阴道微生态异常与高危型人乳头瘤病毒感染及宫颈病变的关系

目的 探讨阴道微生态异常与高危型人乳头瘤病毒（HR-HPV）感染及宫颈病变的相关性。方法 选取2015年1月至2017年6月在十堰市妇幼保健院妇科门诊接受宫颈病变筛查的562例患者为研究对象，分别进行阴道微生态、HR-HPV检测、宫颈脱落细胞检查和组织病理学活检，对检查结果进行分析。结果 562例患者中，宫颈病变发生率为16.01%，液基薄层细胞检测（TCT）阳性率为19.93%，HR-HPV感染率为28.47%，阴道微生态失调发生率为30.78%，其中细菌性阴道病（BV）、滴虫性阴道炎（TV）、外阴阴道假丝酵母菌病（VVC）、需氧菌性阴道炎（AV）和乳杆菌减少检出率分别为24.02%、3.20%、12.28%、8.54%和28.47%。宫颈病变患者微生态失调率为67.78%，明显高于正常组的23.73%（P<0.05）。宫颈病变患者其BV、VVC、AV和乳杆菌减少检出率分别为66.67%、30.0%、22.22%和75.56%，均明显高于正常者的15.89%、8.90%、5.93%和19.49%（P<0.05）；宫颈病变患者HR-HPV阳性率为75.56%，明显高于正常者的19.49%（P<0.05）。HR-HPV阳性患者BV、VVC、AV和乳杆菌减少的检出率分别为51.88%、24.38%、16.88%和62.5%，明显高于HR-HPV阴性患者的12.94%、7.46%、5.22%和14.93%（P<0.05）。结论 阴道微生态环境的改变与高危型HPV感染及宫颈病变的发生具有一定关系。

Relationship among abnormal vaginal microecology,high-risk human papillomavirus infection and cervical lesions

Abstract: Objective To explore the relationship among abnormal vaginal microecology, high-risk human papillomavirus (HR-HPV) infection and cervical lesions. Methods 562 patients who received cervical disease screening in our hospital were included and underwent vaginal microecological test, HR-HPV detection, cervical cytology test and histopathological biopsy. Analysis was performed on the inspection results. Results The incidence rate of cervical lesions was 16.01%. The positive rate of thin-layer cytological test (TCT) was 19.93%. The infection rate of HR-HPV was 28.47%. The incidence rate of vaginal dysbiosis was 30.78%. The detection rates of bacterial vaginosis (BV), trichomonas vaginitis (TV), vulvovaginal candidiasis (VVC), aerobic vaginitis (AV) and Lactobacillus decrease were 24.02%, 3.20%, 12.28%, 8.54% and 28.47% respectively. The rate of dysbiosis in the cervical lesions group was 67.78%, significantly higher than the 23.73% in the normal control group (P<0.05). The detection rates of BV, VVC, AV and Lactobacillus decrease in the cervical lesions group were 66.67%, 30.0%, 22.22% and 75.56% respectively, significantly higher than the 15.89%, 8.90%, 5.93% and 19.49% in the normal control group (P<0.05). The positive rate of HR-HPV in the cervical lesions group was 75.56%, significantly higher than the 19.49% in the normal control group. The detection rates of BV, VVC, AV and Lactobacillus decrease among HR-HPV positive patients were 51.88%, 24.38%, 16.88% and 62.5% respectively, significantly higher than the 12.94%, 7.46%, 5.22% and 14.93% among HR-HPV negative patients (P<0.05). Conclusion Changes in vaginal microecological environment is closely related to high-risk HPV infection and cervical lesions.