不同级别宫颈鳞状上皮内病变患者宫颈分泌物各指标检测情况及其临床意义

Detection of indicators of cervical secretions and its clinical significance in patients with different levels of cervical squamous intraepithelial lesions

目的探讨不同级别宫颈鳞状上皮内病变(SIL)患者宫颈分泌物各指标检测情况及其临床意义,为该类患者的治疗提供参考。方法选取北京市和平里医院妇科2022年3月至2023年5月164例SIL患者为研究对象,根据病理检查结果将患者分为宫颈低度鳞状上皮内病变(LSIL)组(n=72)和宫颈高度鳞状上皮内病变(HSIL)组(n=92),另纳入宫颈癌患者21例为宫颈癌组、健康女性60例为健康组。统计4组受试者阴道白细胞酯酶(LE)、N-乙酰基氨基半乳糖苷酶(NAG)、唾液酸苷酶(SNA)、过氧化氢(H_(2)O_(2))阳性率及pH值;观察4组受试者阴道滴虫感染情况及需氧菌性阴道炎(AV)、细菌性阴道病(BV)阳性率;评估4组受试者阴道清洁度;观察4组受试者HPV感染情况并通过Spearman分析评估宫颈病变程度与阴道微环境、HPV感染的相关性。结果LSIL组、HSIL组、宫颈癌组患者阴道LE、NAG、SNA、H_(2)O_(2)阳性率及pH值均显著高于健康组(均P<0.05),且随着宫颈病变程度的加重,阴道LE、NAG、SNA、H_(2)O_(2)阳性率及pH值均呈上升趋势(均P<0.05)。LSIL组、HSIL组、宫颈癌组患者滴虫感染率及AV、BV阳性率均显著高于健康组(均P<0.05),且随着宫颈病变程度的加重,滴虫感染率及AV、BV阳性率均呈上升趋势(均P<0.05)。LSIL组、HSIL组、宫颈癌组阴道清洁度Ⅰ~Ⅱ级患者占比低于健康组,Ⅲ~Ⅳ级患者占比高于健康组(均P<0.05),且随着宫颈病变程度的加重,阴道清洁度越来越差(均P<0.05)。LSIL组、HSIL组、宫颈癌组高危型HPV感染患者占比、HPV感染总发生率均高于健康组(均P<0.05),随着宫颈病变程度的加重,高危型HPV感染、HPV感染总发生率均呈上升趋势(均P<0.05)。经相关性分析,宫颈病变程度与滴虫感染、AV、BV、LE、NAG、SNA、H_(2)O_(2)、pH值、阴道清洁度、HPV感染均呈正相关(均P<0.05)。结论SIL患者宫颈微生态处于显著失衡状态,宫颈病变程度与分泌物各指标具有显著相关性。

Objective To observe the detection of indicators of cervical secretions in patients with different levels of cervical squamous intraepithelial lesions(SIL)and discuss its clinical significance.Methods A total of 164 patients with SIL in our hospital from March 2022 to May 2023 were enrolled.Based on the pathological examination results,the patients were divided into a low-grade SIL(LSIL)group(n=72)and a high grade SIL(HSIL)group(n=92).Additionally,21 cervical cancer patients were included as the cervical cancer group,and 60 healthy women were included as the control group.The positive rates and pH values of vaginal leukocyte esterase(LE),N-neneneba acetyl galactosamine glycosidase(NAG),sialic acid glycosidase(SNA),hydrogen peroxide(H_(2)O_(2)),vaginal trichomonas infection,and positive rates of aerobic vaginitis(AV)and bacterial vaginosis(BV)in the four groups were observed.The vaginal cleanliness in the four groups was evaluated,and the HPV infection was observed.The degree of cervical lesions and vaginal microenvironment were analyzed using Spearman to observe the correlation with HPV infection.Results The detection rates and pH values of LE,NAG,SNA,and H_(2)O_(2) in the LSIL group,HSIL group,and cervical cancer group were significantly higher than those in the control group respectively(all P<0.05).As the degree of cervical lesions deepened,the positive rates and pH values of LE,NAG,SNA,and H_(2)O_(2) showed an upward trend(all P<0.05).The LSIL group,HSIL group,and cervical cancer group had significantly higher rates of trichomonas infection and positive rates of AV and BV than the control group(all P<0.05).As the degree of cervical lesions deepened,the trichomonas infection,and positive rates of AV and BV showed an upward trend(all P<0.05).The proportion of vaginal cleanliness levelⅠtoⅡin the LSIL group,HSIL group,and cervical cancer group was lower,while that of levelⅢtoⅣwas higher than in the control group respectively(all P<0.05).As the degree of cervical lesions deepened,vaginal cleanliness became worse(all P<0.05).The proportions of high-risk HPV infection and total incidences of HPV infection in the LSIL group,HSIL group,and cervical cancer group were higher than those in the control group,respectively(all P<0.05).As the degree of cervical lesions deepened,the incidence of high-risk HPV infection and HPV infection showed an upward trend(all P<0.05).The degree of cervical lesions was positively correlated with trichomonas infection,AV,BV,LE,NAG,SNA,H_(2)O_(2),pH value,vaginal cleanliness,and HPV infection,with statistically significant differences(all P<0.05).Conclusion The cervical microenvironment of SIL patients is significantly imbalanced,and there is a significant correlation between the degree of cervical lesions and the indicators of secretions.