妊娠期高危型HPV感染及阴道微生态失调对母儿结局的影响

Effects of high⁃risk HPV infection and vaginal dysbiosis on maternal and neonatal outcomes during pregnancy

目的探讨妊娠期高危型人乳头瘤病毒(HPV)感染和阴道微生态失调对母儿结局的影响。方法入组2020年9月至2021年9月在北京市通州区妇幼保健院分娩的5070例妊娠期孕妇。根据是否高危型HPV感染将其分为高危型HPV感染组及对照组。结果高危型HPV感染组pH值≥4.5、阴道清洁度Ⅲ~Ⅳ度、白细胞酯酶、唾液酸苷酶、细菌性阴道炎、Nugent评分高于对照组,差异有统计学意义(P均<0.05);微生态失调、子宫颈上皮瘤样病变、霉菌性阴道炎、产褥期感染发生率高于对照组,两组比较差异有统计学意义(P均<0.05)。高危型HPV感染孕妇中若存在微生态失调,早产、霉菌性阴道炎发生率高于微生态正常组,分娩伴脐带绕颈率低于于微生态正常组,两组比较差异有统计学意义(P均<0.05)。结论高危型HPV感染伴阴道微生态失调可显著提高早产等不良结局的发生率,同时也会增加产褥期感染风险。对该部分人群应进行充分早期筛查、早期干预,以改善母儿结局。

Objective To investigate the impact of high⁃risk human papillomavirus(HPV)infection and abnormal vaginal biology during pregnancy on maternal and infant outcomes.Methods A total of 5070 pregnant women delivered in the Maternal and Child Health Hospital of Tongzhou District from September 2020 to September 2021 were enrolled.According to whether they were infected with high⁃risk HPV,they were divided into two groups:the high⁃risk HPV infection group and the control group.Results The vaginal pH value≥4.5,vaginal cleanlinessⅢ~Ⅳ,leukocyte esterase,sialidase,bacterial vaginosis,and Nugent scores in the high⁃risk HPV infection group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).The incidences of microecological disorders,cervical epithelioma⁃like lesions,fungal vaginitis,and puerperium infection were higher than those in the control group,with a statistically significant difference between the two groups(P<0.05).The incidences of premature delivery and fungal vaginitis in pregnant women with high⁃risk HPV infection and vaginal dysbiosis were higher than that in the normal microecology group,while the rate of childbirth with umbilical cord around the neck higher in the abnormal microecology group with a statistically significant difference(P<0.05).Conclusion Pregnant women with high⁃risk HPV infection combined with vaginal dysbiosis will increase the unfavorable pregnancy outcomes of preterm labor and also the risk of puerperium infection.Adequate early screening and early intervention should be performed to improve maternal and neonatal outcomes.