子宫颈病变患者阴道微生态与高危型HPV感染相关性分析

Correlation between vaginal microecology and high-risk HPV infection in patients with cervical lesions

目的探讨子宫颈病变患者阴道微生态与高危型人乳头瘤病毒(HR-HPV)感染的相关性。方法选取行阴道镜及宫颈组织活检诊断为子宫颈病变的患者1200例,分为低级别鳞状上皮内病变(LSIL)组(592例)、高级别鳞状上皮内病变(HSIL)组(458例)、宫颈癌组150例。所有患者均行阴道微生态检测及高危型HPV感染筛查,比较不同子宫颈病变亚组患者阴道微生态指标、阴道病原体及高危HPV感染情况。结果宫颈癌组患者阴道pH值、过氧化氢(H_(2)O_(2))、白细胞酯酶(LE)、唾液酸脂酶(SNA)、N-乙酰基-氨基半乳糖苷酶(NAG)阳性率均高于HSIL组和LSIL组(P<0.05)。宫颈癌组患者阴道炎类型需氧性阴道炎(AV)、细菌性阴道炎(BV)、滴虫性阴道炎(TV)检出率高于HSIL组和LSIL组(P<0.05);3组念珠菌病(VVC)检出率比较差异无统计学意义(P>0.05)。宫颈癌组阴道生态环境清洁度为Ⅲ~Ⅳ度患者90例,HSIL组256例、LSIL组255例,组间比较差异有统计学意义(P<0.05)。宫颈癌组高危HPV感染亚型16、18型检出率高于HSIL组和LSIL组(P<0.05);3组其它常见亚型31、33、52、58型检出率比较无统计学差异(P>0.05)。Spearman相关性分析显示,阴道微生态指标pH值、H 2O 2、LE、AV、BV、TV及清洁度异常与高危HPV感染呈正相关性(P<0.05),SNA、NAG及VVC与高危HPV感染无明显相关性(P>0.05)。结论子宫颈病变的发展与阴道微生态改变及高危HPV感染密切相关。

Objective To investigate the relationship between vaginal microecology and high-risk human papilloma virus(HPV)infection in patients with cervical lesions.Methods A total of 1200 patients diagnosed with cervical lesions by colposcopy and cervical biopsy were selected.According to the examination results,the patients were divided into low-grade squamous intraepithelial lesions(LSIL)group(n=592),HSIL group(n=458)and cervical cancer group(n=150).Vaginal microecological test and high-risk HPV infection screening was performed in all patients,and vaginal microecological indicators,vaginal pathogens and high-risk HPV infection were compared among different cervical lesion subgroups.Results The positive rates of vaginal pH,hydrogen peroxide(H_(2)O_(2)),leucocyte lipase(LE),sialate lipase(SNA)and N-acetyl-aminogalactosidase(NAG)in cervical cancer group were higher than those in HSIL group and LSIL group(P<0.05).The detection rates of aerobic vaginitis(AV),bacterial vaginitis(BV)and trichomoniasis vaginitis(TV)in cervical cancer group were higher than those in HSIL group and LSIL group(P<0.05).The detection rate of Candidiasis(VVC)among 3 groups was compared(P>0.05).The vaginal ecological environment cleanliness of 90 patients(66.00%)in the cervical cancer group was betweenⅢand IV degrees,which was higher than that of 256 patients(55.90%)in the HSIL group and 255 patients(42.86%)in the LSIL group(P<0.05).The detection rate of high-risk HPV infection subtypes 16 and 18 in cervical cancer group was higher than that in HSIL group and LSIL group(P<0.05);There was no significant difference in the detection rate of other common subtypes 31,33,52 and 58 among the three groups(P>0.05).Spearman correlation analysis showed that abnormal vaginal microecological indicators such as pH,H 2O 2,LE,AV,BV,TV and cleanliness were positively correlated with high-risk HPV infection(P<0.05),while SNA,NAG and VVC were not significantly correlated with high-risk HPV infection(P>0.05).Conclusion The development of cervical lesions is closely related to vaginal microecology and high-risk HPV infection.