高危型人乳头瘤病毒感染的宫颈病变患者治疗前后阴道微生态变化情况分析

Analysis of the changes in vaginal microenvironment of patients with cervical lesions by high-risk human papillomavirus(HR-HPV)infection before and after treatment

目的:探讨宫颈病变患者治疗前后阴道微环境变化情况。方法:选取2021年9月-2022年12月于郑州大学第二附属医院就诊的确诊为高危型人乳头瘤病毒(HR-HPV)感染,阴道镜下宫颈活检结果为LSIL或HSIL,活检前及治疗后6个月均行阴道微生态及HPV检测的患者共194例,其中LSIL患者100例,HSIL患者94例。LSIL组患者采用干扰素药物治疗,HSIL组采用宫颈锥切术治疗。另选取同期于就诊的HPV检测及宫颈薄层液基细胞学检查(TCT)结果均为阴性者188例,作为对照组。分析治疗前后阴道微生态指标的变化情况和相关性。结果:治疗前LSIL组清洁度、白细胞数量、优势菌、Nugent评分异常率高于对照组(P<0.05),治疗后清洁度、白细胞数量、优势菌、Nugent评分、白细胞酯酶的异常率较治疗前均降低(P<0.05);治疗前HSIL组菌群密集度、菌群多样性、优势菌、Nugent、pH值异常率均高于对照组(P<0.05),治疗后菌群多样性、优势菌、pH值、白细胞酯酶的异常率较治疗前均明显降低(P<0.05);治疗后LSIL组HR-HPV转阴32例(32.0%),HSIL组HR-HPV转阴76例(80.9%);治疗后HR-HPV阳性组优势菌、Nugent评分、pH值、过氧化氢的异常率均高于转阴组(P<0.05)。结论:阴道微生态与宫颈病变的发生、发展及转归密切相关。

Objective:To exploring the changes in vaginal microenvironment of patients with cervical lesions by high-risk human papillomavirus(HR-HPV)infection before and after treatment.Methods:194 patients who had been diagnosed with HR-HPV infection and had undergone colposcopy biopsy in the second affiliated hospital of Zhengzhou university from September 2021 to December 2022 were selected in this study.The results of the cervical biopsy of these patients were LSIL or HSIL.And 194 patients had accepted the detections of vaginal microbiota and HPV before biopsy and in 6 months after treatment,and among them,there were 100 patients with LSIL in group A and 94 patients with HSIL in group B.The patients in group A were treated with interferon,and the patients in group B were treated with cervical conization.Another 188 patients with the negative results of HPV infection and thinprep cytologic test(TCT)during the same period were selected in control group.The changes and the correlations of the vaginal micro-ecological indexes of the patients before and after treatment were analyzed.Results:Before treatment,the cleanliness degree,the white blood cell count,the dominant bacteria rate and the abnormal rate of Nugent score of the patients in group A were significantly higher than those of the patients in the control group(P<0.05).After treatment,the cleanliness degree,the white blood cell count,the dominant bacteria,the Nugent score and the abnormal rate of leukocyte esterase of the patients were significantly lower than those of the patients before treatment(P<0.05).Before treatment,the flora density,the flora diversity,the dominant bacteria,the Nugent score and the abnormal pH rate of the patients in group B were significantly higher than those of the patients in the control group(P<0.05).After treatment,the bacterial diversity,the dominant bacteria,the pH value and the abnormal rate of leukocyte esterase of the patients in group B were significantly lower than those of the patients before treatment(P<0.05).After treatment,there were 32(32.0%)cases with HR-HPV turned negative in group A and there were 76(80.9%)cases with HR-HPVturned negative in group B.After treatment,the dominant bacteria,the Nugent score,the pH value and the abnormal rate of hydrogen peroxide of the patients with HR-HPV positive were significantly higher than those of the patients with HR-HPV negative(P<0.05).Conclusion:The vaginal microbiota of the patients is closely related to the occurrence,development and conversion of their cervical lesions by HR-HPV infection.