甘肃地区宫颈癌及癌前病变患者阴道微生态分析

Microecological analysis of cervical cancer and precancerous lesions in Gansu

目的探讨甘肃地区宫颈癌及癌前病变患者阴道微生态分析。方法选择2017年11月至2018年1月,在甘肃省妇幼保健院接受诊治的宫颈癌及癌前病变患者,以80例宫颈癌患者为宫颈癌组及120例癌前病变患者为癌前病变组。同时选择同期健康妇女60例为对照组,分别进行阴道微生态评价,HPV检查。分析阴道微生态变化与HPV感染、病变级别、癌症分期的相关性。结果癌前病变组和宫颈癌组患者HPV阳性占比(64.17%,80.00%),显著高于对照组(15.00%,P<0.05),癌前病变组和宫颈癌组菌群多样性级别分布Ⅰ、Ⅳ级占比(40.83%,60.00%)明显高于对照组(3.33%,P<0.05)。癌前病变组和宫颈癌组菌群密集度级别分布Ⅰ、Ⅳ级占比(37.50%,46.25%)明显高于对照组(10.00%,P <0.05)。癌前病变组和宫颈癌组阴道pH>4.5的占比(57.50%,55.00%),明显高于对照组(11.67%,P<0.05),另外癌前病变组和宫颈癌组H_2O_2阴性占比(60.00%,67.50%),明显高于对照组(23.33%,P<0.05)。在对照组、癌前病变组及宫颈癌组,HPV阳性与阴道微生态正常均呈现显著负相关(P<0.05),另外宫颈癌组阴道微生态失调占比(73.75%)明显高于癌前病变和对照组(16.67%)。经分析发现阴道微生态失调与癌前病变分级显著正相关(P<0.05),而与宫颈癌TNM分期相关性不显著(P>0.05)。结论宫颈癌前病变和宫颈癌患者阴道微生态失调占比较大,且HPV感染与阴道微生态失调密切相关,同时微生态失调与癌前病变的发生发展密切相关,因此建议在甘肃地区宫颈癌筛查防治中,将阴道微生态失调作为重要参考。

Objective To investigate the microecological analysis of cervical cancer and precancerous lesions in Gansu. Methods Select patients with cervical cancer and precancerous lesions who were treated in Gansu provincial maternal and child health hospital from Nov.2017 to Jan.2018. 80 cases of cervical cancer were treated as cervical cancer group and 120 precancerous lesions as precancerous lesions group, and 60 healthy women were selected as control group at the same time. All research subjects were treated Human papillomavirus （HPV）examination and vaginal microecological evaluation. And the relationship on the change of vaginal microecological, the stage of cervical cancer and precancerous lesions was analyzed. Results The proportion of HPV positive in precancerous lesion group and cervical cancer group （64.17 % , 80.00 % ）were significantly higher than that in control group （15.00 % , P 〈0.05）. The bacterial diversity level distribution of Ⅰ, Ⅳ grade proportion in precancerous lesion group and cervical cancer group （40.83 % ,60.00 % ）were significantly higher than that in control group （3.33 % , P 〈0.05）. the distribution of concentration levels of flora Ⅰ, Ⅳ ratio in precancerous lesion group and cervical cancer group （37.50 % ,46.25 % ）were significantly higher than that in control group （10.00 % , P 〈0.05）. The proportion of pH〉4.5 in precancerous lesion group and cervical cancer group （57.50 % ,55.00 % ）were significantly higher than that in control group （11.67 % , P 〈0.05）.the H 2O 2 negative ratioin precancerous lesion group and cervical cancer group（60.00 % ,67.50 % ） were significantly higher than that in control group （23.33 % , P 〈0.05）. In the control group, precancerous lesions and cervical cancer, there were significant negative correlation between HPV positive and vaginal microecology （ P 〉0.05）. In addition, the proportion of vaginal microecological disorder in cervical cancer group（73.75 % ）was significantly higher than that in precancerous lesion and control group. It was found that the microecological imbalance of vagina was positively correlated with the grade of precancerous lesions （ P 〈0.05）, but the correlation with TNM stage of cervical cancer was not significant （ P 〉0.05）. Conclusion Precancerous lesions and cervical cancer patients account for a large proportion of vaginal microecological disorders, and HPV infection is closely related to vaginal microecological disorders, and microecological disorders are closely related to the occurrence and development of precancerous lesions. In the screening and prevention of cervical cancer in Gansu, vaginal microecological disorder is regarded as an important reference.