宫颈病变合并HPV感染者阴道微生物及Th1/Th2变化

Significance of vaginal microflora community and Th1/Th2 cytokines in patients with cervical lesions with HPV infection

目的 探讨宫颈病变合并HPV感染患者阴道微生物群落及Th1/Th2细胞因子表达的影响。方法 选取我院妇科收治的宫颈病变合并HPV感染患者86例为研究组,选择同期入院未合并HPV感染宫颈病变患者86例为对照组。并依据阴道镜下活组织病理学检查将患者分为宫颈上皮内瘤变Ⅰ级(CINI组)72例、宫颈上皮内瘤变Ⅱ级(CINⅡ组)34例、宫颈上皮内瘤变Ⅲ级(CINⅢ组)36例和宫颈癌(CC组)30例。比较不同组患者阴道内环境,分析微生物群落构成,并对血清白细胞介素-12(IL-12)、干扰素-γ、IL-4、IL-8水平进行比较。结果 随着病变程度的加重,IL-12、IFN-γ水平持续降低,IL-4、IL-8水平持续上升,不同病变程度患者之间Th1/Th2细胞因子水平差异存在显著性(F=17.841、18.473,均P<0.01);研究组厚壁菌门占比(54.49%)低于对照组(74.42%)(χ^(2)=8.171,P=0.004),放线菌门、梭杆菌门占比(分别为23.26%、4.65%)高于对照组(分别为10.47%、0.00%)(分别χ^(2)=4.038、χ^(2)=4.095,均P<0.05);研究组IL-12、IFN-γ水平[分别为(12.14±3.9)pg/mL、(135.47±31)pg/mL]低于对照组[分别为(16.91±5.6)pg/mL、(168.24±46)pg/mL],IL-4、IL-8水平[分别为(36.26±11)pg/mL、(128.15±26)pg/mL]高于对照组[分别为(23.75±7.6)pg/mL、(98.82±15)]pg/mL,差异均有统计学意义(t=-6.462、9.049,均P<0.01)。结论 宫颈病变合并HPV感染患者阴道微生物群落种类增加,阴道内乳酸杆菌属下降,Th1/Th2细胞因子平衡被打破,HPV持续感染与宫颈病变程度密切相关。

Objective To investigate the effects of vaginal microflora community and Th1/Th2 cytokines in patients with cervical lesions with HPV infection.Methods All 86 patients with cervical lesions with HPV infection were selected as the study group,and 86 patients without HPV infection were selected as the control group. According to the biopsy under colposcopy,the patients were divided into 72 cases of cervical intraepithelial neoplasia Ⅰ(CINⅠgroup),34 cases of cervical intraepithelial neoplasia Ⅱ(CINⅡ group),36 cases of cervical intraepithelial neoplasia Ⅲ(CINⅢ group)and 30 cases of cervical cancer(CC group). The vaginal environment of different groups of patients was compared,the composition of microbial community was analyzed,and the levels of interleukin-12(IL-12),IFN-γ,IL-4 and IL-8 were compared.Results With the aggravation of the lesion,the levels of IL-12 and IFN-γ were decrease,IL-4 and IL-8 were increased. and the levels of Th1/Th2 cytokines in patients with different degrees of lesions were significantly different(F=17.84 and 18.47,all P<0.01);The rates of thick-walled bacteria in the study group was lower than that in the control group(54.49% vs.74.42%)(χ^(2)=8.17,P=0.004),and the proportion of Actinomycetes and Clostridium was higher than that in the control group(23.26% vs. 10.47%,4.65% vs. 0.00%)(χ^(2)=4.04,4.10,all P<0.05). The levels of IL-12,IFN-γwere lower than those in the control group[(12.14±3.9)vs.(16.91±5.6),(135.47±31)vs.(168.24±46)]pg/mL,the levels of IL-4 and IL-8 were higher than those in the control group[(36.26±11)vs.(23.75±7.6),(128.15±26)vs.(98.82±15)]pg/mL(t=-6.46and 9.05,all P<0.01).Conclusion In patients with cervical lesions complicated with HPV infection,the species of vaginal microbial community increased,the genus of Lactobacillus in the vagina decreased,and the balance of Th1/Th2 cytokines was broken. The continuous HPV infection was closely related to the degree of cervical lesions.