HR-HPV阳性CIN患者LEEP术后阴道微生态状况及其与术后复发的相关因素

Vaginal microecological status after loop electrosurgical excision procedure in high-risk human papillomavirus positive cervical intraepithelial neoplasia patients and its factors associated with postoperative recurrence

目的探讨高危型人乳头瘤病毒(HR-HPV)阳性的宫颈上皮内瘤变(CIN)患者宫颈环形电切术(LEEP)术后阴道微生态状况及其与术后复发的相关因素。方法回顾性分析2017年6月至2020年6月在陕西省核工业二一五医院妇科接受LEEP治疗的80例HR-HPV阳性CIN患者的临床资料。在患者接受LEEP治疗2个月后,对比分析患者治疗前后的阴道微生态[菌群密集度、菌群多样性、乳酸杆菌分级、需氧菌性阴道病检出率(AV)、细菌性阴道病检出率(BV)、外阴阴道假丝酵母菌病检出率(VVC)、滴虫性阴道炎检出率、pH值]变化状况。在患者LEEP术后开展2年的复查随访,分析其术后转归情况,对影响HR-HPV阳性CIN患者LEEP术后病灶残留/复发的相关因素进行单因素分析及多因素Logistic回归分析。结果术后2个月,患者阴道微生态状况中菌群密集度Ⅱ~Ⅲ级、菌群多样性Ⅱ~Ⅲ级、乳酸杆菌Ⅰ~Ⅱa级检出率分别为73.75%、71.25%、81.25%,明显高于术前的30.00%、40.00%、38.75%,差异均有统计学意义(P<0.05);术后2个月,患者AV、BV、VVC、滴虫性阴道炎检出率、pH值分别为20.00%、13.75%、21.25%、3.75%、4.22±0.45,明显低于术前的40.00%、31.25%、42.5%、18.75%、4.71±0.32,差异均有统计学意义(P<0.05);术后2年复诊检查中发现,80例患者中65例患者HR-HPV转阴且病灶无残留及复发,15例患者存在病灶残留及复发;经单因素分析结果显示,菌群密集度是否为Ⅱ~Ⅲ级,菌群多样性是否Ⅱ~Ⅲ级,乳酸杆菌是否为Ⅰ~Ⅱa级,HR-HPV是否感染,AV、BV、VVC、滴虫性阴道炎检出率是否高于10%,pH值是否高于4.5与HR-HPV阳性的CIN患者LEEP术后病灶残留及复发相关(P<0.05);经多因素Logistic回归分析结果显示,菌群密集度不为Ⅱ~Ⅲ级,菌群多样性不为Ⅱ~Ⅲ级,乳酸杆菌分级不为Ⅰ~Ⅱa级,HR-HPV阳性,AV、BV、VVC、滴虫性阴道炎检出率均高于10%、pH值高于4.5是HR-HPV阳性的CIN患者LEEP术后病灶残留及复发的主要因素(P<0.05)。结论HR-HPV阳性CIN患者采用LEEP术治疗能改善患者阴道微生态状况,其中菌群密集度,菌群多样性,乳酸分级,是否HR-HPV感染,AV、BV、VVC、滴虫性阴道炎检出率,pH值与术后是否复发密切相关。

Objective To investigate the vaginal microecological status of high-risk human papillomavirus(HR-HPV)positive cervical intraepithelial neoplasia(CIN)patients after cervical loop electrosurgical excision procedure(LEEP)and its factors associated with postoperative recurrence.Methods The clinical data of 80 HR-HPV positive CIN patients who received LEEP treatment in the Department of Gynecology,No.215 Hospital of Shaanxi Nuclear In-dustry from June 2017 to June 2020 were retrospectively analyzed.After 2 months of LEEP treatment,the changes of vaginal microecological status[before and after treatment,including bacterial density,microbial diversity,lactobacilli classification,aerobic vaginosis detection rate(AV),bacterial vaginosis detection rate(BV),vulvovaginal candidiasis de-tection rate(VVC),trichomoniasis detection rate,and pH value]were compared and analyzed.Patients were followed up for 2 years after LEEP to analyze their postoperative outcome.Univariate analysis and multivariate Logistic regression analysis were performed on the related factors affecting the residual/recurrence of lesions after LEEP in HR-HPV positive CIN patients.Results Two months after surgery,the detection rates of bacterial density levelⅡ-Ⅲ,bacterial diversity levelⅡ-Ⅲ,and lactobacillus levelⅠ-Ⅱa in the patient's vaginal microecological status were 73.75%,71.25%,and 81.25%,which were significantly higher than 30.00%,40.00%,and 38.75%in the preoperative levels(P<0.05).Two months after surgery,the detection rates of AV,BV,VVC,trichomoniasis vaginitis and pH values were 20.00%,13.75%,21.25%,3.75%,and 4.22±0.45,which were significantly lower than 40.00%,31.25%,42.5%,18.75%,and 4.71±0.32 be-fore surgery(P<0.05).During the follow-up examination,it was found that 65 out of 80 patients had negative HR-HPV and no residual or recurrent lesions,while 15 patients had residual or recurrent lesions.The results of univariate analysis showed that whether the bacterial population density was levelⅡ-Ⅲ,whether the bacterial diversity was levelⅡ-Ⅲ,whether the lactobacilli were levelⅠ-Ⅱa,whether HR-HPV was infected,whether the detection rates of AV,BV,VVC,trichomonas vaginitis were higher than 10%,and whether the pH value was higher than 4.5 were related to the residual and recurrent lesions in HR-HPV positive CIN patients after LEEP surgery(P<0.05).The results of multivariate logistic regres-sion analysis showed that the density of the bacterial community not of levelⅡ-Ⅲ,the diversity of the bacterial communi-ty not of levelⅡ-Ⅲ,the lactobacillus grade not of levelⅠ-Ⅱa,HR-HPV positive,the detection rates of AV,BV,VVC,trichomonas vaginitis higher than 10%,and pH value higher than 4.5 were the main factors for residual and recurrent le-sions in HR-HPV positive CIN patients after LEEP surgery(P<0.05).Conclusion LEEP surgery can improve the vagi-nal microecological of patients with HR-HPV positive CIN,and bacterial density,bacterial diversity,lactobacilli classifica-tion,HR-HPV infection,detection rate of AV,BV,VVC,and trichomonas vaginitis,pH value are closely related to postop-erative recurrence.