乳杆菌对HSIL全子宫切除术后HR-HPV清除率及阴道微生态的影响

Effect of lactobacillus intervention on the clearance rate of high-risk HPV and vaginal microecology in patients with HSIL after total hysterectomy

目的探讨在因子宫颈高级别鳞状上皮内瘤变(HSIL)行全子宫切除术(TH)后经阴道使用乳杆菌对机体清除高危型人乳头瘤病毒(HR-HPV)效率及阴道微生态的影响。方法选取2021年1月至2022年10月3所医院收治的HSIL合并HR-HPV感染行TH的患者120例,按随机数字表法分为对照组和研究组,每组各60例。对照组术后定期复查,研究组在TH术后1月开始经阴道给予乳杆菌,疗程5个月。比较两组HR-HPV清除率,术后1月及6月时阴道菌群密集度正常比例、菌群多样性正常比例、乳杆菌数目≥3+比例、阴道pH值正常比例、过氧化氢阴性比例、白细胞酯酶阴性比例、炎症因子(TNF-α和IL-6)水平和不良反应发生情况。结果研究组HR-HPV完全清除率和总清除率高于对照组(69.5%vs 44.8%,89.8%vs70.7%)(P<0.05),术后6月时研究组阴道菌群密集度正常比例、菌群多样性正常比例、乳杆菌数目≥3+比例、阴道pH值正常比例、过氧化氢阴性比例、白细胞酯酶阴性比例高于对照组(P<0.05),血清TNF-α、IL-6水平均低于对照组(P<0.05)。研究组无乳杆菌相关不良反应发生。结论在HSIL合并HR-HPV感染行TH术后使用乳杆菌能更好地恢复阴道微生态平衡,增加机体对HR-HPV的清除率,降低机体炎症反应,具有良好的安全性。

Objective To observe the effect of lactobacillus intervention on the clearance rate of high-risk human papillomavirus(HR-HPV)and vaginal microecology in patients with high-grade squamous intraepithelial lesion(HSIL)after total hysterectomy(TH).Methods Patients with HSIL and cervical HR-HPV infection(120 cases)from January 2021 to October 2022 were randomly divided into the control group(n=60)or the observation group(n=60).The patients in the control group were regularly reviewed after operation,while those in the observation group were given lactobacillus capsules vaginally 1 month after TH for 5 months.The clearance rate of HR-HPV,proportion of normal vaginal flora density,proportion of normal flora diversity,proportion of lactobacillus≥3+,proportion of normal vaginal pH value,negative proportion of hydrogen peroxide,negative proportion of leukocyte esterase,inflammatory factor(TNF-αand IL-6)levels at 1 month and 6 months after TH,and adverse reactions during intervention were compared between the two groups.Results The complete clearance rate and total clearance rate of HR-HPV in the observation group were higher than those in the control group respectively(P<0.05).At 6 months after TH,the proportion of normal vaginal flora density,proportion of normal flora diversity,proportion of Lactobacillus≥3+,proportion of normal vaginal pH value,negative proportion of hydrogen peroxide,and the negative proportion of leukocyte esterase in the observation group were higher,while the levels of serum TNF-αand IL-6 were lower than those in the control group,respectively(P<0.05).There was no adverse reactions related to lactobacillus occurred in the observation group during intervention.Conclusion Lactobacillus can promote the recovery of vaginal microecological balance after TH in patients with HSIL and cervical HR-HPV infection,increase the clearance rate of HR-HPV,and reduce the inflammatory response of the body,with good safety.