妇科门诊阴道镜检查人群阴道微生态改变与人乳头瘤病毒感染的相关性

The relationship between vaginal microecological changes and human papillomavirus infection in gynecological outpatients examined by colposcopy

目的初步探讨妇科门诊阴道镜检查人群人乳头瘤病毒(human papillomavirus,HPV)感染与其阴道微生态改变的相关性,以了解妇科疾病患者病原体感染与其阴道稳态和生殖道健康的关系。方法随机选择2020年4月到2022年4月在我院妇科门诊行阴道镜检查的患者130例,均进行阴道微生态和宫颈HPV检测。根据HPV DNA基因分型结果进行分组,检测HPV感染组和未感染组人群阴道分泌物的清洁度、病原体和阴道微生态相关指标,对阴道微生态改变和HPV感染的相关性进行统计学分析。结果130例研究对象中,HPV感染者101例(77.69%)。101例HPV感染者中,以单一感染(76例,58.46%)为主,其中又以单一HR-HPV(high-risk HPV)感染(72例,55.38%)为主。101例HPV感染者中,有21种HPV亚型被检出,排名前5位的亚型分别为HPV16、HPV52、HPV58、HPV53、HPV18,占比分别为16.15%、9.23%、8.46%、6.92%、5.38%。101例HPV感染者和29例HPV未感染者相比,阴道清洁度、阴道pH值、白细胞数量异常、白细胞酯酶活性和唾液酸苷酶阳性率差异均有统计学意义(均P<0.05),H2O2阳性率组间差异无统计学意义(P>0.05)。HPV阴性组的阴道乳杆菌异常率及各菌群阳性率均显著低于HPV多重感染组和HPV单一感染组。HPV多重感染组患者乳杆菌异常率、衣原体和解脲脲原体阳性率均高于HPV单一感染组(均P<0.05)。结论阴道微生态失调严重影响患者HPV感染率,且HPV感染与阴道清洁度、菌群密集度、pH值异常和白细胞酯酶阳性率异常有关。

Objective To explore the relationship between human papillomavirus(HPV)infection and vaginal microecological changes in gynecological outpatients examined by colposcopy,so as to understand the correlation between pathogen infection and vaginal homeostasis and reproductive tract health in the patients.Methods One hundred and thirty patients who underwent colposcopy in our gynecology clinic from April 2020 to April 2022 were randomly selected for vaginal microecology and cervical HPV detection.According to the results of DNA genotyping in patients with HPV infection,the cleanliness of vaginal secretions,pathogens and related indexes of vaginal microecology in HPV infection group and non-infection group were detected,and the correlation between vaginal microecological changes and HPV infection was statistically analyzed.Results Of the 130 subjects,101 were infected with HPV(77.69%),most of which single infection(76 cases,58.46%),mainly single high-risk-HPV(HR-HPV)infection(72 cases,55.38%);21 HPV subtypes were detected,with the top five subtypes being HPV16,HPV52,HPV58,HPV53 and HPV18,accounting for 16.15%,9.23%,8.46%,6.92%and 5.38%respectively.There were significant differences in vaginal microflora cleanliness,pH and leukocyte count,leukocyte esterase activity and sialidase positive rate between HPV infection group and non-HPV infection group(all P<0.05),but not in H2O2 positive rate(P>0.05).The abnormal rate of Lactobacillus and positive rate of each flora in HPV negative group were significantly lower than those in HPV multiple infection group and HPV single infection group.The abnormal rate of Lactobacillus and positive rates of Chlamydia trachomatis and Ureaplasma urealyticum in HPV multiple infection group were significantly higher than those in HPV single infection group respectively.Conclusion Vaginal microecological imbalance seriously affects the infection rate of HPV,and HPV infection is related to cleanliness,microflora density,abnormal pH value and abnormal positive rate of leukocyte esterase.