人乳头瘤病毒感染与子宫颈性传播感染及阴道微生态特征的相关性

Association between human papillomavirus,sexually transmitted infections,and vaginal microflora

目的探讨人乳头瘤病毒(HPV)与子宫颈性传播感染(STI)病原体及阴道微生态特征之间的相关性。方法收集2021年11月—2022年1月于首都医科大学附属北京妇产医院妇科门诊行HPV分型及STI病原学检测者共655例,同时行阴道微生态检测者479例。将HPV检测结果阳性的154例设为研究组,阴性的501例设为对照组,对结果进行分析。结果①两组间STI病原体总检出率差异有统计学意义(65.58%对50.50%,P=0.001)。HPV感染组中非常明确的STI病原体,即沙眼衣原体(CT)、生殖支原体(Mg)、淋病奈瑟菌(NG)、单纯疱疹病毒Ⅱ型(HSV-Ⅱ)的总检出率为9.09%,显著高于对照组的3.59%(P=0.006)。人型支原体(Mh)在HPV感染组的检出率高于阴性组(7.79%对3.99%),但差异无统计学意义。②两组中检出率最高的病原体均为解脲支原体(UU),且两组差异有统计学意义(62.99%对48.10%,P=0.001),研究组中有19.8%为UU合并其他病原体感染,显著高于对照组中的8.70%(P=0.004),UU中以单一型微小脲原体(Up)阳性为主(79.49%对83.11%),Up3(38.46%对32.42%)、Up6(32.05%对35.16%)和Up1(8.97%对14.61%)检出率差异均无统计学意义,解脲脲原体(Uu)感染仅在≥25岁组中呈现出与HPV感染显著相关(P<0.05)。③患者年龄随着共感染STI病原体的种类增加而显著降低(P=0.002)。④两组间阴道微生态指标均无显著差异,STI病原体感染与阴道微生态无明显相关。⑤STI病原体与HPV感染之间的logistic回归分析显示,Uu感染是发生HPV感染的独立危险因素(OR=2.620,95%CI:1.114~6.164,P=0.027),UU亚型及STI病原体的多重感染将显著增加HPV的感染风险(OR=1.594,95%CI:1.070~2.375;OR=1.666,95%CI:1.245~2.229,P<0.05)。结论单一型UU是女性下生殖道的常驻菌群,与HPV感染并无相关。CT、Mg、NG、HSV-Ⅱ以及STI病原体、UU亚型的多重感染与HPV感染有关,尤其应关注≥25岁女性的STI感染情况。

Objective To investigate the correlation between human papillomavirus(HPV),pathogens of cervical sexually transmitted infection(STI),and vaginal microflora.Methods A total of 655 patients underwent HPV typing and STI etiological detection from November 2021 to January 2022.And 479 of the 655 patients also received vaginal microflora assay at the same time.The 154 HPV-positive patients were enrolled as the study group,and 501 HPV-negative patients were enrolled as controls.Results The overall infection rate of STI showed significant difference between the two groups(65.58%vs.50.50%,P=0.001).The overall infection rate of Chlamydia trachomatis(CT),Mycoplasma genitalium(Mg),Neisseria gonorrhoeae(NG),and Herpes simplex virus typeⅡ(HSV-Ⅱ)was 9.09%in HPV-positive group,significantly higher than that in the control group(3.59%)(P=0.006).Mycoplasma hominis(Mh)infection rate was numerically higher in HPV infection group than in control group(7.79%vs.3.99%).The most prevalent pathogens in both groups were Ureaplasma urealyticum(UU),but the prevalence was significantly different(62.99%vs.48.10%,P=0.001).In the study group,UU co-infected with other pathogens was identified in 19.8%of the patients,which was significantly higher than the prevalence(8.70%)in the control group(P=0.004).Single serotype of Ureaplasma parvum(Up)accounted for the majority(79.49%vs.83.11%),but there was no significant difference in the prevalence of Up3(38.46%vs.32.42%),Up6(32.05%vs.35.16%),and Up1(8.97%vs.14.61%).Ureaplasma urealyticum(Uu)infection was significantly associated with HPV infection only in the females≥25 years of age(P<0.05).The number of STI infections increased significantly with the decrease of patient age(P=0.002).Vaginal microflora did not show significant difference between the two groups.STI pathogens did not correlate with vaginal microflora.Logistic regression analysis of STI pathogens and HPV infection showed that Uu infection was an independent risk factor for HPV infection(OR=2.620,95%CI:1.114-6.164,P=0.027).Multiple infection by UU subtypes and STI pathogens significantly increased the risk of HPV infection(OR=1.594,95%CI:1.070-2.375;OR=1.666,95%CI:1.245-2.229,P<0.05).Conclusions Single serotype of UU is a resident microflora in female genital tract and does not correlate with HPV infection.CT,Mg,NG,HSV-Ⅱ,STI pathogens subtypes,and UU subtypes are associated with HPV infection.Special attention should be paid to the risk of STI infection in women≥25 years of age.