宫颈癌患者阴道微生态变化及其与细胞免疫的相关性探讨

Changes of vaginal microecology in patients with cervical cancer and its correlation with cellular immunity

目的 探讨宫颈癌患者阴道微生态变化及其与细胞免疫的相关性。方法 回顾性分析2018年1月-2020年5月本院收治的且经病理确诊的73例宫颈癌患者(宫颈癌组)和同期65例体检筛查宫颈正常者(正常宫颈组)的临床病例资料。两组均采用直接涂片法、革兰染色法检测阴道分泌物中乳酸杆菌、滴虫、支原体、衣原体、细菌性阴道病、霉菌、淋菌、假丝酵母菌、人乳头瘤病毒(HPV)及阴道唾液酸甘酶活性、白细胞酯酶、过氧化氢等。另采用流式细胞仪检测外周血T淋巴细胞(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))及自然杀伤细胞(CD16^(+)CD56^(+))水平。观察各组阴道微生态变化情况及外周血CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、CD16^(+)CD56^(+)水平。另对比宫颈癌组中感染致病微生物者、阴道微生态失调者与未感染致病微生物者、阴道微环境正常者的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、CD16^(+)CD56^(+)水平,采用Pearson相关性分析法分析宫颈癌组阴道乳酸杆菌定植密度与细胞免疫的相关性。结果 宫颈癌组滴虫、支原体、衣原体、霉菌、细菌性阴道病、HPV感染检出率及阴道微生态失调率均高于正常宫颈组,宫颈癌组乳酸杆菌定植密度低于正常宫颈组,差异均有统计学意义(P<0.05),宫颈癌组淋菌、假丝酵母菌感染检出率与正常宫颈组比较差异均无统计学意义(P>0.05);宫颈癌组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、CD16^(+)CD56^(+)水平均低于正常宫颈组,CD8^(+)水平高于正常宫颈组,差异均有统计学意义(P<0.05);宫颈癌组中滴虫、支原体、衣原体、霉菌、细菌性阴道病、HPV感染者及阴道微生态失调者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、CD16^(+)CD56^(+)均低于未感染者、阴道微环境正常者,CD8^(+)高于未感染者、阴道微环境正常者,差异均有统计学意义(P<0.05);宫颈癌患者乳酸杆菌定植密度与CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、CD16^(+)CD56^(+)呈正相关性(P<0.05),与CD8^(+)呈负相关性(P<0.05)。结论 宫颈癌患者阴道致病微生物感染率较健康人群高,同时细胞免疫功能降低,增加罹患宫颈癌的风险。

Objective To explore the changes of vaginal microecology in patients with cervical cancer(CC) and its relationship with cellular immunity. Methods The clinical data of 73 patients with CC(CC group) confirmed by pathology in our hospital from January 2018 to may 2020 and 65 cases of normal cervix(NC group) in the same period were analyzed retrospectively. The vaginal secretion was detected for lactobacillus, trichomonas, mycoplasma, chlamydia, bacterial vaginosis, mould, gonococcus, candida, human papillomavirus(HPV), sialyl glycidase activity, leukocyte esterase and hydrogen peroxide. The levels of peripheral blood T lymphocytes(CD3^(+), CD4^(+), CD8^(+), CD4^(+)/CD8^(+)) and natural killer cells(CD16^(+)CD56^(+)) were also detected. The changes of vaginal microecology were observed;the levels of CD3^(+), CD4^(+), CD8^(+), CD4^(+)/CD8^(+) and CD16^(+)CD56^(+) were compared between the patients with pathogenic microorganism infection and vaginal microecological disorders and those within CC group, and the correlation between vaginal lactobacillus colonization density and cellular immunity in CC group was analyzed by using Pearson correlation analysis. Results The detection rates of trichomonas, mycoplasma, chlamydia, mould, bacterial vaginosis, HPV infection and vaginal microecological disorder in CC group were higher, but the colonization density of lactobacillus was lower than in NC group, respectively, and the differences were statistically significant(P<0.05), while there were no significant differences in the detection rates of gonococcus and candida infection between the two groups(P>0.05). The levels of CD3^(+), CD4^(+), CD4^(+)/CD8^(+) and CD16^(+)CD56^(+) in CC group were lower, but that of CD8;was higher than in NC group, respectively, and the differences were statistically significant(P<0.05). The levels of CD3^(+), CD4^(+), CD4^(+)/CD8^(+) and CD16^(+)CD56^(+) in patients with pathogenic microorganism infection and vaginal microecological disorder were lower, but that of CD8^(+) was higher than those in the CC group patients, and the differences were statistically significant(P<0.05). Pearson correlation analysis showed that lactobacillus colonization density was positively correlated with CD3^(+), CD4^(+), CD4^(+)/CD8^(+), CD16^(+)CD56^(+)(P<0.05), but negatively correlated with CD8^(+)(P<0.05). Conclusion Compared with healthy people, the detection rates of trichomonas vaginalis, mycoplasma, chlamydia, mould, bacterial vaginosis, HPV and vaginal microecological imbalance significantly increased in patients with cervical cancer, while the count of lactobacillus significantly reduced;and the cellular immune function decreased, which may be related to pathogenic microorganism infection, vaginal microecological disorder and decrease of lactobacillus.