妊娠期HPV感染对阴道微生态及母儿结局的影响

Impact of HPV infection on vaginal microecology and maternal and neonatal outcomes

目的:人乳头瘤病毒(human papilloma virus,HPV)是一种球形DNA病毒,其发病与机体的免疫状态及妊娠等多种因素有关。妊娠期女性由于免疫力降低更易发生HPV感染,引起阴道微生态严重失调,且不利于妊娠结局。因此,本研究着重探讨HPV感染对妊娠期阴道微生态及母儿结局的影响。方法:选取2017年11月至2019年7月在海南医学院第一附属医院产科接受产检的140例妊娠期HPV感染孕妇作为HPV感染组,另选取同期150例HPV阴性的正常孕妇作为对照组。在孕28~34周时收集所有孕妇的阴道分泌物,检测阴道pH值、清洁度、菌群密集度、菌群多样性、优势菌及病原微生物等并评价微生态状况,记录孕妇的不良妊娠结局。结果:HPV感染组孕妇阴道pH值>4.5、菌群密集度Ⅰ~Ⅱ级、菌群多样性Ⅰ~Ⅱ级、外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)及细菌性阴道病(bacterial vaginosis,BV)的构成比均显著高于对照组(均P<0.05);2组孕妇阴道清洁度,各类优势菌、滴虫阴道炎(trichomonas vaginitis,TV)、BV阴性及BV中间型的构成比相比,差异均无统计学意义(均P>0.05);HPV感染组孕妇微生态失调发生率明显高于对照组(P<0.05)。对照组和HPV感染组孕妇自然分娩率和剖宫产率相比,差异无统计学意义(P>0.05)。HPV感染组孕妇早产、产褥感染、产后出血及绒毛膜羊膜炎发生率均显著高于对照组(均P<0.05);2组孕妇胎膜早破发生率差异无统计学意义(P>0.05)。微生态失调的HPV感染孕妇早产、产后出血及胎膜早破发生率均明显高于微生态正常的HPV感染孕妇(均P<0.05);微生态正常的HPV感染孕妇与微生态失调的HPV感染孕妇产褥感染、绒毛膜羊膜炎发生率相比,差异均无统计学意义(均P>0.05)。结论:妊娠期HPV感染的孕妇更易发生阴道微生态失调,且可增加早产、绒毛膜羊膜炎等不良妊娠结局发生的风险。

Objective:Human papillomavirus(HPV)is a kind of spherical DNA virus,which is related to many factors such as immune status and pregnancy.Due to the decrease of immunity,pregnant women are more likely to have HPV infection,which causes serious imbalance of vaginal microecology and is not beneficial to pregnancy outcome.Therefore,this study focuses on the impact of HPV infection on vaginal microecology and maternal and neonatal outcomes.Methods:A total of 140 pregnant women with HPV infection during pregnancy,who received obstetric examination in the First Affiliated Hospital of Hainan Medical College from November 2017 to July 2019,were selected as a HPV infection group,and 150 normal pregnant women with HPV negative in the same period were selected as a control group.Vaginal secretions were collected from all the pregnant women at 28-34 weeks of gestation to evaluate vaginal pH,cleanliness and microecological status,and to record pregnancy outcomes for all pregnant women.Results:The proportions of vaginal pH>4.5,constituent ratio of flora density and diversity ofⅠ-Ⅱ,positive detection rate of vulvovaginal candidiasis(VVC)and bacterial vaginosis(BV)in HPV infected pregnant women were significantly higher than those in the control group(all P<0.05).There was no significant difference in vaginal cleanliness,dominant bacteria classification,detection rate of trichomonas vaginitis(TV),BV negative,and BV intermediate type between the 2 groups(all P>0.05).The incidence of microecological imbalance in pregnant women with HPV infection was significantly higher than that in the control group(P<0.05).There was no significant difference in natural delivery rate and cesarean section rate between the control group and the HPV infection group(P>0.05).The incidences of premature delivery,puerperal infection,postpartum hemorrhage,and chorioamnionitis in the HPV infection group were significantly higher than those in the control group(all P<0.05).There was no significant difference in the incidence of premature rupture of membranes between the 2 groups(P>0.05).The incidences of premature delivery,postpartum hemorrhage,and premature rupture of membranes of HPVinfected pregnant women in microecological imbalance group were significantly higher than those in the microecological normal group(all P<0.05).There was no significant difference in the incidences of puerperal infection and chorioamnionitis between the microecological normal group and the microecological imbalance group(all P>0.05).Conclusion:Pregnant women with HPV infection during pregnancy are more likely to have vaginal microecological disorders,and can increase the risk of adverse pregnancy outcomes such as premature delivery and chorioamnionitis.