宫颈高危型人乳头瘤病毒感染与阴道菌群及宫颈局部免疫功能的关系

Relationship between high-risk human papillomavirus infection and vaginal flora and cervical local immune function

目的探讨宫颈高危型人乳头瘤病毒(HPV)感染与阴道菌群及宫颈局部免疫功能的相关性。方法选取2013年1月-2015年12月医院妇科门诊有生殖道感染症状的患者300名,根据是否有高危型-HPV感染分为高危型-HPV组(高危型-HPV阳性组)123例和对照组(高危型-HPV阴性组)177例,检测所有患者中高危型-HPV感染、阴道菌群和宫颈分泌物CD_4^+ T、CD_8^+ T情况。结果 300例患者中高危型-HPV感染者123例,感染率为41.0%,其中HPV16亚型70例,占56.9%,其次为HPV52亚型,占13.8%。高危型-HPV组乳酸杆菌、衣原体、解脲脲原体、细菌性阴道病的阳性率高于对照组(P<0.05),两组人支原体、霉菌和滴虫的阳性率比较差异无统计学意义;高危型-HPV组宫颈分泌物CD_4^+ T和CD_4^+ T/CD_8^+ T均低于对照组(P<0.05),两组宫颈分泌物CD_8^+ T比较差异无统计学意义;多因素logistic回归结果显示,衣原体、解脲脲原体是高危型-HPV感染的独立影响因素(P<0.05)。结论宫颈高危型人乳头瘤病毒感染与阴道菌群及宫颈局部免疫功能有关,衣原体、解脲脲原体是高危型-HPV感染的独立影响因素。

OBJECTIVE To explore the relationship between cervical high-risk human papillomavirus （HPV） infection and vaginal flora and cervical local immune function.METHODS A total of 300 patients with genital tract infection who were treated in gynecology outpatient department form Jan 2013 to Dec 2015 were enrolled in the study and divided into the high-risk HPV group （high-risk HPV positive group） with 123 cases and the control group （high-risk HPV negative group） with 177 cases.The prevalence of high-risk HPV infection,vaginal flora,and CD4 ＋ T,CD8 ＋T in cervical secretions of all the patients were observed.RESULTS Of the 300 patients,123 had the high-risk HPV infection,with the infection rate 41.0%,of whom 56.9% （70 cases） had HPV16 infection,and 13.8% had HPV52 infection.The positive rate of Lactobacilli,Chlamydia,Ureaplasma urealyticum,or bacterial vaginosis was significantly higher in the high-risk HPV group than in the control group （P〈0.05）.There was no significant difference in the positive rate of Mycoplasma,mycete,or trichomonas between the two groups.The levels of CD4 ＋ T and CD4 ＋ T/CD8 ＋ T in cervical secretions were lower in the high-risk HPV group than in the control group （P〈0.05）,and there was no significant difference in the cervical secretions CD8 ＋T level between the two groups.The result of multivariate logistic regression analysis indicated that the Chlamydia and U.urealyticum were the independent risk factors for the high-risk HPV infection （P〈0.05）.CONCLUSION The cervical infection with high-risk HPV is associated with the vaginal flora and cervical local immune function.The Chlamydia and U.urealyticum are the independent risk factors for the high-risk HPV infection.