宫颈高危型HPV感染程度与阴道菌群、宫颈局部调节性T细胞的关系分析

The relationship of cervical high-risk HPV infection with vaginal flora and local regulatory T cells

目的探讨宫颈高危型人乳头瘤病毒(human papilloma viruses,HPV)感染感染是否转阴与阴道菌群及宫颈局部调节性T细胞关系。方法选择2018年9月至2019年12月南通市妇幼保健院收治的230例高危HPV感染患者为研究对象,所有患者随访6个月,观察两组阴道菌群和宫颈局部CD4+CD25+Foxp3+T细胞表达差异,Logistic回归分析影响高危HPV持续感染的因素。结果高危型HPV持续感染组绝经、性生活次数≥2次/周、流产次数≥3次、吸烟史、HSIL、CSCC比例高于高危型HPV转阴组(P<0.05)。高危型HPV持续感染组衣原体、解脲脲原体、细菌性阴道病阳性率高于高危型HPV转阴组(P<0.05),乳酸杆菌阳性率低于高危型HPV转阴组(P<0.05),LSIL组、HSIL组高危型HPV持续感染的衣原体、解脲脲原体、细菌性阴道病阳性率高于高危型HPV转阴(P<0.05),乳酸杆菌阳性率低于高危型HPV转阴(P<0.05)。CSCC组高危型HPV持续感染的细菌性阴道病阳性率高于高危型HPV转阴(P<0.05),乳酸杆菌阳性率低于高危型HPV持续感染(P<0.05)。高危型HPV转阴组局部调节性T细胞明显高于高危型HPV持续感染组(P<0.05)。LSIL组、HSIL组高危型HPV转阴局部调节性T细胞高于高危型HPV持续感染(P<0.05)。乳酸杆菌、衣原体、解脲脲原体、CSCC、CD4+CD25+Foxp3+T细胞与高危型HPV持续感染独立相关(P<0.05)。结论宫颈高危型HPV持续感染与阴道微生态紊乱程度及宫颈局部调节性T细胞免疫功能紧密相关,可能增加宫颈癌发生风险。

Objective To investigate the relationship between the outcome of high-risk human papilloma viruses(HPV)infection with the vaginal flora and local regulatory T cells in the cervix.Methods From September 2018 to December 2019,in Nantong Maternal and Child Health hospital,230 cases of high-risk HPV patients were collected and divided into 3 groups.All patients were followed up for 6 months.The expressions of vaginal flora and cervical local CD4+CD25+Foxp3+T cells were observed.Logistic regression analysis was used to analyze the influence factors of persistent infection of highrisk HPV.Results The following factors in high-risk HPV persistent infection group were higher than the high-risk HPV translating negative group:menopause,sexual activity≥2 times/week,miscarriage frequency≥3 times,smoking history,HSIL,CSCC ratio(P<0.05).The positive rate of chlamydia,Ureaplasma Urealyticum(UU),and bacterial vaginosis in the high-risk HPV persistent infection group were all higher than that in the high-risk HPV translating negative group(P<0.05),while the positive rate of lactobacilli was lower(P<0.05).The positive rates of Chlamydia,UU,and bacterial vaginosis of highrisk HPV infection in LSIL group,HSIL group were all higher than that of high-risk HPV negative(P<0.05),and the positive rate of Lactobacillus was lower(P<0.05).In CSCC group,the positive rates of bacterial vaginosis of high-risk HPV infection was higher than that of high-risk HPV negative(P<0.05),and the positive rate of Lactobacillus was lower(P<0.05).The local regulatory T cells in the high-risk HPV negative group were significantly higher than those in the high-risk HPV persistent infection group(P<0.05).The high-risk HPV negative local regulatory T cells in the LSIL and HSIL groups were higher than the high-risk HPV persistent infection(P<0.05).Lactobacillus,chlamydia,UU,CSCC,CD4+CD25+Foxp3+T cells were independently associated with persistent infection of high-risk HPV(P<0.05).Conclusion High-risk HPV infection of the cervix might be closely related to the degree of vaginal microecological disorder and local regulatory T cell immune function of the cervix,which may increase the risk of cervical cancer.