宫颈病变患者阴道微生态及高危型人乳头瘤病毒感染分析

Analysis of vaginal microecology and high-risk human papilloma virus infection in patients with cervical lesions

目的分析不同严重程度宫颈病变患者阴道微生态、高危型(HR)人乳头瘤病毒(HPV)感染情况,为纠正宫颈病变微生态失衡、防治宫颈病变提供依据。方法回顾性收集2018年12月-2019年12月海口市妇幼保健院收治且完成HR-HPV检查、宫颈活检的86例宫颈病变患者的临床资料,依据宫颈病变严重程度分为低级别组(n=26)、高级别组(n=35)、宫颈癌组(n=25);按1∶2比例选择同期就诊但宫颈细胞学、HR-HPV均阴性的43例正常人作为对照组,入院后均完成阴道微生态平衡及阴道菌群检测,分析不同级别宫颈病变阴道微生态、HR-HPV感染情况。结果宫颈病变HR-HPV感染率为91.86%;HPV感染位列前三亚型为HPV 16、HPV 52、HPV 18,随宫颈病变程度的上升,HPV 16感染率上升(P<0.05),HPV 52感染率降低(P<0.05);低级别组、高级别组、宫颈癌组菌群密集度异常、菌群多样性异常及其他优势菌所占比例较对照组高(P<0.05),随宫颈病变程度的上升,菌群密集度异常率、多样性异常率及其他优势菌所占比例增加(P<0.05);低级别组、高级别组、宫颈癌组白细胞酯酶、唾液酸苷酶活性、过氧化氢、酸碱值及脯氨酸氨基肽酶阳性率高于对照组(P<0.05),随宫颈病变程度的上升,以上各阳性率上升(P<0.05);低级别组、高级别组、宫颈癌组细菌性阴道炎(BV)发病率高于对照组(P<0.05);宫颈病变等级与BV发病率呈正相关(r=0.476,P<0.05)。结论宫颈病变进展与HR-HPV感染、阴道微生态失衡及BV发生密切相关,阴道微生态紊乱、HR-HPV感染两者可能协同参与宫颈病变进展过程。

OBJECTIVE To analyze the vaginal microecology and high-risk(HR) human papilloma virus(HPV) infection in patients with cervical lesions of different severity, so as to provide basis for correcting microecological imbalance and preventing cervical lesions. METHODS The clinical data of 86 patients with cervical lesions who received HR-HPV examination and cervical biopsy in Haikou Maternal and Child Health Hospital between Dec. 2018 and Dec. 2019 were retrospectively collected. According to different severity of cervical lesions, they were divided into the low-level group(n=26), high-level group(n=35) and cervical cancer group(n=25). Another 43 normal people with negative results in cervical cytology and HR-HPV during the same period were enrolled as the control group. After admission, all patients were tested for vaginal microecology balance and vaginal floras. The vaginal microecology and HR-HPV infection among patients with cervical lesions in different severity were analyzed. RESULTS The HR-HPV infection rate of cervical lesions was 91.86%. The top three subtypes of HPV infection were HPV 16, HPV 52 and HPV 18. With the exacerbation of cervical lesions, infection rate of HPV 16 was significantly increased(P<0.05), and infection rate of HPV 52 was significantly decreased(P<0.05). The proportions of abnormal floras density, abnormal floras diversity and other dominant floras in low-level group, high-level group and cervical cancer group were significantly higher than that in the control group(P<0.05). With the exacerbation of cervical lesions, the above proportions were significantly increased(P<0.05). The activities of leukocyte esterase and sialidase, hydrogen peroxide, pH value and positive rate of proline aminopeptidase in the low-level group, high-level group and cervical cancer group were significantly higher than that in the control group(P<0.05). With the exacerbation of cervical lesions, the positive rate of each index was significantly increased(P<0.05). The incidence of bacterial vaginitis(BV) in the low-level group, high-level group and cervical cancer group was significantly higher than that in the control group(P<0.05). The cervical lesion grade was positively correlated with incidence of BV(r=0.476, P<0.05). CONCLUSION The progression of cervical lesions is closely related to HR-HPV infection, vaginal microecology imbalance and BV occurrence. Both vaginal microecology disturbances and HR-HPV infection may participate in the progression of cervical lesions.