人乳头瘤病毒感染和阴道微环境紊乱与宫颈病变的关系

Relations of human papillomavirus infection,vaginal micro-environmental disorder with cervical lesion

目的探讨人乳头瘤病毒(HPV)感染和阴道微环境紊乱与宫颈病变的关系及其交互效应。方法从课题组前期建立的自然人群队列中选取基线调查时确定的正常宫颈(NC)妇女623人、低度宫颈病变(CINⅠ)妇女303人及高度宫颈病变(CINⅡ/Ⅲ)妇女93人为研究对象。以NC为对照组、CIN为病例组,采用病例对照研究方法,在收集研究对象人口学特征、生殖情况、生活习惯、既往病史宫颈病变相关因素的基础上,应用导流杂交法检测HPV分型,需氧菌性阴道炎/细菌性阴道炎联合检测试剂盒检测阴道分泌物中的H2O2,精密pH试纸检测阴道pH值,涂片法检测阴道清洁度。利用SPSS 20.0软件进行相关资料的分析。结果HPV(CINⅠ:aOR=1.39,95%CI:1.01~1.90;CINⅡ/Ⅲ:aOR=11.74,95%CI:6.96~19.80)、H2O2(CINⅠ:aOR=2.09,95%CI:1.47~2.98;CINⅡ/Ⅲ:aOR=4.12,95%CI:2.01~8.43)、清洁度(CINⅡ/Ⅲ:aOR=2.62,95%CI:1.65~4.14)和综合指标(CINⅠ:aOR=1.67,95%CI:1.24~2.25;CINⅡ/Ⅲ:aOR=4.24,95%CI:2.30~7.81)均可增加宫颈病变的患病风险,随着宫颈病变的进展,HPV(趋势性χ^2=81.33,P<0.001)感染率、阴道pH值(趋势性χ^2=5.06,P=0.024)、H2O2(趋势性χ^2=26.19,P<0.001)、清洁度(趋势性χ^2=19.55,P<0.001)和综合指标(趋势性χ^2=30.50,P<0.001)的异常率均呈逐渐升高趋势。交互作用分析显示,HPV感染与阴道微环境的综合指标在CINⅡ/Ⅲ组中显示有正相加交互作用,而无论HPV感染与否,阴道微环境紊乱致CINⅠ的OR值比较接近。结论HPV感染和阴道微环境紊乱均可增加宫颈病变的患病风险,尤其在CINⅡ/Ⅲ发生发展中两者可能存在协同作用,而在CINⅠ发生中阴道微环境紊乱的作用不可忽视。

Objective To study the relations of human papillomavirus(HPV)infection,vaginal micro-environmental disorder with cervical lesion.Methods A total of 1019 women including 623 with normal cervical(NC),303 with low-grade cervical lesion(CINⅠ)and 93 with high-grade cervical lesion(CINⅡ/Ⅲ)were enrolled in this study from the communities in Shanxi province,China.Case-control method was adopted,with NC as the control group and CIN as the case group.Related information was collected including demographic characteristics and relevant factors related to cervical lesions.HPV genotypes were detected by flow-through hybridization technology.Vaginal pH was detected by the pH test paper.Vaginal H2O2 was detected by the combined detection kit of aerobic vaginitis and bacterial vaginosis.Vaginal cleanliness was detected by smear method.Results Data from the unconditional logistic regression analysis showed that HPV infection(CINⅠ:aOR=1.39,95%CI:1.01-1.90;CINⅡ/Ⅲ:aOR=11.74,95%CI:6.96-19.80),H2O2(CINⅠ:aOR=2.09,95%CI:1.47-2.98;CINⅡ/Ⅲ:aOR=4.12,95%CI:2.01-8.43),cleanliness(CINⅡ/Ⅲ:aOR=2.62,95%CI:1.65-4.14),and composite indicators(CINⅠ:aOR=1.67,95%CI:1.24-2.25;CINⅡ/Ⅲ:aOR=4.24,95%CI:2.30-7.81)all had increased the risk of cervical lesion and the trend on the severity(P<0.001)of cervical lesions.Additionally,we observed a synergic effect between HPV infection and vaginal micro-environmental composite indicator in CINⅡ/Ⅲ.With or without HPV infection,the ORs value of CINⅠcaused by vaginal micro-environment disorder remained close.Conclusions Results from our study revealed that vaginal micro-environmental composite indicator could increase the risk for cervical lesion,in particular with the high-grade ones which all posed stronger risks when combined with HPV infection.However,the role of vaginal micro-environment disorder in the occurrence of CINⅠshould not be ignored.