妊娠期女性HPV感染及阴道微生态失衡对妊娠结局及新生儿的影响

Effects of HPV infection and imbalance of vaginal microecology in pregnant women on pregnancy outcomes and neonates

目的探讨妊娠期女性人乳头瘤病毒(HPV)感染及阴道微生态失衡对妊娠结局及新生儿结局的影响,为该类患者的治疗提供参考。方法选取2020年6月至2023年6月于我院产检的102例HPV阳性妊娠妇女(HPV阳性组)以及同期产检的78例HPV阴性妊娠妇女(HPV阴性组)为研究对象,于怀孕28~34周时,收集阴道分泌物评价阴道微生态状况;另根据微生态评价结果将HPV阳性组对象分为微生态正常组(n=26)和微生态失调组(n=76);比较HPV阳性组与HPV阴性组对象阴道微生态情况、妊娠结局及新生儿结局,比较微生态正常组与微生态失调组对象妊娠结局及新生儿结局。结果HPV阳性组和HPV阴性组对象滴虫性阴道炎(TV)和外阴阴道假丝酵母菌病(VVC)发生率、阴道清洁度比较差异均无统计学意义(χ2=1.520、0.678、0.111,均P>0.05),而阴道pH、细菌性阴道病(BV)发生率、阴道菌群密集度、阴道菌群多样性以及微生态失调发生率比较差异均有统计学意义(χ2=10.106、8.247、4.337、5.236、13.865,均P<0.05)。HPV阳性组对象早产、宫内感染、产褥感染及产后出血发生率显著高于HPV阴性组(χ2=5.710、10.721、6.799、4.294,均P<0.05),而两组对象剖宫产率及胎膜早破发生率比较差异无统计学意义(χ2=1.067、0.666,均P>0.05)。HPV阳性组新生儿感染发生率显著高于HPV阴性组(χ2=9.001,P<0.05),两组胎儿窘迫、新生儿窒息和胎儿宫内生长受限(FGR)发生率比较差异均无统计学意义(χ2=2.503、1.547、0.560,均P>0.05)。微生态失调组对象早产发生率显著高于微生态正常组(χ2=4.130,P<0.05),而两组胎膜早破、宫内感染、产褥感染及产后出血发生率比较差异均无统计学意义(χ2=1.401、0.578、0.141、1.368,均P>0.05)。微生态失调组与微生态正常组胎儿窘迫、新生儿窒息、FGR和新生儿感染发生率比较差异均无统计学意义(χ2=0.261、0.698、1.057、0.242,均P>0.05)。结论妊娠期HPV感染能引发阴道微生态失调,增加不良母婴结局发生风险。

Objective To explore the effects of human papilloma virus(HPV)infection and imbalance of vaginal microecology in pregnant women on pregnancy outcomes and neonatal outcomes so as to provide reference for the treatment of such patients.Methods A total of 102 pregnant women with HPV positive(HPV-positive group)and 78 pregnant women with HPV negative(HPV-negative group)who underwent antenatal examination in the hospital were enrolled as the research objects between June 2020 and June 2023.After 28-34 weeks of pregnancy,vaginal secretions were collected to evaluate vaginal microecology status.According to evaluation results of vaginal microecology,pregnant women in HPVpositive group were divided into normal microecology group(n=26)and microecology imbalance group(n=76).The vagin-al microecology,pregnancy outcomes and neonatal outcomes were compared between HPV-positive group and HPV-negative group.The pregnancy outcomes and neonatal outcomes were compared between normal microecology group and microecology imbalance group.Results There were no significant differences in the incidences of trichomoniasis vaginitis(TV)and vulvovaginal candidiasis(VVC)or vaginal cleanliness between HPV-positive group and HPV-negative group(χ2=1.520,0.678,0.111;all P>0.05),but in vaginal pH,incidence of bacterial vaginosis(BV),intensity and diversity of vaginal floras,and incidence of microecology imbalance(χ2=10.106,8.247,4.337,5.236,13.865;all P<0.05).The incidences of premature delivery,intrauterine infection,puerperal infection and postpartum hemorrhage in HPV-positive group were significantly higher than those in HPV-negative group(χ2=5.710,10.721,6.799,4.294;all P<0.05),but there were no significant differences in the incidences of cesarean section and premature rupture of membranes between the two groups(χ2=1.067,0.666;all P>0.05).The incidence of neonatal infection in HPV-positive group was significantly higher than that in HPV-negative group(χ2=9.001,P<0.05),but there were no significant differences in the incidences of fetal distress,neonatal asphyxia and fetal growth restriction(FGR)between the two groups(χ2=2.503,1.547,0.560;all P>0.05).The incidence of premature delivery in microecology imbalance group was significantly higher than that in normal microecology group(χ2=4.130,P<0.05),but there were no significant differences in the incidences of premature rupture of membranes,intrauterine infection,puerperal infection and postpartum hemorrhage between the two groups(χ2=1.401,0.578,0.141,1.368;all P>0.05).There were no significant differences in the incidences of fetal distress,neonatal asphyxia,FGR and neonatal infection between normal microecology group and microecology imbalance group(χ2=0.261,0.698,1.057,0.242;all P>0.05).Conclusion HPV infection during pregnancy will cause imbalance of vaginal microecology and increase the risk of adverse maternal and neonatal outcomes.