高危型人乳头瘤病毒阳性患者不同级别宫颈病变阴道微生态特征分析

Analysis of vaginal microecological characteristics in HR-HPV positivepatients with different grades of cervical lesions

目的 探讨阴道微生态环境、高危型人乳头瘤病毒(HR-HPV)感染与宫颈病变之间的关系。方法 选取2023年在郑州市妇幼保健院进行宫颈检查的300例宫颈疾病患者和60例普通患者进行阴道微生态、HR-HPV检测,对比分析不同类型宫颈病变患者HR-HPV感染情况、乳酸菌减少情况、脯氨酸氨基肽酶(GADP)、白细胞酯酶(LE)、阴道p H值和阴道菌群的变化。结果 300例宫颈疾病患者包括慢性宫颈炎102例、低级别鳞状上皮内病变(LSIL)90例、高级别鳞状上皮内病变(HSIL)76例、宫颈鳞癌(SCC)32例。SCC组、HSIL组和LSIL组患者HR-HPV阳性率分别为81.3%、53.9%和33.3%,均高于慢性宫颈炎组13.7%(P均<0.05)。Spearman相关性分析结果显示:宫颈病变患者阴道内乳酸杆菌减少,阴道p H值>4.5,阴道菌群密度Ⅲ、Ⅳ级与HR-HPV感染有相关性(r分别为0.520,0.501和0.487,P均<0.05)。结论 宫颈病变患者阴道内的微生态环境出现了异常变化,HR-HPV感染与宫颈病变密切相关。

Objective To explore the relationship between vaginal microecological environment,high-risk human papillomavirus(HR-HPV)infection,and cervical lesions.Methods A total of 300 patients with cervical diseases and 60 ordinary patients who underwent cervical examination in Zhengzhou Maternal and Child Health Hospital in 2023 were selected for vaginal microbiota and HR-HPV testing,and the status of HR-HPV infection,reduction of lactic acid bacteria,proline aminopeptidase(GADP),leukocyte esterase(LE),vaginal pH and vaginal microbiota in patients with different types of cervical lesions were compared and analyzed.Results The 300 patients with cervical diseases included 102 cases of chronic cervicitis,90 cases of low-grade squamous intraepithelial lesions(LSIL),76 cases of high-grade squamous intraepithelial lesions(HSIL),and 32 cases of cervical squamous cell carcinoma(SCC).The positive rates of HR-HPV in the SCC group,HSIL group,and LSIL group were 81.3%,53.9%,and 33.3%,respectively,which were higher than those in the chronic cervicitis group,which was 13.7%(all P<0.05).The results of Spearman correlation analysis showed that the decrease of lactobacilli in the vagina,the vaginal pH value greater than 4.5,and the vaginal microbiota density of III and IV were significantly correlated with HR-HPV infection(r=0.520,0.501 and 0.487,respectively;all P<0.05).Conclusions The abnormal changes of microecological environment in the vagina of patients with cervical lesions and HR-HPV infection are closely correlated with cervical lesions.