高级别子宫颈鳞状上皮内病变行LEEP术后阴道微生态与HPV转归的相关性研究

Study on the correlation between vaginal microecology and HPV outcome after LEEP for high grade squamous intraepithelial lesions

目的:探讨高级别子宫颈鳞状上皮内病变行LEEP术后阴道微生态与HPV转归的相关性,为提高HSIL临床治疗效果,改善预后,提供新的思路。方法:选取2016年2月至2019年9月在本院行LEEP术的128例高级别子宫颈鳞状上皮内病变患者,术后随访1年,比较HPV转阴和HPV持续感染患者的阴道微生态指标,并分析HPV转阴的影响因素。结果:术后随访1年,HPV转归阴性83例,年龄(40.34±5.69)岁,CINⅡ级48例、CINⅢ级35例;转归持续感染45例,年龄(39.89±5.42)岁,CINⅡ级25例、CINⅢ级20例。两组年龄、CIN分级无显著性差异(P>0.05);持续感染组菌群密集度Ⅳ级构成比、菌群多样性Ⅳ级构成比显著高于阴性组,且优势菌以革兰阳性大杆菌为主,占83.13%,差异具有统计学意义(P<0.05);两组Nugent评分、PH值差异无统计学意义(P>0.05);Logistic回归分析结果显示:菌群密集度、菌群多样性、优势菌评估进入方程,均为高级别子宫颈鳞状上皮内病变行LEEP术后HPV持续感染的独立危险因素。结论:临床上对于高级别子宫颈鳞状上皮内病变患者的治疗不仅要重视HPV感染的监测,还应该关注患者阴道微生态的改变,及时纠正阴道微生态可促进HPV转归,改善疾病的预后,在临床治疗过程中的重要作用不容忽视。

Objective:To explore and analyze the correlation between vaginal microecology and HPV outcome after LEEP for high grade squamous intraepithelial lesions(HSIL),and to provide new ideas for improving the clinical treatment effect of HSIL and the prognosis.Methods:128 patients with HSIL who underwent LEEP surgery in our hospital from February 2016 to September 2019 were chosen and followed up for 1 year after surgery,with the vaginal microecological indicators of patients with the HPV negative conversion and HPV persistent infection compared,and the influencing factors of HPV negative conversion analyzed.Results:After 1-year follow-up,83 cases of HPV turned out to be negative,whose ages are(40.34±5.69);there were 48 cases of CIN II and 35 cases of CIN III;there were 45 cases of persistent infection,whose ages were(39.89±5.42),including 25 cases of CIN II and 20 cases of CIN III;there was no significant difference in age and CIN grade between the two groups(P>0.05);the bacterial population density gradeⅣcomposition ratio and the bacterial diversity gradeⅣcomposition ratio in the persistent infection group were significantly higher than those of the negative group,and the dominant bacteria are mainly Gram-positive,accounting for 83.13%,the difference being statistically significant(P<0.05);there were no difference in Nugent scores and PH values between the two groups(P>0.05);Logistic regression analysis showed that the density grade,the diversity grade and the dominant bacteria evaluation went into the equation,and they were all independent risk factors for HPV persistent infection after LEEP for HSIL.Conclusion:Doctors should not only pay attention to the monitoring of HPV infection,but also pay attention to the changes in the vaginal microecology of patients in the clinical treatment of patients with HSIL.Timely correction of the vaginal microecology can promote the outcome of HPV and improve the prognosis of the disease,playing a very important role in the clinical treatment.