宫颈上皮内瘤变合并人乳头瘤病毒感染患者宫颈环形电切术后的病原菌分布炎症因子水平变化及临床意义

Distribution of pathogens,changes of inflammatory factors and clinical significance in patients with CIN complicated with HR-HPV infection after LEEP

目的分析宫颈上皮内瘤变(CIN)合并人乳头瘤病毒(HR-HPV)感染患者宫颈环形电切(LEEP)术后的病原菌分布、炎症因子水平变化及临床意义。方法回顾性选取某院于2019年7月至2021年7月间收治的82例CIN合并HR-HPV感染患者作为研究对象。比较所有患者手术前后阴道微生态检测情况复诊HR-HPV阴性与HR-HPV阳性患者的阴道微生态检测情况、不同宫颈病变患者炎性因子与淋巴细胞水平、不同HPV感染类型者炎性因子与淋巴细胞水平。结果术后菌群密集度Ⅱ~Ⅲ级、多样性Ⅱ~Ⅲ级、乳酸分级Ⅰ~Ⅱa级明显多于术前,需氧菌性阴道病(AV)、细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)以及滴虫性阴道炎的检出率明显低于术前,术后pH值明显低于术前,差异均有统计学意义(P<0.05)。复诊HR-HPV阳性CIN患者菌群密集度Ⅱ~Ⅲ级、多样性Ⅱ~Ⅲ级、乳酸杆菌分级Ⅰ~Ⅱa级明显低于HR-HPV阴性CIN患者,AV、BV、VVC及滴虫性阴道炎的检出率明显高于HR-HPV阴性CIN患者,pH值高于HR-HPV阴性CIN患者,差异有统计学意义(P<0.05)。HPV感染者其CINⅠ、CINⅡ、CINⅢ的IL-4、CD8^(+)水平依次升高,IL-2、IFN-γ、CD3^(+)、CD4^(+)水平依次降低,差异有统计学意义(P<0.05)。与单一感染相比,多重感染者IL-4、CD8^(+)水平高于单一感染患者,白细胞介素(IL)-2、干扰素(IFN)-γ、CD3^(+)、CD4^(+)水平低于单一感染患者,差异有统计学意义(P<0.05)。结论阴道微生态失衡可影响宫颈正常的免疫力,有效促进CIN的进展与癌变的发生,对阴道微生态的改善可有效抑制HR-HPV的感染以及宫颈细胞的异常增生和癌变。IL-4、CD8^(+)水平的升高,IL-2、IFN-γ、CD3^(+)、CD4^(+)水平的降低与HR-HPV感染类型以及宫颈癌病变阶段存在一定的关系,炎性因子与T淋巴细胞群在宫颈病变的发展以及HR-HPV感染方面扮演着较为重要的角色。

Objective To analyze the distribution of pathogens,changes of inflammatory factors and clinical significance in patients with cervical intraepithelial neoplasia(CIN)complicated with human papillomavirus(HR-HPV)infection after cervical circular electrosurgical excision(LEEP).Methods Eighty-two patients with CIN complicated with HR-HPV infection treated in our hospital from July 2019 to July 2021 were selected retrospectively.Compare vaginal microecological detection of all patients before and after the operation,vaginal microecological detection of HR HPV negative and HR HPV positive patients,inflammatory factors and lymphocyte levels in patients with different cervical lesions,and inflammatory factors and lymphocyte levels in patients with different types of HPV infection.Results The levels of flora densityⅡ~Ⅲ,diversityⅡ~Ⅲand lactate gradeⅠ~Ⅱa after operation were significantly higher than those before operation.The detection rates of aerobic vaginosis(AV),bacterial vaginosis(BV),vulvovaginal candidiasis(VVC)and trichomonal vaginitis were significantly lower than those before the operation,and the pH value after the operation was significantly lower than that before operation,the difference was statistically significant(P<0.05).The flora density,diversity and lactate grade of HR-HPV positive CIN patients were significantly lower than those of HR-HPV negative CIN patients and the detection rates of AV,BV,VVC and trichomonal vaginitis were significantly higher than those of HR-HPV negative CIN patients,and the pH value was higher than that of HR-HPV negative CIN patients,the difference was statistically significant(P<0.05).In HPV-infected patients,the levels of interleukin(IL)-4 and CD8^(+)of CINⅠ,CINⅡand CINⅢincreased successively,and the levels of IL-2 and infection(IFN)-γ,and the levels of CD3^(+)and CD4^(+)decreased in turn,the difference was statistically significant(P<0.05).Compared with single infection,the levels of IL-4 and CD8^(+)in patients with multiple infections were higher than those in patients with single infection.The level of CD4^(+)was lower than that of a single infection,and the differ-ence was statistically significant(P<0.05).Conclusion The imbalance of vaginal microecology can affect the normal immunity of the cervix,and effectively promote the progress of CIN and the occurrence of canceration.The improve-ment of vaginal microecology can effectively inhibit the infection of HR-HPV and the abnormal proliferation and can-ceration of cervical cells.The increased levels of IL-4,CD8^(+),IL-2 and IFN-γ,and the decreased levels of CD3^(+)and CD4^(+)were related to the type of HR-HPV infection and the stage of cervical cancer.Inflammatory factors and the T lymphocyte population play an important role in the development of cervical lesions and HR-HPV infection.