阴道微生态失衡与高危型人乳头瘤病毒感染及宫颈上皮内瘤变的关系

Relationship between vaginal microecology imbalance and high-risk human papillomavirus infection and cervical intraepithelial neoplasia

目的探讨阴道微生态失衡与高危型人乳头瘤病毒(HPV)感染及宫颈上皮内瘤变的关系。方法选择2021年1—12月在平邑县人民医院进行宫颈癌筛查的6132名女性作为研究对象,所有研究对象均行阴道微生态检查、高危型HPV检查、宫颈液基细胞学检查,观察阴道微生态情况、高危型HPV感染情况及宫颈上皮内瘤变情况,比较并分析不同类型HPV感染患者、宫颈上皮内瘤变患者以及正常患者的阴道微生态特征。结果高危型HPV感染阳性者的乳酸杆菌少/无、阴道清洁度Ⅲ~Ⅳ度、念珠菌阳性占比均明显高于高危型HPV感染阴性者〔乳酸杆菌少/无:54.87%(411/749)比28.71%(542/1888),阴道清洁度Ⅲ~Ⅳ度:34.98%(262/749)比9.69%(183/1888),念珠菌阳性:19.76%(148/749)比9.85%(186/1888),均P<0.05〕。高危型HPV感染阳性与阴性者的细菌性阴道病阳性率、滴虫阳性率比较差异均无统计学意义〔细菌性阴道病阳性:10.28%(77/749)比10.70%(202/1888),滴虫阳性:0.67%(5/749)比0.64%(12/1888),均P>0.05〕。宫颈上皮内瘤变者的乳酸杆菌少/无、阴道清洁度Ⅲ~Ⅳ度、念珠菌阳性占比均明显高于宫颈上皮正常者〔乳酸杆菌少/无:43.88%(574/1308)比38.66%(1865/4824),阴道清洁度Ⅲ~Ⅳ度:36.70%(480/1308)比16.40%(791/4824)、念珠菌阳性:21.02%(275/1308)比12.31%(584/4824),均P<0.05〕;宫颈上皮内瘤变者与宫颈上皮正常者的细菌性阴道病阳性、滴虫阳性占比差异均无统计学意义〔细菌性阴道病阳性:11.54%(151/1308)比10.45%(504/4824),滴虫阳性:0.92%(12/1308)比0.56%(27/4824),均P>0.05〕。结论高危型HPV感染和宫颈上皮内瘤变与女性阴道微生态失衡有一定关系,如乳酸杆菌数量、阴道清洁度、是否存在念珠菌感染等,临床应加强对上述指标的监测,降低高危型HPV感染和宫颈上皮内瘤变的发生风险。

Objective To explore the relationship between vaginal microecology imbalance and high-risk human papillomavirus(HPV)infection and cervical intraepithelial neoplasia.Methods The 6132 women who had been screened for cervical cancer in Pingyi County People's Hospital from January to December 2021 were selected as research subjects.All the subjects underwent vaginal microecology examination,high-risk HPV examination,and cervical fluid based cytology to observe their vaginal microecology,high-risk HPV infection and cervical intraepithelial neoplasia,and the vaginal microecology of patients with different types of HPV infection,cervical intraepithelial neoplasia and normal patients were analyzed.Results The proportion of Lactobacilli less/no,vaginal cleanlinessⅢ-Ⅳgrade and Candida positive in high-risk HPV positive patients were higher than those in high-risk HPV negative patients[Lactobacilli less/no:54.87%(411/749)vs.28.71%(542/1888),vaginal cleanlinessⅢ-Ⅳgrade:34.98%(262/749)vs.9.69%(183/1888),Candida positive:19.76%(148/749)vs.9.85%(186/1888),all P<0.05].There was no significant difference in the positive rate of bacterial vaginosis and Trichomonas between high-risk HPV positive and negative patients[bacterial vaginosis:10.28%(77/749)vs.10.70%(202/1888),Trichomonas positive:0.67%(5/749)vs.0.64%(12/1888),both P>0.05].The proportion of Lactobacilli less/no,vaginal cleanlinessⅢ-Ⅳgrade and Candida positive in cervical intraepithelial neoplasia patients was higher than those in normal cervical epithelium patients[Lactobacilli less/no:43.88%(828/1308)vs.38.66%(1885/4824),vaginal cleanlinessⅢ-Ⅳgrade:36.70%(480/1308)vs.16.40%(791/4824),Candida positive:21.02%(275/1308)vs.12.31%(584/4824),all P<0.05].There was no significant difference in the positive rates of bacterial vaginosis and Trichomonas between patients with positive cervical intraepithelial neoplasia and normal cervical epithelium[bacterial vaginosis positive:11.54%(151/1308)vs.10.45%(504/4824),Trichomonas positive:0.92%(12/1308)vs.0.56%(27/4824),both P>0.05].Conclusions The high-risk HPV infection and cervical intraepithelial neoplasia are related to the imbalance of vaginal microecology,such as the number of Lactobacillus,cleanliness grade of vagina,and presence of Candida infection.The monitoring of the above indicators should be strengthened in clinic to reduce the risk of high-risk HPV infection and cervical intraepithelial neoplasia.