妊娠早期阴道微生态与宫颈人乳头瘤病毒感染临床特点分析

Clinical characteristics of vaginal microecology and cervical human papillomavirus infection in pregnant women of early stage

目的通过检测妊娠早期孕妇阴道分泌物中的细菌性阴道病(bacterial vaginosis,BV)、外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)、滴虫性阴道炎(trichomonas vaginitis,TV)和宫颈人乳头瘤病毒(human papillomavirus,HPV)的感染情况,分析妊娠早期孕妇下生殖道感染情况,探讨妊娠早期孕妇阴道微生态变化与宫颈HPV感染的关系。方法选取2017年1~12月于首都医科大学附属北京天坛医院门诊产检的妊娠早期孕妇1019例,采集阴道分泌物检测BV、VVC、TV和阴道清洁度,同时采集宫颈脱落细胞,采用聚合酶链反应(PCR)检测宫颈HPV感染情况。结果1019例妊娠早期孕妇中,阴道微生态失调者共359例(35.2%),其中,BV阳性46例(4.5%),VVC阳性50例(4.9%),TV阳性6例(0.6%),清洁度Ⅲ~Ⅳ337例(33.1%);单一感染组286例(28.1%);2种混合感染者66例(6.5%);3种混合感染组7例(0.7%)。宫颈HPV阳性126例(12.4%),其中高危型HPV阳性110例(10.8%)。与BV阴性组相比,BV阳性组中HPV感染发生率高,二者比较差异有统计学意义(P<0.001,OR:4.16,95%CI:2.10-7.92);此外,高危型HPV感染发生率在BV阳性组中亦较高(P<0.001,OR:3.42,95%CI:1.58-6.91),而VVC和TV与HPV感染无关,差异无统计学意义(P>0.05)。多因素Logistic回归分析亦表明,BV阳性对HPV感染(P<0.001,OR:3.96,95%CI:1.95-7.85)和高危型HPV感染(P=0.00249,OR:3.26,95%CI:1.46-6.82)均有显著影响。结论妊娠早期阴道微生态失调发生率较高,妊娠早期BV感染与宫颈HPV感染密切相关。

Objective This study aims to investigate the infection of bacterial vaginosis(BV), vulvovaginal candidiasis(VVC), trichomonas vaginitis(TV) in vaginal secretions of early stage pregnant women, in addition, cervical human papillomavirus(HPV) was also detected. Furthermore, the relationship between vaginal microecological changes and HPV infection was analyzed.Methods From January 2017 to December 2017, 1 019 cases of pregnant women in early stage pregnancy were included in Beijing Tiantan Hospital, Capital Medical University. Vaginal secretions were collected to detect BV, VVC, TV and vaginal cleanliness. Cervical exfoliated cells were also collected to detect HPV infection through polymerase chain reaction.Results Among 1 019 early pregnant women, 359(35.2 %) were vaginal microecological disorders, 46(4.5 %) were BV positive, 50(4.9 %) were VVC positive, 6(0.6 %) were TV positive, 337(33.1 %) were cleanliness Ⅲ~Ⅳ, 286(28.1 %) were single infection group, 66(6.5 %) were 2 kinds mixed infection group and 7(0.7 %) were 3 kinds mixed infection group. 126 cases(12.4 %) were cervical HPV positive, of which 110 cases(10.8 %) were high-risk HPV positive. Compared with BV negative group, the incidence of HPV infection in BV positive group was higher(P<0.001,OR:4.16, 95 % CI:2.10-7.92). The incidence of high-risk HPV infection in BV positive group was also higher(P<0.001,OR:3.42, 95 % CI:1.58-6.91), while there was no significant difference between VVC or TV infection with HPV infection. Multivariate Logistic regression analysis also showed that BV infection in early pregnancy had effects on HPV infection(P<0.001,OR:3.96,95 % CI:1.95-7.85) and high-risk HPV infection(P=0.00249,OR:3.26,95 % CI:1.46-6.82).Conclusion The incidence of vaginal microecological disorders is high in early pregnancy. BV infection in early pregnancy is closely related to cervical HPV infection.