高危型人乳头瘤病毒感染宫颈病变程度和阴道菌群分布的关系

Relationship between degree of cervical lesions and distribution of vaginal flora in patients with high-risk human papillomavirus infection

目的探讨高危型人乳头瘤病毒(HR-HPV)感染宫颈病变程度、阴道菌群分布变化及其关系.方法选取2021年1月-2022年12月于长江大学附属第一医院行HPV检测的HR-HPV感染阳性患者160例为阳性组,根据宫颈病变程度分为宫颈低级别鳞状上皮内病变(LSIL)组(75例,CIN 1级)、宫颈高级别鳞状上皮内病变(HSIL)组(60例,CIN 2~3级)、宫颈癌组(25例,宫颈活检确诊),另选180例同期行HPV检测的HR-HPV感染阴性患者为阴性组.比较阳性组、阴性组及不同宫颈病变程度患者阴道菌群分布情况,分析HR-HPV感染的危险因素,并构建预测模型分析预测价值.结果阳性组沙眼衣原体、解脲支原体、细菌、假丝酵母检出率均高于阴性组(P<0.05).宫颈癌组沙眼衣原体、解脲支原体、细菌、假丝酵母检出率高于HSIL组和LSIL组(P<0.05).解脲支原体感染、细菌性阴道炎是HR-HPV感染的危险因素(P<0.05).构建预测模型:logit(P)=-10.331+解脲支原体感染×0.973+细菌性阴道炎×0.795.当logit(P)>9.85时,曲线下面积(AUC)值为0.869,95%CI为0.828~0.903,敏感度为78.12%,特异度为77.78%.结论阴道菌群失衡,尤其是解脲支原体感染、细菌性阴道炎与HR-HPV感染及宫颈病变程度密切相关,据此构建的预测模型可较准确预测HR-HPV感染发生,临床应用价值较高.

OBJECTIVE To explore the degree of cervical lesions and distribution of vaginal flora in the patients with high-risk human papillomavirus(HR-HPV)infection and analyze the association between them.METHODS Totally 160 patients who were tested positive for HR-HPV in the First Affiliated Hospital of Changjiang University from Jan 2021 to De 2022 were assigned as the positive group and were divided into the low-grade squamous intraepithelial lesions(LSIL)group with 75 cases(CIN grade 1),the high-grade squamous intraepithelial lesions(HSIL)group with 60 cases(CIN grade 2-3)and the cervical cancer group with 25 cases(diagnosed by cervical biopsy)according to the degree of cervical lesions.Meanwhile,18o patients who were tested negative for HRHPV were chosen as the negative group.The distribution of vaginal flora was observed and compared between the positive group and the negative group and among the patients with different degree of cervical lesions,the risk factors for the HR-HPV infection were analyzed,and a prediction model was established to analyze the predictive val'ues.RESULTS The isolation rates of Chlamydia trachomatis,Ureaplasma urealyticum,bacteria and Candida of the positive group were higher than those of the negative group(P<0.05).The isolation rates of C.trachomatis,U.urealyticum,bacteria and Candida of the cervical cancer group were higher than those of the HSIL group and the LSIL group(P<o.05).U.urealyticum infection and bacterial vaginitis were the risk factors for the HR-HPV infection(P<0.05).The prediction model was as follows:logit(P)=-10.331+U.urealyticum infection X 0.973+bactieral vaginitis X0.795.When logit(P)was more than 9.85,the area under curve(AUC)was 0.869,95%CI was 0.828-0.903,the sensitivity was 78.12%,and the specificity was 77.78%.CONCLUSION The imbalance of vaginal flora,the U.urealyticum infection and bacterial vaginitis in particularly,is closely associated with the HR-HPV infection and degree of cervical lesions.The prediction model can accurately predict the occurrence of HR-HPV infection,and it has high clinical value.