阴道微生态及阴道免疫状态与宫颈病变相关性研究

The correlation between vaginal micro-ecology, vaginal immune status and cervical lesions

目的探讨不同阴道微生态环境及阴道免疫状态与宫颈病变的相关性。方法选取2014年11月至2017年12月就诊于内蒙古医科大学附属医院经病理确诊的宫颈低级别病变(LSIL)136例、宫颈高级别病变(HSIL)263例、宫颈癌33例,健康女性100例为对照组,调查流行病学情况、阴道微生态及阴道免疫状态,分析不同宫颈病变患者的影响因素。结果初次性生活年龄≤20岁、每周性生活次数≥2在宫颈病变组所占比例较高。吸烟、饮酒及乳、肉饮食在宫颈病变组所占比例较高。IgG含量、氨试验(+)、优势菌菌群失调、革兰阳性短杆菌感染(+)、线索细胞(+)、白细胞酯酶(LE)(+)及凝固酶(GADP)(+)在HSIL组及以上的发生高于LSIL组及对照组(P<0.05)。分泌型免疫球蛋白A(s IgA)、IL-2在HSIL组及以上水平降低(P<0.05)。多因素回归分析结果显示:IgG水平增高、GADP(+)是宫颈病变的危险因素;sIgA、IL-2及IL-10水平增高是宫颈病变的保护因素。结论阴道微生态平衡及局部免疫在防御及清除HR-HPV感染中起重要作用。

Objective To explore the correlation between different vaginal micro-ecological environment,vaginal immune status and cervical lesions.Methods One-hundred healthy females were selected as the control group,136 cases of low-grade squamous intraepithelial lesion(LSIL)、263 cases of high-grade squamous intraepithelial lesion(HSIL)and 33 cases of cervical squamous cell carcinoma(SCC)were assigned to the research group to investigate the epidemiology,vaginal micro-ecology and vaginal immunity,and analyze the influencing factors of different cervical lesions.Results The age of the first sexual life<20 years old and the sexual frequency>2 per week accounted for a higher proportion in the cervical lesion group.Smoking,drinking,milk and meat diet accounted for a higher proportion in the cervical lesion group.The incidence of IgG content,ammonia test(+),dominant bacteria imbalance,gram-positive short bacillus infection(+),clue cells(+),LE(+)and GADP(+)in HSIL group and above was higher than that in LSIL group and control group(P<0.05).SIgA and IL-2 decreased in HSIL group and above.The results of multivariate regression analysis showed that increased IgG level and GADP(+)were risk factors of cervical lesions.Increased levels of slgA,IL-2 and IL-10 are protective factors for cervical lesions.Conclusion Vaginal micro-ecological balance,and appropriate local immunity play an important role in the prevention and clearance of HR-HPV infection.