阴道微生态变化与宫颈人乳头瘤病毒感染及宫颈病变的相关性研究

Study on the correlation between vaginal microecological changes and cervical human papillomavirus infection and cervical lesions

目的分析不同宫颈病变患者阴道微生态变化及人乳头瘤病毒(HPV)感染情况,探讨阴道微生态与宫颈病变及HPV感染的相关性。方法回顾性分析2022年1月至2023年8月于该院就诊的361例宫颈病变患者作为研究组,根据宫颈病变严重程度将研究组分为宫颈癌组(11例)、高级别病变组(CINⅡ~CINⅢ,64例)、低级别病变组(CINⅠ,204例)、宫颈炎组(82例)。另选取同期进行健康体检且宫颈细胞学正常、HPV阴性女性140例为对照组。检测各组阴道分泌物唾液酸苷酶(SNa)阳性、过氧化氢(H_(2)O_(2))缺乏、白细胞酯酶(LE)阳性、pH值>4.5、N-乙酰氨基己糖苷酶(NAG)阳性情况,观察细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)、滴虫性阴道炎(TV)情况。检测并记录不同宫颈病变严重程度患者HPV亚型感染情况及不同亚型感染患者微生态情况。结果宫颈癌组、高级别病变组、低级别病变组、宫颈炎组与对照组SNa阳性、H_(2)O_(2)缺乏、LE阳性、pH值>4.5、NAG、BV比较,差异均有统计学意义(P<0.05),且宫颈炎组、低级别病变组、高级别病变组、宫颈癌组随着病变严重程度的加深,阳性率不断增加,差异均有统计学意义(P<0.05)。5组VVC、TV比较,差异均无统计学意义(P>0.05)。361例患者中HPV阳性265例,阳性率为73.4%,其中高危型HPV(HR-HPV)阳性250例,占比为94.3%(250/265),低危型HPV(LR-HPV)阳性15例,占比为5.7%(15/265)。宫颈癌组HR-HPV阳性率为90.9%(10/11),高级别病变组HR-HPV阳性率为87.5%(56/64),低级别病变组HR-HPV阳性率为83.8%(171/204),宫颈炎组HR-HPV阳性率为34.1%(28/82),各组阳性率与宫颈炎组比较,差异均有统计学意义(P<0.05)。HR-HPV阳性率占比最高的3种亚型分别为HPV52、HPV16、HPV58,宫颈癌组HPV亚型以HPV16为主,占54.5%。高危型HPV感染患者SNa阳性、H_(2)O_(2)缺乏、pH值>4.5、BV比例均高于低危型HPV感染患者,差异均有统计学意义(P<0.05)。高危型HPV感染患者与低危型HPV感染患者LE阳性,NAG阳性,VVC、TV比例比较,差异均无统计学意义(P>0.05)。结论阴道微生态失衡会促进HPV持续感染的致癌作用并加重宫颈病变的进展,宫颈病变与HPV感染、阴道微生态失衡密切相关。关注阴道微生态的变化并维持微生态的平衡,对预防HPV感染、宫颈癌的治疗及转归具有重要意义。

Objective To analyze the changes of vaginal microecology and human papillomavirus(HPV)infection in patients with different cervical lesions,and to explore the correlation between vaginal microecology and cervical lesions and HPV infection.Methods A total of 361 patients with cervical lesions treated in our hospital from January 2022 to August 2023 were retrospectively analyzed as the study group.According to the severity of cervical lesions,the study group was divided into cervical cancer group(11 cases),high-grade lesion group(CINⅡ-CINⅢ,64 cases),low-grade lesion group(CINⅠ,204 cases)and cervicitis group(82 cases).Another selection in the same period for physical examination and normal cervical cytology and HPV negative women 140 cases as control group.Test groups of vaginal secretion of saliva acid glycosides enzyme(SNa)positive,lack of hydrogen peroxide(H_(2)O_(2)),leukocyte esterase(LE)positive,pH value>4.5,N-acetyl aminocaproic glycosidase(NAG)positive cases and observation of bacterial vaginal disease(BV),vulva vagina candida(VVC),trichomonas vaginitis disease(TV).The infection of HPV subtypes in patients with different severity of cervical lesions and the microecology of patients with different subtypes of infection were detected and recorded.Results There were significant differences in SNa positive,H_(2)O_(2) deficiency,LE positive,pH value>4.5,NAG and BV between cervical cancer group,high-grade lesion group,low-grade lesion group,cervicitis group and control group(P<0.05).The positive rate of cervicitis group,low-grade lesion group,high-grade lesion group and cervical cancer group increased with the deepening of the severity of the lesion,and the differences were statistically significant(P<0.05).There was no significant difference in VVC and TV among the 5 groups(P>0.05).Among 361 patients,265 cases were HPV positive,with a positive rate of 73.4%,including 250 cases of high-risk HPV(HR-HPV)positive,accounting for 94.3%(250/265),and 15 cases of low-risk HPV(LR-HPV)positive,accounting for 5.7%(15/265).The positive rate of HR-HPV was 90.9%(10/11)in cervical cancer group,87.5%(56/64)in high-grade lesion group,83.8%(171/204)in low-grade lesion group and 34.1%(28/82)in cervicitis group,compared with cervicitis group,the positive rate of each group was statistically significant(P<0.05).The three subtypes with the highest proportion of HR-HPV positive rates were HPV52,HPV16 and HPV58,and HPV16 was the main HPV subtype in cervical cancer group,accounting for 54.5%.The proportions of SNa positive,H_(2)O_(2) deficiency,pH>4.5 and BV in high-risk HPV infection patients were higher than those in low-risk HPV infection patients,and the differences were statistically significant(P<0.05).There was no significant difference in the proportion of LE positive,NAG positive,VVC and TV between patients with high-risk HPV infection and patients with low-risk HPV infection(P>0.05).Conclusion Vaginal microecological imbalance can promote the carcinogenic effect of persistent HPV infection and aggravate the progress of cervical lesions.Cervical lesions are closely related to HPV infection and vaginal microecological imbalance.It is of great significance to pay attention to the changes of vaginal microecology and maintain the balance of vaginal microecology for the prevention of HPV infection and the treatment and outcome of cervical cancer.