宫颈癌前病变伴HPV高危型感染患者阴道微生态检测及临床意义

Detection and clinical significance of vaginal microecology in patients with cervical intraepithelial neoplasia and high⁃risk HPV infection

目的探讨宫颈癌前病变伴人乳头瘤病毒(HPV)高危型感染患者阴道微生态状况,为感染防治提供依据。方法选取2020年3月-2023年1月在儋州市人民医院确诊的78例宫颈癌前病变患者,根据HPV-DNA筛查结果分为HPV高危型感染组与未感染组,比较两组患者的一般资料及阴道微生态状况,并分析阴道微生态与宫颈癌前病变伴HPV高危型感染的关系。结果78例宫颈癌前病变患者中,检测出HPV高危型感染患者25例,主要为HPV16型32.00%、HPV18型20.00%、HPV52型16.00%。感染组的需氧菌性阴道炎(AV)发生率、细菌性阴道病(BV)发生率、乳酸杆菌异常率、阴道pH异常率明显高于未感染组,差异均有统计学意义(χ^(2)=5.598、6.228、10.626、8.569,P=0.018、0.013、0.001、0.003),阴道病原体主要为线索细胞(39.74%)、假丝酵母(7.69%)、阴道滴虫(33.33%)。二分类logistic回归分析,乳酸杆菌Ⅱb及Ⅲ级(OR=4.768,P=0.004)、阴道pH异常(OR=3.846,P=0.002)均为影响宫颈癌前病变患者合并HPV高危型感染的独立危险因素。结论乳酸杆菌Ⅱb及Ⅲ级比例较高、阴道pH异常均可能是宫颈癌前病变患者伴HPV高危型感染的独立危险因素,改善患者阴道微生态环境有利于降低HPV高危型感染风险,减少病情进展至宫颈癌的风险。

Objective To explore vaginal microecology status and correlation in patients with cervical intraepithelial neoplasia(CIN)and high⁃risk human papilloma virus(HPV)infection.Methods A total of 78 patients with CIN diagnosed in Danzhou People's Hospital from March 2020 to January 2023 were enrolled.According to the results of HPV⁃DNA screening,they were divided into high⁃risk HPV infection group and non⁃infection group.The general data and vaginal microecology in the two groups were compared.The relationship between vaginal microecology and CIN combined with high⁃risk HPV infection was analyzed.Results Among the 78 CIN patients,there were 25 cases with high⁃risk HPV infection,mainly including type HPV16(32.00%),HPV18(20.00%)and HPV52(16.00%).The incidence of bacterial vaginosis(BV)and aerobic vaginitis(AV),abnormal rates of Lactobacillus and vaginal pH in infection group were significantly higher than those in non⁃infection group,the differences were statistically significant(χ^(2)=5.598,6.228,10.626,8.569,P=0.018,0.013,0.001,0.003).The vaginal pathogens were mainly on clue cells(39.74%),Candida(7.69%)and Trichomonas vaginalis(33.33%).Binary logistic regression analysis showed that Lactobacillus of typesⅡb andⅢ(OR=4.768,P=0.004)and abnormal rate of vaginal pH(OR=3.846,P=0.002)were independent risk factors of high⁃risk HPV infection in CIN patients.Conclusions High proportion of typesⅡb andⅢLactobacillus and abnormal rate of vaginal pH might be independent risk factors of high⁃risk HPV infection in CIN patients.Improving vaginal microecology could beneficial to reduce the risks of high⁃risk HPV infection and disease progression to cervical cancer.