病原菌分布特征及血清Toll样受体2水平对宫颈癌伴阴道混合感染的预测价值

The distribution characteristics of vaginal pathogens and serum TLR2 levels in patients with cervical cancer predicting development of a mixed vaginal infection

目的分析和探讨病原菌分布特征及血清Toll样受体2(TLR2)水平对宫颈癌患者伴阴道混合感染的预测价值。方法2017年1月-2020年6月本院收治的宫颈癌患者356例,根据是否合并阴道感染分为感染组和未感染组。取患者临床标本进行病原菌分离培养,利用全自动微生物分析仪鉴定病原菌分布情况;抽取患者静脉血,分离血清,采用ELISA法检测TLR2、白介素-13(IL-13)、超敏C-反应蛋白(hs-CRP)及肿瘤坏死因子-α(TNF-α)水平。收集患者的临床资料,通过单因素方差分析法和多因素Logistic回归分析法分析影响宫颈癌患者合并阴道感染的相关因素。绘制TLR2工作特征曲线(ROC),分析患者血清TLR2水平对阴道感染的预测价值。结果356例宫颈癌患者中共有112例合并阴道感染,感染发生率31.46%(112/356),其中继发混合感染占41.96%(47/112)。混合感染中以AV+BV+MP感染居多,占17.86%(20/112)。与未感染组比较,感染组患者TLR2、TNF-α、IL-13以及hs-CRP等炎症因子水平均显著升高(均P<0.01)。患者临床资料经单因素方差分析后再作Logistic回归分析,患者年龄(OR=3.766,95%CI 1.637~8.662)、是否有阴道炎病史(OR=2.812,95%CI 1.456~5.433)、合并糖尿病(OR=2.721,95%CI 1.544~4.794)、放疗(OR=3.629,95%CI=1.761~7.480)、化疗(OR=3.083,95%CI=1.633~5.717)、手术治疗(OR=2.573,95%CI 1.426~4.641)以及术后引流时间(OR=2.273,CI 1.275~4.052)均为宫颈癌合并阴道感染发生的独立危险因素。ROC曲线分析显示,血清TLR2的截断值为8.13 ng/L时,其诊断宫颈癌继发阴道感染的曲线下面积(AUC)为0.837(95%CI 0.739~0.934),敏感度为79.46%,特异度为82.14%,具有较高诊断效能。结论宫颈癌患者合并阴道感染发生率较高,且多为混合感染,感染菌分布类型主要为AV+BV+MP;TLR2在宫颈癌继发阴道感染患者高表达,检测血清TLR2对感染具有较高的诊断预测价值。

Objective To analyze and explore the distribution characteristics of pathogens and the predictive value of the serum toll-like receptor 2(TLR2)level in patients with cervical cancer and a mixed vaginal infection.Methods Three hundred and fifty-six patients with cervical cancer seen at this hospital from January 2017 to June 2020 were divided into those with an infection and those without an infection depending on whether they had a vaginal infection.Clinical samples were collected for pathogen isolation and culture,and the distribution of pathogens was identified by an automated microbial analyzer.Venous blood was collected and serum was separated.TLR2,IL-13,hs-CRP,and TNF levels were detected using ELISA-α.Clinical data on the patients were collected,and the related factors affecting patients with cervical cancer and a vaginal infection were analyzed using univariate analysis of variance and multivariate logistic regression analysis.The operating characteristic curve(ROC)was plotted for TLR2,and the predictive value of the serum TLR2 level with regard to a vaginal infection was analyzed.Results Of 356 patients with cervical cancer,112 also had a vaginal infection,for an incidence of infection 31.46%(112/356).Of those patients,41.96%(47/112)had a secondary mixed infection.Aerobic vaginitis(AV)+bacterial vaginosis(BV)+a Mycoplasma genitalium(MP)infection was the most common mixed infection,and it was found in 17.86%(20/112)of patients with an infection.The levels of inflammatory factors such as TLR2,TNF-α,IL-13,and hs-CRP were significantly higher in patients with an infection than levels in patients without an infection(P<0.01 for all).The clinical data on the patients were analyzed using logistic regression after one-way analysis of variance.The patient’s age(OR:3.766,95%CI:1.637-8.662),whether there was a history of vaginitis(OR:2.812,95%CI:1.456-5.433),and diabetes(OR:2.721,95%CI:1.544-4.794),radiotherapy(OR:3.629,95%CI:1.761-7.480),chemotherapy(OR:3.083,95%CI:1.633-5.717),surgery(OR:2.573,95%CI:1.426-4.641)and postoperative drainage time(OR:2.273,95%CI:1.275-4.052)were independent risk factors for cervical cancer and a vaginal infection.ROC curve analysis indicated that when the cut-off value for serum TLR2 was 8.13 ng/L.The area under the curve(AUC)for serum TLR2 in the identification of a vaginal infection secondary to cervical cancer was 0.837(95%CI:0.739-0.934),its sensitivity was 79.46%,and its specificity was 82.14%,indicating that TLR2 has a high level of diagnostic efficiency.Conclusion A vaginal infection was highly prevalent in patients with cervical cancer,and most of those infections were mixed infections.The main type of infection was AV+BV+MP.TLR2 is highly expressed in patients with a vaginal infection secondary to cervical cancer.Measurement of serum TLR2 is a worthwhile way to identify and predict development of an infection.