌占23．08％，对青霉素耐药率可高达100％。两组在菌群分布和细菌耐药性方面比较；差异无统计学意义p〉0．05）。研究组细菌感染同时伴HP堪染者70例，对照组12例，两组比较差异无统计学意义（P〉0．05）。结论：宫颈癌患者阴道致病菌主要以大肠埃希菌为主，致病菌对传统抗生素耐药率高，应根据药敏试验结果合理使用抗生素。生殖道细菌感染可能未协同高危HPV感染增加宫颈癌发生的危险。

Objective： To determine the vaginal flora distribution in cervical cancer patients and the common pathogenic bacteria as well as drug resistance, and to explore the correlation of vaginal bacterial infection and high-risk human papillomavirus （HR-HPV） infection with cervical cancer. Methods： A total of 216 patients with cervical cancer served as an experimental group, and 53 patients with chronic cervicitis served as a control group. The patients＇ vaginal fluid in two groupswas collected before the treatment for regular bacterial culture and HPV testing. The distribution and drug resistance of bacteria in two groups of vaginal secretion were observed, and the correlation of the bacterial infection and HPV infection with the cervical cancer was analyzed. Results： The gram-negative and gram-positive bacteria accounted for 74.38% and 21.49% in the experimental group, respectively. They were mainly resistant to ampicillin and piperacillin or penicillin and erythromycin. The gram-negative and gram-positive bacteria accounted for 42.31% and 23.08% in the control group, respectively. They were mainly resistant to ampiciUin and piperacillin or penicillin. HPV-positive rates in the experiment group and the control group were 60.65% and 41.51%, respectively. There were 70 patients （32.41%） and 12 patients （22.64%） with both bacterial infection and HPV-positive infection in the experiment group and the control group, respectively. However, there was no statistical difference between the 2 groups （P〉0.05）. Conclusion： Escherichia coli are the main pathogen in cervical cancer and they are highly resistant to antibiotics. Bacterial infection in genital tract is not an efficient cofactor for HPV to cause the cervical cancer.