宫颈癌癌前病变及宫颈癌患者阴道微生态失调相关因素

Related factors of vaginal microecology in cervical cancer precancerous lesions and cervical cancer patients

目的探讨宫颈癌癌前病变及宫颈癌患者阴道微生态失调相关因素。方法选择2016年7月至2018年12月我院收治的200例宫颈癌和癌前病变患者为研究对象,其中宫颈癌患者100例(宫颈癌组),癌前病变患者100例(癌前组),另选50例健康女性为对照组。观察各组对象阴道微生态指标(菌群密集度、菌群多样性、pH和H2O2)水平、HPV感染情况及乳杆菌分布情况。分析患者阴道微生态变化与HPV感染的关系。结果癌前组和宫颈癌组阴道菌群密集度Ⅰ-Ⅳ级的患者分别占33.00%和42.00%,显著高于对照组的10.00%(χ^2=15.7629,P=0.0001);菌群多样性Ⅰ-Ⅳ级的患者分别占35.00%和41.00%,同样高于对照组的6.00%(χ^2=19.7831,P<0.0001)。癌前组和宫颈癌组阴道pH>4.5的患者分别占53.00%和56.00%,高于对照组的12.00%(χ^2=29.2673,P<0.0001);H2O2阴性患者占比分别为63.00%和70.00%,显著高于对照组的18.00%(χ^2=39.3437,P<0.0001);此外,癌前组和宫颈癌组患者HPV检测阳性率分别为62.00%和73.00%,显著高于对照组的6.00%(χ^2=63.6242,P<0.0001)。癌前组和宫颈癌组患者阴道乳杆菌定植密度中位数分别为115(97~279)个/HP和107(81~201)个/HP,显著低于对照组的279(157~365)个/HP(χ^2=8.7421,P<0.0001)。在HPV感染患者中,乳杆菌阳性率及乳杆菌定植密度中位数均低于对照组。Spearman相关分析显示HPV感染与患者阴道微生态正常程度呈负相关,阴道微生态失调与癌前病变分级呈正相关。结论宫颈癌前病变和宫颈癌的发生与患者阴道微生态失调、HPV感染、乳杆菌减少密切相关;同时癌前病变的发展与阴道微生态失调具有相关性。

Objective To investigate the factors affecting vaginal microecology in patients with cervical cancer precancerous lesions and cervical cancer.Methods A total of 200 patients with cervical cancer and precancerous lesions admitted to our hospital from July 2016 to December 2018 were enrolled,including 100 patients with cervical cancer(CC)and 100 patients with precancerous lesions(PL).Another 50 healthy women were selected as the control group.The differences in vaginal microecological indicators,HPV infection and Lactobacillus distribution were observed.The correlation between vaginal microecological changes and HPV infection were analyzed.Results In PL group and CC group,the patients with vaginal flora diversity of I-IV grade accounted for 33.00%and 42.00%respectively,significantly higher than the 10.00%in control group(χ^2=15.7629,P=0.0001);those with diversity of I-IV accounted for 35.00%and 41.00%,respectively,also significantly higher than the 6.00%in the control group(χ^2=19.7831,P<0.0001).In PL group and CC group,patients with pH>4.5 accounted for 53.00%and 56.00%respectively,higher than the 12.00%in the control group(χ^2=29.2673,P<0.0001),and those with negative H2O2 accounted for 63.00%and 70.00%respectively,significantly higher than the 18.00%in the control group.(χ^2=39.3437,P<0.0001).The positive rates of HPV detection in PL and CC groups were 62.00%and 73.00%respectively,significantly higher than that in the control group(χ^2=63.6242,P<0.0001).The median colonization density of lactic acid bacteria was 115(97-279)/HP in PL group and 107(81-201)/HP in CC group,significantly lower than the 279(157-365)/HP in the control group.In the patients with HPV infection,the positive rate of Lactobacilli and the median Lactobacillus colonization density were also significantly lower than in the control group.Spearman correlation analysis showed that HPV infection was significantly negatively correlated with vaginal microecology.There was a significant positive correlation between vaginal microecological disorders and precancerous lesion stage.Conclusion The occurrence of cervical precancerous lesions and cervical cancer is significantly associated with HPV infection,lactobacillus reduction and vaginal microecological disorders.Microecological disorders are also closely related to the development of precancerous lesions.