阴道微生态及酶改变与高危型人乳头瘤病毒感染及宫颈上皮内瘤变发生风险的相关性研究

The correlation between vaginal microecology and enzyme changes and the risk of HR-HPV infection and CIN

目的观察阴道微生态及酶改变与高危型人乳头瘤病毒(HR-HPV)感染及宫颈上皮内瘤变(CIN)发生风险的相关性。方法选取2017年1月至2021年5月南京市红十字医院收治的243例宫颈病变患者作为研究对象。均行阴道微生态检测、人乳头瘤病毒(HPV)分型检测、阴道镜下活检,根据检查结果将患者分为HR-HPV组、低危型人乳头瘤病毒(LR-HPV)组和无HPV感染组,另将患者分为CIN组与未发生CIN组。比较HR-HPV组、LR-HPV组和无HPV感染组的阴道微生态及酶水平,比较CIN组与未发生CIN组阴道微生态及酶水平,采用Logistic回归分析检验主要指标与HR-HPV感染及CIN发生的关系。结果243例宫颈病变患者中,HR-HPV组92例,LR-HPV组93例,无HPV感染组58例;发生CIN 111例,其中CINⅠ组43例、CINⅡ组57例、CINⅢ组11例,未发生CIN组132例。HR-HPV组β-葡萄糖醛酸酶(GUS)、唾液酸酐酶(SNA)、过氧化氢(H_(2)O_(2))阳性率均高于LR-HPV组、无HPV感染组,差异具有统计学意义(P<0.05);CIN组GUS、SNA、H_(2)O_(2)阳性率高于未发生CIN组,差异具有统计学意义(P<0.05)。Logistic回归分析检验结果显示,GUS、SNA、H_(2)O_(2)阳性是HR-HPV感染及CINⅢ级发生的危险因素(OR>1,P<0.05)。结论阴道微生态及酶改变与HR-HPV感染及CIN发生风险有关,GUS、SNA、H_(2)O_(2)阳性可增加HR-HPV感染及CINⅢ级发生风险。

Objective To observe the correlation between vaginal microecology and enzyme changes and the risk of high-risk human papilloma virus(HR-HPV)infection and cervical intraepithelial neoplasia(CIN).Methods 243 patients with cervical lesions treated in the Nanjing Red Cross Hospital from January 2019 to May 2021 were selected as the research objects.Vaginal microecology test,human papilloma virus(HPV)typing test and colposcopy biopsy were performed.According to the examination results,the patients were divided into HR-HPV group,low-risk human papilloma virus(LR-HPV)group and non-HPV infection group,then divided the rest of them into CIN group and non-CIN group.The vaginal microecology and enzyme levels of HR-HPV group,LR-HPV group and non-HPV infection group were compared.Vaginal microecology and enzyme levels were compared between CIN group and non-CIN group.Logistic regression analysis was used to test the relationship between the main indexes and HR-HPV infection and CIN.Results Among 243 patients with cervical lesions,92 cases in HR-HPV group,93 cases in LR-HPV group,and 58 cases in non-HPV infection group.CIN occurred in 111 cases,including 43 cases in CIN I group,57 cases in CINⅡgroup,11 cases in CINⅢgroup,and 132 cases in non-CIN group.The positive rates ofβ-glucuronidase(GUS),sialic anhydrase(SNA)and hydrogen peroxide(H_(2)O_(2))in HR-HPV group were higher than those in LR-HPV group and non-HPV infection group,and the differences were statistically significant(P<0.05).The positive rates of GUS,SNA and H_(2)O_(2) in CIN group were higher than those in non-CIN group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that GUS,SNA and H_(2)O_(2) positivity were risk factors for HR-HPV infection and CINⅢ(OR>1,P<0.05).Conclusions Vaginal microecology and enzyme changes are related to the risk of HR-HPV infection and CIN.Positive GUS,SNA and H_(2)O_(2) can increase the risk of HR-HPV infection and CINⅢ.