基于阴道微生态对比研究宫颈HPV16与HPV52单一亚型感染特征

Characteristics of cervical HPV16 and HPV52 single subtype infections based on comparison of vaginal microbiome

目的对比分析宫颈人乳头瘤病毒(HPV)16与52单一亚型感染阴道微生态特征,探讨HPV16与52单一亚型阳性患者阴道微生态差异的临床意义,探求治疗不同亚型HPV感染的方法。方法将2020年2月至2023年1月在遂宁市第一人民医院妇产科门诊常规宫颈癌筛查的女性(20~65岁)作为研究对象,纳入符合标准的HPV16型、HPV52型、HPV阴性研究对象各165例作为参试者,HPV16、52型均为单一亚型感染,HPV阴性组作为对照组,3组参试者一般资料对比差异无统计学意义(P<0.05)。3组研究对象均行HPV分型、液基薄层细胞学(TCT)、阴道微生态检测,对比分析3组参试者阴道微生态相关指标(pH、过氧化氢、唾液酸苷酶、白细胞酯酶、葡萄糖醛酸酶、乙酰氨基葡萄糖苷酶、白细胞、杆菌、球菌、线索细胞、滴虫、清洁度)以及TCT情况。结果(1)3组参试者的阴道内pH情况,HPV16型组(5.01±0.31)显著高于HPV52型组(4.71±0.42)(F=56.26,P<0.05),也较对照组(4.68±0.43)明显异常(F=47.10,P<0.05);而HPV52型组阴道内pH与对照组比较差异无统计学意义(F=0.12,P>0.05)。(2)HPV16型组参试者阴道内白细胞酯酶、阴道微生态、TCT、pH>4.5异常人数较HPV52型组、对照组显著增多,差异均有统计学意义(均P<0.05),但是HPV52型组参试者阴道内白细胞酯酶、pH>4.5异常人数较对照组无明显增加,差异均无统计学意义(均P>0.05);而HPV16型组参试者阴道内过氧化氢、葡萄糖醛酸酶、乙酰氨基葡萄糖苷酶、清洁度、白细胞、杆菌较HPV52型组差异均无统计学意义(均P>0.05),但是2组均较对照组明显异常,差异均有统计学意义(均P<0.05);3组参试者阴道内唾液酸苷酶、球菌、线索细胞、滴虫比较差异均无统计学意义(均P>0.05)。结论无论是HPV16型还是52型患者均存在阴道微生态失衡,HPV16型患者较52型更易出现微生态失调和子宫颈上皮内病变,可能与其阴道内较高pH有关,调节pH可能是治疗高危型HPV16型的一个方向,但可能并不适用于HPV52型,治疗HPV52型患者需要寻找新的思路。

Objective To compare and analyze the characteristics of vaginal microecology of cervical human papillomavirus(HPV)16 and 52 single subtype infections,and explore the clinical significance of vaginal microbiome differences between HPV16 and 52 single subtype positive patients.Methods A total of 165 cases each of HPV16,HPV52 and HPV-negative subjects were included;all the HPV16 and HPV52 cases were single subtype infections,and the HPV-negative group was used as a blank control group.There was no statistical difference in the general data among the three groups(P<0.05).HPV typing,liquid-based thin-layer cytology(TCT),and vaginal microecology were detected in all three groups,and the relevant indexes of vaginal microecology(pH,hydrogen peroxide,sialidase,leukocyte esterase enzyme,glucuronidase,acetylglucosaminidase,leukocyte,bacilli,coccus,clue cells,trichomoniasis,cleanliness)and TCT were compared and analyzed.Results(1)The intravaginal pH value was significantly higher in the HPV16 group(5.01±0.31)than in the HPV52(4.71±0.42)group(F=56.26,P<0.05),and significantly abnormal(F=47.10,P<0.05)compared to that in the blank control group(4.68±0.43),while there was no significant difference in intravaginal pH value between HPV52 group and the control group(F=0.12,P>0.05).(2)Compared with HPV52 group and blank control group,the number of abnormal vaginal leukocyte esterase,vaginal microecology,TCT,pH>4.5 abnormalities in HPV16 group and blank control group significantly increased(all P<0.05),but the number of vaginal leukocyte esterase and pH>4.5 in HPV52 group did not increased significantly compared with the blank control group(all P>0.05).Compared with the HPV52 group,there were no significant differences in vaginal hydrogen peroxide,glucuronidase,acetylglucosaminidase,cleanliness,leukocytes and bar bacteria in HPV16 group(all P>0.05),but both groups were significantly abnormal compared with the blank control group(all P<0.05).There were no significant differences in vaginal sialidase,coccus,lead cells and trichomoniasis among the three groups(all P>0.05).Conclusion Both HPV16 and HPV52 patients have vaginal microecological imbalance.HPV16 patients are more likely to have microbiosis and cervical intraepithelial lesions than patients with HPV52 infection,which may be related to the higher vaginal pH.Adjusting pH may be a direction for the treatment of highrisk HPV16 patients,but it may not be applicable for HPV52,and new ideas need to be found for the treatment of HPV52.