下生殖道常见性传播病原体检测及其与HPV感染和子宫颈上皮内瘤变的相关性

Detection of common STIs pathogens in lower reproductive tract and its relationship with HPV infection and cervical intraepithelial neoplasia

目的检测性传播感染(STIs)病原体,如沙眼衣原体(CT)、人型支原体(MH)、微小脲原体(UP1、3、6、14)和解脲脲原体(UU)等在女性下生殖道的感染率,探讨其与人乳头瘤病毒(HPV)感染和子宫颈上皮内瘤变(CIN)之间的相关性。方法以2017年11月至2019年5月期间在中国医科大学塔城医院进行子宫颈癌筛查的360例女性为研究对象,采用PCR及导流杂交方法,对受试者子宫颈脱落细胞进行STIs病原体、HPV和子宫颈细胞学检查,对需要行阴道镜活检的受试者,根据病理结果分为正常组、CIN组和子宫颈癌组,比较STIs感染在组间的差异。结果 (1)在360例受试者中,215例被检出STIs感染,感染率为59.7%,6种检出率较高的STIs病原体为UP6、UP3、MH、UU、CT、UP1,感染率分别为20.6%、19.2%、18.6%、10.3%、9.7%、7.5%;在感染类型中,STIs以混合型感染为主,其中单一、双重和多重感染率分别为41.3%、37.3%、21.4%;HPV以单一型感染为主,其中单一、双重、多重感染率分别为82.4%、14.1%、3.5%;HPV阳性组及HPV阴性组之间STIs感染率差异有统计学意义(χ^2=7.088,P<0.05),表明两者之间感染具有一致性。(2)10种STIs病原体与HPV感染之间logistic回归分析显示,MH、UP1感染组与未感染组之间HPV感染率比较,差异有统计学意义(MH:OR=4.579,95%CI 1.607~13.048,P<0.05;UP1:OR=1.100,95%CI 1.060~1.140,P<0.05),提示MH、UP1感染是HPV感染的独立危险因素。(3)MH、UU感染率在子宫颈细胞学异常组与正常组之间比较,差异有统计学意义(MH:χ^2=6.259,P<0.05;UU:χ^2=5.623,P<0.05),提示MH和UU感染与子宫颈细胞学异常呈正相关。(4)HPV感染女性中STIs感染率在病理组织学异常组与正常组之间比较,差异无统计学意义,即HPV感染导致CIN乃至浸润癌的过程中与STIs病原体的感染无关。结论 HPV感染女性一般伴随STIs混合感染,两者之间存在内在关联,下生殖道MH、UP1、UU感染是HPV感染和CIN的危险因素,应当引起临床的关注。

Objective To investigate the infection rates of common sexually-transmitted infection(STIs)pathogens such as Chlamydia trachomatis(CT),Mycoplasma hominis(MH),Ureaplasma parvum(UP1、UP3、UP6、UP14)and Ureaplasma urealyticum(UU)etc.,in the female lower genital tract,and to explore their correlation with HPV infection and cervical intraepithelial neoplasia(CIN).Methods Totally 360 women who underwent cervical cancer screening in Tacheng Hospital of China Medical University from November 2017 to May 2019 were included in this research,and specimens of cervical exfoliation cells were given STIs and HPV and cytology tests by PCR and flow-through hybridization;the patients who needed to undergo colposcopy biopsy examinations were divided into normal,CIN and cervical cancer group according to the pathological results,and the differences in STIs infection were compared among the groups.Results(1)Among the 360 subjects,215 were found to be infected with STIs,with a rate of 59.7%. The six pathogens with a higher detection rate were UP6,UP3,MH,UU,CT and UP1,the infection rate(%)being 20.6%,19.2%,18.6%,10.3%,9.7% and 7.5%,respectively. STIs was mainly mixed infection,and the rate of single,double and multiple infection was 41.3%,37.3% and 21.4%,respectively. HPV was mainly a single infection,and the rate of single,double and multiple infection was 82.4%,14.1% and 3.5%,respectively. There was a significant difference in STIs infection rate between HPV positive and negative group(χ^2=7.088,P<0.05),indicating the high consistency.(2)Logistic regression analysis of 10 STIs pathogens and HPV infection showed that there was statistically significant difference in HPV infection rate between the MH,UP1-infected and uninfected groups(MH:OR=4.579,95%CI 1.607-13.048,P<0.05;UP1:OR=1.100,95%CI 1.060-1.140,P<0.05),suggesting that MH and UP1 infections were independent risk factors for HPV infenction.(3)The difference in MH and UU infection rate between the abnormal and normal cytological groups was significant(MH:χ^2=6.259,P<0.05;UU:χ^2=5.623,P<0.05),indicating that MH and UU infection was positively correlated with cervical cytological abnormalities.(4)There was no significant difference between the abnormal and the normal histopathological group in the infection rate of STIs in patients with HPV infection,that was,the process of HPV infection inducing cervical tissue neoplasia and even infiltrating cancer had no relationship with STIs pathogens.Conclusion HPV infection is generally accompanied by mixed infection of STIs,and there is a strong connection between them. The infection of MH,UP1 and UU in the lower genital tract are risk factors for HPV and cervical intraepithelial neoplasia,which should be clinically concerned about.