不同级别宫颈病变与人乳头瘤病毒感染及阴道微环境的关系研究

Relationship of HPV Infection and Vaginal Microenvironment with Different Grades of Cervical Lesions

背景 宫颈液基细胞学与人乳头瘤病毒(HPV)联合筛查的实施使宫颈癌(CC)成为高度可预防的疾病;明确宫颈病变与HPV感染及阴道微环境对CC的早期防治非常重要。目的 探讨不同级别宫颈病变与HPV感染及阴道微环境的关系。方法 选择2019年7月至2020年3月就诊于新疆医科大学第一附属医院妇科中心行宫颈组织活检且行阴道微环境检测〔阴道pH值、白细胞酯酶、过氧化氢(H_(2)O_(2))及凝固酶〕的患者为研究对象,患者均行HPV检测。结果 本研究共纳入1 168例患者,根据病理检查结果分为慢性宫颈炎(NC)组496例、低级别鳞状上皮内病变(LSIL)组174例、高级别鳞状上皮内病变(HSIL)组478例、CC组20例。NC组、LSIL组、HSIL组、CC组HPV感染阳性率分别为75.8%(376例)、84.5%(147例)、92.7%(443例)、95.0%(19例)。四组HPV感染阳性率比较,差异有统计学意义(χ^(2)=54.209,P<0.05),其中HSIL组HPV阳性感染率高于NC组、LSIL组(P<0.008 3)。四组研究对象的阴道pH值、白细胞酯酶、H_(2)O_(2)、凝固酶异常率比较,差异有统计学意义(P<0.05)。HPV感染阳性患者阴道pH值、白细胞酯酶、H_(2)O_(2)、凝固酶异常率高于HPV感染阴性者(P<0.05)。多因素Logistic回归分析结果显示,阴道pH值>4.5、H_(2)O_(2)异常是宫颈病变级别的影响因素(P<0.05)。结论 不同级别宫颈病变患者的HPV阳性感染率、阴道微环境异常率有差异,HPV感染阳性患者阴道pH值、白细胞酯酶、H_(2)O_(2)、凝固酶异常率较高,阴道pH值>4.5和H_(2)O_(2)异常是宫颈病变级别的影响因素。

Background Cervical cancer(CC) is highly preventable owing to the use of liquid-based cytology combined with human papillomavirus(HPV) screening.Identifying the relationship of vaginal microenvironment and HPV infection with cervical lesions is very important for early prevention of CC.Objective To investigate the relationship of HPV infection and vaginal microenvironment with different grades of cervical lesions.Methods Participants were recruited from Gynecology Center,the First Affiliated Hospital of Xinjiang Medical University from July 2019 to March 2020.All of them performed cervical biopsy and vaginal microenvironment test (assessed using indices including vaginal pH value,leukocyte esterase,H_(2)O_(2)and coagulase),as well as HPV test.Results There were 1 168 patients in this study,ccording to pathological examination of cervical biopsy,the patients were divided into groups of chronic cervicitis(NC)(n=496),low-grade squamous intraepithelial lesion(LSIL)(n=174),high-grade squamous intraepithelial lesion(HSIL) (n=478),and CC(n=20).The prevalence of HPV infection in LSIL,HSIL,CC,and NC groups was 84.5%(147 cases),92.7%(443 cases),95.0%(19 cases) and 75.8%(376 cases).The positive rate of HPV infection among the four groups was statistically significant(χ^(2)=54.209,P<0.05).The positive infection rate of HPV in HSIL group was higher than that in NC group and LSIL group (P<0.008 3).The rates of vaginal pH value,leukocyte esterase,H_(2)O_(2)and coagulase abnormalities differed significantly across the four groups(P<0.05).Moreover,the abnormal rates of these four above-mentioned indicators of HPV-positive group were higher than HPV-negative group(P<0.05).Multinomial Logistic regression analyses found that vaginal pH value>4.5 and H_(2)O_(2)were the influencing factors of cervical lesions(P<0.05).Conclusion There are differences in HPV infection rate and abnormal rate of vaginal microenvironment among patients with cervical lesions of different grades.The abnormal rates of pH value,leukocyte esterase,H_(2)O_(2)and coagulase in patients with HPV infection positive group are higher.Vaginal pH value(>4.5) and abnormal of H_(2)O_(2)may be the factors for cervical lesions.