阴道微环境因子对高危型HPV感染者24个月后转归的影响

Influence of vaginal microenvironment factors on the outcomes of patients after 24 months of high-risk human papillomavirus infection

目的:探讨阴道微环境因子对高危型人乳头瘤病毒(HR-HPV)感染转归的影响。方法:采用前瞻性队列研究方法,在2020年1月-2021年12月选取本院就诊的HR-HPV感染者487例为研究对象,收集基线资料,应用导流杂交技术检测HR-HPV分型,检测阴道分泌物中阴道微环境因子,随访24个月复查HR-HPV感染转归情况,分析感染者临床特征及阴道微环境因子对HR-HPV感染转归的影响。结果:随访24个月,413例完成了随访,49.6%由阳性转阴,持续感染率为50.4%,其中同型持续感染113例(27.3%),异形持续感染95例(23.0%),持续感染中HR-HPV分型以HPV16(26.7%)最高,其次分别为HPV58(26.2%)、HPV52(25.0%)和HPV39(25.0%)。转阴组阴道PH值、唾液酸苷酶和白细胞酯酶异常率低于持续感染组,且均为HR-HPV感染者发生持续感染的风险因素(P<0.05)。结论:阴道PH值、唾液酸苷酶和白细胞酯酶等阴道微环境因子异常可增加HR-HPV感染者持续感染风险,且HPV16发生同型感染持续可能性更大。

Objective:To investigate the influence of vaginal microenvironment factors on the outcomes of patients with highrrisk human pillomavirus(HR-HPV)infection.Methods:A prospective cohort study was conducted to select 487 patients with HR-HPV infection from January to December 2018.Baseline data of the patients were collected.HR-HPV typing of the patients was detected by diversion hybridization,and the vaginal microenvironment factors in vaginal secretions of the patients were detected.The outcomes of patients were followed up for 24 months.The clinical characteristics of the patients with HR-HPV infection and the influence of vaginal microenvironment factors of the patients on their outcomes were analyzed.Results:After 24 months of follow-up,413 patients had completed the follow-up.There were 49.6%patients with HR-HPV infection from positive to negative,and the persistent infection rate of HR-HPV of the patients was 50.4%,including 113(27.3%)patients with persistent infection of homotypic HPV and 95(23.0%)patients with persistent infection of heteromorphic HPV.Among the patients with persistent HPV infection,the infection rate(26.7%)of HPV16 was the highest,then followed by HPV58(26.2%),HPV52(25.0%),and HPV39(25.0%).The abnormal rates of the vaginal PH,and the sialidase and leucocyte esterase levels of the patients with HR-HPV infection from positive to negative were significantly lower than those of the patients with persistent HPV infection.The abnormal vaginal PH value,and sialidase and leucocyte esterase levels of the patients were all the risk factors of their HR-HPV persistent infection(P<0.05).Conclusion:The abnormality of vaginal microenvironment factors,such as vaginal pH value,and sialidase and leukocyte esterase levels of the patients maybe increase the risk of HR-HPV persistent infection,and the possibility of persistent homotypic infection of HPV16 is greater.