宫颈癌患者术后辅助放疗对阴道微生态状况的影响及与预后的相关性

Study on the effect of adjuvant radiotherapy after cervical cancer surgery on vaginal microecology and the correlation with prognosis

目的分析宫颈癌患者术后辅助放疗对阴道微生态状况的影响及与预后的相关性。方法选取2018年1月—2020年1月萍乡市妇幼保健院收治的103例宫颈癌患者为研究对象,均在术后进行辅助放疗,并检测阴道微生态状况。结果辅助放疗前后,患者阴道清洁度、菌群多样性、菌群密集度及Nugent评分比较差异均有统计学意义(均P<0.05)。术后辅助放疗后预后良好和预后不良宫颈癌患者阴道清洁度、菌群多样性(除Ⅳ级以外)、菌群密集度(除Ⅳ级以外)及Nugent评分比较差异均有统计学意义(均P<0.05)。logistic回归分析结果显示:阴道清洁度、菌群多样性、菌群密集度、Nugent评分、pH值是宫颈癌预后不良的影响因素(OR=1.339、1.321、1.455、1.417、1.542,均P<0.05)。ROC曲线显示:5项联合对宫颈癌预后不良的预测价值高于阴道清洁度、菌群多样性、菌群密集度、Nugent评分、pH值单项检测。结论宫颈癌患者术后辅助化疗治疗后阴道微生态状况异常,但预后良好患者阴道微生态状况优于预后不良患者,阴道微生态指标联合检测对宫颈癌预后不良的预测价值较高。

Objective To analyze the effect of adjuvant radiotherapy after cervical cancer surgery on vaginal microecology and the correlation with prognosis.Methods A total of 103 patients with cervical cancer treated in Pingxiang Municipal Maternal and Child Health Care Hospital from January 2018 to January 2020 were selected as study object,adjuvant radiotherapy after cervical cancer surgery was performed,and vaginal microecology was detected.Results There were statistically significant differences in vaginal cleanliness,bacterial diversity,bacterial density,and Nugent score between before and after adjuvant radiotherapy(all P<0.05).There were statistically significant differences in vaginal cleanliness,bacterial diversity(exceptⅣgrade),bacterial density(exceptⅣgrade),and Nugent score between good prognosis cervical cancer patients and poor prognosis cervical cancer patients(all P<0.05).Logistic regression analysis showed that vaginal cleanliness,bacterial diversity,bacterial density,Nugent score,and pH value were the risk factors for poor prognosis of cervical cancer(OR=1.339,1.321,1.455,1.417,1.542,all P<0.05).ROC curve showed that the predictive value of combined detection of five items for poor prognosis of cervical cancer was higher than those of single detection of vaginal cleanliness,bacterial diversity,bacterial density,Nugent score,and pH value.Conclusion Vaginal microecology of patients with cervical cancer after adjuvant chemotherapy is abnormal,but vaginal microecology of patients with good prognosis is better than that of patients with poor prognosis.The combined detection of vaginal microecology indicators has a high predictive value for poor prognosis of cervical cancer.