人乳头瘤病毒感染与阴道和宫颈微生态的相关性分析

Correlation between human papillomavirus infection and vaginal,cervical microecology

目的探讨人乳头瘤病毒(HPV)感染与阴道、宫颈微生态之间的关系,为避免HPV持续感染及阻断宫颈病变提供理论依据。方法选取2014年1月~2019年12月佛山市妇幼保健院门诊确诊的HPV感染患者7386例为研究组,选取同期门诊健康体检的7820例HPV阴性妇女为对照组,分别对其行阴道微生态分析及宫颈解脲支原体(UU)、衣原体(CT)、淋球菌(NG)的检测。结果HPV感染组阴道、宫颈微生态失衡检出率明显高于HPV阴性组(87.00%vs.39.26%,60.5%vs.18.99%),年龄超过30岁和持续性高危型HPV(HR-HPV)感染者的阴道、宫颈微生态失衡的检出率也明显高于对照组(87.85%vs.85.89%、67.52%vs.50.22%和92.14%vs.18.23,44.50%vs.5.99%)。阴道分泌物涂片中,非特异性阴道炎检出率最高,线索细胞次之,假丝酵母菌排第三,滴虫检出率较低,差异均有统计学意义(χ^(2)=3034.43、6417.17、163.12和233.65,P值均<0.01)。宫颈管病原体中,UU检出率最高,CT次之,NG检出率较低,差异均有统计学意义(χ^(2)=1792.60、295.43和141.70,P值均<0.01)。且混合感染检出率也在增加(χ^(2)=1894.97,P<0.01)。HPV感染者阴道乳酸杆菌总检出率不高,持续性高危型HPV(HR-HPV)感染者阴道乳酸杆菌基本呈现阴性;HPV感染者阴道分泌物pH值异常升高。结论HPV感染与阴道乳酸杆菌减少、阴道及宫颈微生态失衡有关。针对HPV感染的女性,积极纠正阴道、宫颈微生态失衡有利于降低HPV持续感染,从而阻断宫颈病变的发生。

Objective To explore the correlation between Human Papillomavirus(HPV)infection and the microecology of vagina and cervix,so as to provide theoretical basis for avoiding persistent HPV infection and blocking cervical lesions.Methods 7386 patients with HPV infection diagnosed in the outpatient clinic of Foshan Maternal and Child Health Hospital from January 2014 to December 2019 were selected as the study group,and 7820 HPVnegative women in the same period were selected as the control group.Vaginal microecological analysis and cervical ureaplasma urealyticum(UU),chlamydia trachomatis(CT)and neisseria gonorrhoeae(NG)detection were performed respectively.Results The detection rate of vaginal and cervical microecological imbalance in HPV infection group was significantly higher than that in HPV negative group(87.00%vs.39.26%60.5%vs.18.99%).The detection rate of vaginal and cervical microecological imbalance in patients over 30 years old and persistent high-risk HPV(HR-HPV)infection was also significantly higher than that in the control group(87.85%vs.85.89%,67.52%vs.50.22% and 92.14%vs.18.23,44.50%vs.5.99%).In vaginal secretion smears,the detection rate of non-specific vaginitis was the highest,followed by clue cells,Candida was the third,and the detection rate of trichomonas was lower(χ^(2)=3034.43,6417.17,163.12 and 233.65,P<0.01respectively).Among the pathogens in cervical canal,the detection rate of UU was the highest,followed by CT,and the detection rate of NG was lower,which were statistically significant(χ^(2)=1792.60,295.43 and 141.70,P<0.01 respectively).The detection rate of mixed infection was also increasing(χ^(2)=1894.97,P<0.01).The total detection rate of vaginal lactobacilli in patients with HPV infection was not high,but vaginal lactobacillus in persistent HR-HPV infection was basically negative,and the value of PH in vaginal secretions of HPV infection increased abnormally.Conclusion HPV infection is related to the decrease of vaginal lactobacilli and the imbalance of vaginal and cervical microecology.For women with HPV infection,actively correcting the microecological imbalance of vagina and cervix is helpful to reduce persistent HPV infection and block the occurrence of cervical lesions.