阴道微生态变化对复发性外阴阴道假丝酵母菌病患者高危型HPV感染的影响研究

Effects of vaginal microecological changes on high-risk HPV infection in patients with recurrent vulvovaginal candidiasis

目的探讨阴道微生态变化对复发性外阴阴道假丝酵母菌病(RVVC)患者高危型人乳头状瘤病毒(HPV)感染的影响。方法选取120例无外阴瘙痒、分泌物增多、异味等阴道炎症临床症状符合纳入标准患者,根据阴道分泌物检测及HPV筛查结果,分为RVVC并高危型HPV阳性组[RVVC+HR-HPV(+)组]、RVVC并高危型HPV阴性组[RVVC+HR-HPV(-)组]、单纯高危型HPV阳性组([HR-HPV(+)组])、高危型HPV阴性组[HR-HPV(-)组],各30例。比较四组患者阴道微生态指标(菌群密集度、多样性、阴道清洁度、乳酸菌、pH值、过氧化氢酶、唾液酸苷酶等)及HPV B6/B7mRNA表达情况。结果四组患者清洁度、阴道菌群密集度、阴道菌群多样性、pH值、乳酸菌、过氧化氢酶异常发生率比较,差异具有统计学意义(P<0.05)。唾液酸苷酶、β-氨基半乳糖苷酶异常发生率比较,差异无统计学意义(P>0.05)。阴道清洁度异常[OR-5.211(95%CI:1.278,21.237)]、阴道菌群密集度异常[OR=3.286(95%CI:1.085,9.952)]、阴道菌群多样性异常[OR=3.824(95%CI:1.150,12.713)]pH值异常[OR=4.375(95%CI:1.320,14.504)]、乳酸菌异常[OR=3.500(95%CI:1.112,11.017)]、过氧化氢酶异常[OR=6.000(95%CI:1.890,19.043)]的RVVC患者较无异常的RVVC患者感染HR-HPV的风险更高(χ^(2)=5.963,P=0.015;χ^(2)=4.593,P=0.032;χ^(2)=5.079,P=0.024;Х=6.239,P=0.012;χ^(2)=4.800,P=0.028;χ^(2)=10.000,P=0.002)。RVVC+HR-HPV(+)组E6/B7mRNA阳性率高于HR-HPV(+)组,差异具有统计学意义(P<0.05)。结论大部分RVVC患者在无症状期仍存在阴道微生态失衡,且该环境更易感染HR-HPV,主要表现为阴道清洁度、阴道菌群密集度、阴道菌群多样性、pH值及过氧化氢酶方面异常,且RVVC合并HR-HPV感染的患者E6/E7mRNA表达明显增加,保持RVVC患者无症状期阴道微生态平衡可-定程度避免或降低HR-HPV感染风险,同时可通过E6/E7mRNA表达检测来对RVVC合并HR-HPV阳性患者发展为宫颈癌的早期预警。

Objective To investigate the effect of vaginal microecological changes on high-risk human papillomavirus(HPV)infection in patients with recurrent vulvovaginal candidiasis(RWC).Methods 120 patients with clinical symptoms of vaginal inflammation such as no vulvar pruritus,increased secretion,odor and so on were selected and met the inclusion criteria.According to the results of vaginal secretion detection and HPV screening,They were divided into RWC and high-risk HPV positive group[RWC+HR-HPV(+)group],RWC and high-risk HPV negative group[RWC+HR-HPV(-)group],high-risk HPV positive group[HR-HPV(+)group],high-risk HPV negative group[HR-HPV(-)group],30 cases in each group.The vaginal microecological indicators(bacterial flora concentration,diversity,vaginal cleanliness,lactic acid bacteria,pH value,catalase,sialidase,etc.)and HPV E6/E7mRNA expression were compared among the four groups.Results There were statistically significant differences in cleanliness,vaginal flora concentration,vaginal flora diversity,pH value,lactic acid bacteria,and abnormal incidence of catalase among the four groups(P<0.05).There was no significant difference in the incidence of abnormal sialidase and β-galactosidase(P>0.05).Abnormal vaginal cleanliness[0R=5.211(95%CI:1.278,21.237)],abnormal vaginal microbiota concentration[0R=3.286(95%CI:1.085,9.952)],abnormal vaginal microbiota diversity[OR=3.824(95%CI:1.150,12.713)],abnormal pH[0R=4.375(95%CI:1.320,14.504)],abnonnal lactic acid bacteria[OR=3.500(95%CI:1.112,11.017)]abnonnal catalase[OR=6.000(95%CI:1.890,19.043)]RWC patients had a higher risk of HR-HPV infection than normal RWC patients(χ^(2)=5.963,P=0.015;χ^(2)=4.593,P=0.032;χ^(2)=5.079,P=0.024;χ^(2)=6.239,P=0.012;χ^(2)=4.800,P=0.028;χ^(2)=10.000,P=0.002).The positive rate of E6/E7mRNA in RWC+HR-HPV(+)group was higher than that in HR-HPV(+)group,and the difference was statistically significant(P<0.05).Conclusion Most RWC patients still have vaginal microecological imbalance in the asymptomatic period,and this environment is more likely to be infected with HR-HPV mainly manifested in vaginal cleanliness,vaginal flora density,vaginal flora diversity,pH value,peroxidation Hydrogenase is abnonnal,and the expression of E6/E7 mRNA in patients with RWC complicated by HR-HPV infection is significantly increased.Maintaining the vaginal microecological balance in asymptomatic patients with RWC can avoid or reduce the risk of HR-HPV infection to a certain extent.Detection for early warning of cervical cancer in patients with RWC and HR-HPV positive.