子宫颈病变患者阴道微生态环境与HR-HPV感染的相关性及子宫颈病变的影响因素分析

Analysis of Relationship between Vaginal Microecological Environment and HR-HPV Infection in Patients with Cervical Lesions and Influencing Factors of Cervical Lesions

目的:探讨阴道微生态环境、高危型人乳头瘤状病毒(HR-HPV)感染与子宫颈病变的相关性。方法:选择2018年1月-2020年4月本院接受子宫颈筛查的子宫颈病变患者300例,包括慢性子宫颈炎102例、低级别子宫颈鳞状上皮内病变(LSIL)90例、高级别子宫颈鳞状上皮内病变(HSIL)76例、子宫颈癌(CC)32例,分别作为慢性子宫颈炎组、LSIL组、HSIL组、CC组,另选择同期体检的健康女性60例作为对照组。比较各组HR-HPV情况、乳酸杆菌减少、白细胞酯酶(LE)试验及凝固酶(GADP)、阴道pH值及阴道菌群密度,并分析子宫颈病变患者阴道微生态环境与HR-HPV感染的相关性,以及影响子宫颈病变发生的危险因素。结果:CC组、HSIL组、LSIL组及慢性子宫颈炎组HR-HPV阳性率均显著高于对照组,随病变严重程度的增加各组HR-HPV阳性率逐渐升高,各组HR-HPV阳性率比较差异有统计学意义(P<0.05)。CC组、HSIL组、LSIL组及慢性子宫颈炎组乳酸杆菌减少率、革兰阳性杆菌感染率、GADP阳性率、LE阳性率、阴道pH>4.5率、阴道菌群密度Ⅲ、Ⅳ级率均显著高于对照组(P<0.05)。HR-HPV阳性组乳酸杆菌减少率、革兰阳性杆菌感染率、GADP阳性率、LE阳性率、阴道pH>4.5率、阴道菌群密度Ⅲ、Ⅳ级率均显著高于HR-HPV阴性组(P<0.05)。Spearman相关分析显示,子宫颈病变患者阴道乳酸杆菌减少、阴道pH>4.5、阴道菌群密度Ⅲ、Ⅳ级与HR-HPV感染呈正相关(r=0.520、0.501、0.487,P=0.000、0.000、0.000)。多因素Logistic回归分析结果显示,HR-HPV阳性、乳酸杆菌减少、阴道pH>4.5及阴道菌群密度Ⅲ、Ⅳ级是女性发生子宫颈病变的危险因素(P<0.05)。结论:子宫颈病变患者阴道微生态环境发生异常改变,HR-HPV感染率增高,两者密切相关,HR-HPV阳性、乳酸杆菌减少、阴道pH>4.5、阴道菌群密度Ⅲ、Ⅳ级是女性发生子宫颈病变的危险因素。

Objective:To explore the relationship between vaginal microenvironment,high-risk human papillomavirus(HR-HPV)infection and cervical lesions.Method:A total of 300 patients with cervical lesions in our hospital from January 2018 to April 2020,including 102 cases of chronic cervicitis,90 cases of low-grade cervical squamous intraepithelial lesion(LSIL),76 cases of high-grade cervical squamous intraepithelial lesion(HSIL)and 32 cases of cervical cancer(CC),were selected as the chronic cervicitis group,the LSIL group,the HSIL group and the CC group respectively,and 60 healthy women who underwent physical examination at the same period were selected as the control group.The HR-HPV status,lactobacilli reduction,leukocyte esterase(LE)test and coagulase(GADP),vaginal pH and vaginal flora density were compared among the groups,and the correlation between the vaginal microecological environment and HR-HPV infection in patients with cervical lesions,as well as the risk factors affecting the occurrence of cervical lesions were analyzed.Result:The positive rate of HR-HPV in the CC group,the HSIL group,the LSIL group and the chronic cervicitis group was significantly higher than that in the control group,and the positive rate of HR-HPV in each group increased gradually with the increase of the severity of the disease,and there was significant difference in the positive rate of HR-HPV among each group(P<0.05).In the CC group,the HSIL group,the LSIL group and the chronic cervicitis group,the rate of lactobacillus reduction,the rate of Gram-positive bacilli infection,the positive rate of GADP,the positive rate of LE,the rate of vaginal pH>4.5 and the rate of vaginal flora density gradeⅢorⅣwere significantly higher than those in the control group(P<0.05).The Lactobacillus reduction rate,the infection rate of Gram-positive bacilli,the positive rate of GADP,the positive rate of LE,the rate of vaginal pH>4.5 and the rate of vaginal flora density gradeⅢorⅣin the HR-HPV positive group were significantly higher than those in the HR-HPV negative group(P<0.05).Spearman correlation analysis showed that the reduction of lactobacilli,vaginal pH>4.5,vaginal flora density gradeⅢorⅣwere positively correlated with HR-HPV infection(r=0.520,0.501,0.487;P=0.000,0.000,0.000).Multivariate Logistic regression analysis showed that HR-HPV positive,lactobacillus reduction,vaginal pH>4.5,and vaginal flora density gradeⅢorⅣwere the risk factors of cervical lesions in women(P<0.05).Conclusion:Abnormal changes of vaginal microenvironment and higher HR-HPV infection rate in patients with cervical lesions are closely related.Positive HR-HPV,lactobacillus reduction,vaginal pH>4.5 and vaginal flora density gradeⅢorⅣare risk factors of cervical lesions in women.