沙眼衣原体、解脲支原体感染与人乳头瘤病毒感染及宫颈病变的关系探讨

The correlation of Chlamydia trachomatis and Ureaplasma urealyticum infection with human papillomavirus infection and cervical lesions

目的分析沙眼衣原体(CT)、解脲支原体感染与人乳头瘤病毒(HPV)感染及宫颈病变的关系。方法400例宫颈病变患者,按病理诊断结果分为宫颈炎组(200例)、宫颈上皮内瘤变组(CIN组,183例)、宫颈恶性肿瘤组(17例)。患者均行宫颈筛查及生殖道病原体检测、白带常规检查,宫颈筛查异常者按诊疗规范进一步治疗。分析宫颈病变患者HPV分型及感染情况、生殖道病原体感染情况,分析生殖道病原体感染与HPV感染的关系。结果①400例患者中,有182例感染了HPV,其中24例为宫颈炎HPV感染者,占比13.19%;CIN、宫颈恶性肿瘤合并HPV感染的有158例,占比86.81%。在182例患者中,以高危型HPV感染为主,HPV16、52、58型属于比较常见的基因型。单一HPV感染141例,占比77.47%,多重HPV感染41例,占比22.53%。随着宫颈病变严重程度升高,单一HPV感染率逐渐升高,宫颈炎组、CIN组、宫颈恶性肿瘤组单一HPV感染率比较差异具有统计学意义(P<0.05)。随着宫颈病变严重程度升高,多重HPV感染率有升高后下降趋势,宫颈炎组、CIN组、宫颈恶性肿瘤组多重HPV感染率比较差异具有统计学意义(P<0.05)。②400例患者中,合并生殖道病原体感染的有154例,感染率为38.50%,其中宫颈炎组生殖道病原体感染率为32.00%(64/200),CIN组为44.81%(82/183),宫颈恶性肿瘤组为47.06%(8/17),比较差异具有统计学意义(P<0.05)。③单因素分析显示:沙眼衣原体、解脲脲原体(Uu)、微小脲原体(Up)、人型支原体(Mh)阳性与阴性患者的HPV阳性率比较差异具有统计学意义(P<0.05)。Logistic回归分析显示:沙眼衣原体、解脲脲原体、微小脲原体、人型支原体感染是HPV感染的危险因素(P<0.05)。结论分析不同程度宫颈病变患者的相关信息,单一、高危型HPV感染是最主要的类型,HPV16型、HPV52型和HPV58型属于普遍存在的基因型;CIN或宫颈恶性肿瘤患者沙眼衣原体、解脲支原体的感染率明显较高,生殖道支原体与衣原体感染增加HPV感染风险,应注重两者筛查,以预防HPV感染。

Objective To analyze the correlation of Chlamydia trachomatis(CT)and Ureaplasma urealyticum infection with human papillomavirus(HPV)infection and cervical lesions.Methods 400 patients with cervical lesions were divided into cervicitis group(200 cases),cervical intraepithelial neoplasia group(CIN group,183 cases),and cervical malignancy group(17 cases)according to pathological diagnosis.All patients underwent cervical screening and detection of genital tract pathogens and routine leucorrhea,and patients with abnormal cervical screening were further treated according to the diagnostic and therapeutic specifications.The HPV typing and infection of patients with cervical lesions,and the infection of genital tract pathogens were analyzed,as well as the correlation between genital tract pathogens infection and HPV infection.Results(i)Out of the 400 patients,182 cases had HPV infection,of which 24 cases were cervicitis with HPV infection,accounting for 13.19%,and 158 cases were CIN,cervical malignancy combined with HPV infection,accounting for 86.81%.Among the 182 patients,high-risk HPV infections were predominant,and HPV types 16,52 and 58 were the more common genotypes.There were 141 cases of single HPV infection,accounting for 77.47%,and 41 cases of multiple HPV infection,accounting for 22.53%.With increasing severity of cervical lesions,the rate of single HPV infection gradually increased,and the difference in the single HPV infection rate between the cervicitis group,CIN group,and cervical malignancy group was statistically significant(P<0.05).With increasing severity of cervical lesions,the multiple HPV infection rate had a tendency to increase and then decrease,and the difference in the multiple HPV infection rate between the cervicitis group,CIN group,and cervical malignancy group was statistically significant(P<0.05).(ii)Among the 400 patients,154 cases were infected with genital tract pathogens,the infection rate was 38.50%,including 32.00%(64/200)in the cervicitis group,44.81%(82/183)in the CIN group,and 47.06%(8/17)in the cervical malignancy group.The difference was statistically significant(P<0.05).(iii)Univariate analysis showed that the difference in HPV positive rate between Chlamydia trachomatis,Ureaplasma urealyticum(Uu),Ureaplasma parvum(Up),and Mycoplasma hominis-positive and negative patients was statistically significant(P<0.05).Logistic regression analysis showed that Chlamydia trachomatis,Ureaplasma urealyticum,Ureaplasma parvum,and Mycoplasma hominis infections were risk factors for HPV infection(P<0.05).Conclusion Analyzing the relevant information of patients with different degrees of cervical lesions shows that single and high-risk HPV infection is the most common type,while HPV16,HPV52,and HPV58 are common genotypes.The infection rates of Chlamydia trachomatis and Ureaplasma urealyticum are significantly higher in patients with CIN or cervical malignancy.Genital tract infections of mycoplasma and Chlamydia infection increase the risk of HPV infection,and attention should be paid to screening both to prevent HPV infection.