HR-HPV感染聚焦超声治疗前后阴道微生态分析

Analysis of vaginal microecology before and after focused ultrasound treatment of HR-HPV infection

目的 分析高危型人乳头瘤样病毒(high-risk human papillomavirus, HR-HPV)感染妇女使用聚焦超声(focused ultrasound, FUS)治疗前后阴道微生态的变化情况。方法 收集2020年7月至2021年7月在柳州市妇幼保健院妇科门诊就诊的HR-HPV感染并进行宫颈FUS治疗的120例妇女的病例资料,比较术前及术后3个月阴道分泌物检查结果,进行阴道微生态评价。结果 患者术前及术后3个月阴道菌群密集度及多样性比较,差异均有统计学意义(P<0.05)。阴道微生态异常主要包括菌群异常、菌群抑制及菌群增殖过度。术前菌群正常占42.5%,术后3个月菌群正常占92.5%;术前及术后3个月阴道分泌物的白细胞酯酶阳性率(73.3%vs 55.8%)、唾液酸酐酶阳性率(35%vs 19.2%)、细菌性阴道炎(46.7%vs 3.3%)、霉菌性阴道炎(35%vs 4.2%)及HR-HPV阳性率(100%vs 7.5%)、HO阴性率(32.5%vs 2.5%)、滴虫性阴道炎阳性率(6.7%vs 0)比较,差异均有统计学意义(P<0.05);术前pH值及Nagent评分[(4.62±0.08),(5.49±1.86)分]均高于术后3个月水平[(4.38±0.15),(2.33±1.59)分],差异有统计学意义(P<0.05)。结论 HR-HPV感染患者经FUS治疗后3个月阴道微生态明显改善,FUS治疗能够促进HR-HPV的阴转率,是一种有效的宫颈HR-HPV感染治疗方式。

Objective To analyze the changes of vaginal microecology in women with high-risk human papillomavirus(HRHPV)infection before and after treatment with focused ultrasound(FUS).Methods The case data of 120 women with HR-HPV infection who underwent cervical FUS treatment in the Gynecological Outpatient Department of Liuzhou Maternity and Child Healthcare Hospital from July 2020 to July 2021 were collected,and the vaginal secretion examination before and 3 months after the operation were compared.As a result,vaginal microecological evaluation was carried out.Results There were significant differences in the density and diversity of vaginal flora before surgery and 3 months after surgery(P<0.05).The abnormal vaginal microecology mainly includes abnormal flora,inhibition of flora and excessive proliferation of flora.Normal flora accounted for 42.5% before operation,and 92.5% at 3 months after operation;leukocyte esterase(73.3%vs 55.8%),sialidase in vaginal secretions before and 3 months after surgery(35%vs 19.2%),bacterial vaginitis(46.7%vs 3.3%),fungal vaginitis(35%vs 4.2%),HR-HPV positive rate(100%vs 7.5%),H_(2)O_(2) negative rate(32.5%vs 2.5%)and the positive rate of trichomonas vaginitis(6.7%vs 0),the differences were statistically significant(P<0.05);Preoperative pH value and Nagent score[(4.62±0.08),(5.49±1.86)points]were higher than 3 months after operation[(4.38±0.15),(2.33±1.59)points],the differences were statistically significant(P<0.05).Conclusion The vaginal microecology of patients with HR-HPV infection was significantly improved 3 months after FUS treatment.FUS treatment can promote the negative conversion rate of HR-HPV and is an effective treatment for cervical HR-HPV infection.