阴道微生态状况与持续性高危型人乳头瘤病毒感染及转归相关性研究

Study on Correlation between Vaginal Microecology and Persistent High-risk HPV Infection and Outcome

目的研究阴道微生态状况与持续性高危型人乳头瘤病毒(HPV)感染及转归的相关性,为预防HPV的感染及宫颈癌的防治提供参考依据。方法选取2019年1月至2021年1月于我院接受HPV筛查的育龄期女性作为研究对象,将其按照高危型HPV感染状态的差异分成高危型HPV持续感染组200例、一过性感染组100例以及正常对照组100例,检测其阴道微生态状况并进行对比。以多因素Logistic回归分析明确高危型HPV持续性感染的相关影响因素。此外,以随机数字表法将持续感染组患者分为观察组和对照组,每组各100例。观察组使用乳酸菌阴道胶囊进行干预,对照组不予以任何干预,比较两组微生态状况及HPV转阴率。结果持续感染组无避孕措施人数占比高于一过性感染组及正常对照组(均P<0.05),3组年龄、BMI、首次性生活年龄、性生活频率、人工流产以及文化程度对比均不明显(均P>0.05)。持续感染组阴道微生态异常、菌群密集度异常、菌群多样性异常、阴道分泌物pH>4.5、过氧化氢酶异常、唾液酸苷酶异常以及白细胞脂酶异常发生率均高于一过性感染组以及正常对照组(均P<0.05)。经多因素Logistic回归分析发现,阴道微生态异常、菌群密集度异常、菌群多样性异常、阴道分泌物pH>4.5以及无避孕措施均是高危型HPV持续性感染的危险因素(均OR>1,P<0.05)。观察组治疗后3个月、6个月的转阴率及阴道微生态正常人数占比均高于对照组(均P<0.05)。结论阴道微生态状况与持续性高危型HPV感染及转归均密切相关,临床工作中可能通过改善阴道微生态状况,从而实现对持续性高危型HPV的防治。

Objective To study the correlation between vaginal microecology and persistent high-risk human papillomavirus(HPV)infection and outcome,so as to provide a reference for the prevention of HPV infection and treatment of cervical cancer.Methods Women of reproductive age who received HPV screening in our hospital from January 2019 to January 2021 were selected as research objects,and divided into highrisk HPV persistent infection group(n=200),transient infection group(n=100)and normal control group(n=100)according to the difference of infection status.The vaginal microecology was detected and compared.Multivariate logistic regression analysis was used to clarify the related factors of high-risk HPV persistent infection.In addition,patients in the persistent infection group were divided into observation group and control group according to the random number table method,with 100 cases in each group.The observation group used lactobacillus vaginal capsules for intervention,and the control group did not receive any intervention.The microecological status and HPV conversion rate of the two groups were compared.Results The incidence of abnormal vaginal microecology,abnormal bacterial community density,abnormal bacterial diversity,pH of vaginal secretion>4.5,abnormal catalase,abnormal sialidase and abnormal leucocyte lipase were higher in the persistent infection group than in the transient infection group and the normal control group(all P<0.05).The proportion of people without contraception in the persistent infection group was higher than that in the transient infection group and the normal control group(all P<0.05),and there were no significant differences in age,BMI,first sexual age,sexual frequency,induced abortion and educational level among the three groups(all P>0.05).Multivariate Logistic regression analysis showed that abnormal vaginal microecology,abnormal flora concentration,abnormal flora diversity,vaginal secretions pH>4.5 and no contraceptive measures were risk factors for persistent infection of high-risk HPV(all OR>1,P<0.05).The negative conversion rate and the proportion of normal vaginal microecology in observation group were higher than those in control group at 3 and 6 months after treatment(all P<0.05).Conclusion Vaginal microecological status is closely related to persistent high-risk HPV infection and prognosis.It is possible to improve the vaginal microecological status in clinical work,so as to realize the prevention and treatment of persistent high-risk HPV.