宫颈高危型HPV感染后的转归与阴道微生态的相关性分析

对宫颈高危型HPV HR-HPV感染后的转归进行阴道微生态及其危险因素分析, 以探讨宫颈高危型HPV感染后的转归与阴道微生态的相关性。

选取2019年7月至2020年9月在中山市博爱医院妇科门诊就诊的进行机会性宫颈癌筛查女性, 对其中符合研究纳入标准及排除标准的291例HR-HPV阳性者进行阴道微生态分析并随访, 在排除宫颈病变后, 6~12个月后再次进行HR-HPV检测, 若再次阳性者为持续感染组, 转阴性者为病毒清除组。分析2组的阴道微生态是否存在差异, 并进一步分析HR-HPV持续感染的危险因素。

符合研究纳入标准及排除标准的291例HR-HPV阳性者中持续感染组173例, 占59.45%, 平均年龄43.02岁±9.16岁(22~64岁); 病毒清除组118例, 占40.55%, 平均年龄40.26岁±9.00岁(24~66岁)。2组间年龄比较差异无统计学意义(F=0.041, P=0.839)。2组的阴道微生态分析表明, 病毒持续感染组的细菌性阴道病感染率、乳杆菌异常率、pH值异常率、白细胞酯酶阳性率分别为15.03%、41.62%、74.41%和22.54%, 这4项指标均大于病毒清除组, 2组间差异有统计学意义(χ²=7.088、14.369、9.585、4.487, P=0.008、＜0.001、0.002、0.034)。而2组在外阴阴道假丝酵母菌感染、滴虫性阴道炎、菌群密集度、多样性、过氧化氢酶、唾液酸苷酶、β-葡萄糖醛酸苷酶和乙酰氨基葡萄糖苷酶等指标方面的差异无统计学意义。Logistic回归分析显示乳杆菌异常、pH值异常是HR-HPV持续感染的危险因素, 其OR值分别为2.076(95%CI: 1.156~3.728)、2.121(95%CI: 1.218~3.688)(P＜0.05)。

宫颈HR-HPV感染后的转归与细菌性阴道病、白细胞酯酶阳性、乳杆菌异常及pH值异常存在一定的相关性, 尤其是乳杆菌异常、pH值异常是HR-HPV持续感染的危险因素, 需要重视。同时, 临床工作中可以考虑通过积极治疗下生殖道感染性疾病, 重建阴道微生态平衡, 以利于HR-HPV的清除, 降低宫颈病变的发生率。

Correlation between the outcome of cervical high-risk HPV infection and vaginal microecology

ObjectiveTo analyze the vaginal microecology and risk factors to the outcome of cervical high-risk HPV infection to explore the correlation between the outcome of cervical high-risk HPV infection and vaginal microecology.Methods291 women with positive HR-HPV in the gynecological outpatient department of our hospital from July 2019 to September 2020 were selected for vaginal microecological analysis and follow-up. After cervical lesions were excluded, HR-HPV detection was conducted again after 6-12 months. The patients who were still positive were divided in the persistent infection group, and those who turned negative were divided in the virus clearance group. The difference in vaginal microecology between the two groups were analyzed, and the risk factors of HR-HPV persistent infection were further analyzed.ResultsAmong the 291 patients, 173(59.45%) were in the persistent infection group, with an average age of 43.02±9.16 years(22-64 years), and 118(40.55%) in the virus clearance group, with an average age of 40.26±9.00 years(24-66 years). There was no significant difference in age between the two groups(F=0.041, P=0.839). The vaginal microecology analysis showed that the bacterial vaginosis infection rate, rate of abnormal Lactobacillus, abnormal pH value, and positive rate of leukocyte esterase in the persistent viral infection group were 15.03%, 41.62%, 74.41%, and 22.54%, respectively, all of which were greater than those in the virus clearance group with statistically significant differences. However, there were no significant differences between the two groups in vulvovaginal candidiasis infection, trichomonal vaginitis, flora density, diversity, catalase, sialidase, β-glucuronidase and acetylglucosaminidase. Logistic regression analysis showed that abnormal Lactobacillus and abnormal pH value were risk factors for persistent HR-HPV infection. The OR values were 2.076(95% CI: 1.156-3.728) and 2.121(95% CI: 1.218-3.688)(P < 0.05).ConclusionThe outcome of cervical HR-HPV infection is relate to bacterial vaginosis, leukocyte esterase positive, abnormal Lactobacillus and abnormal pH value, especially abnormal lactobacillus. Abnormal pH value is a risk factor for persistent HR-HPV infection, which should be paid attention. Active treatment of lower genital tract infections can be considered for the reconstruction of vaginal microecological balance, in order to facilitate the clearance of HR-HPV and reduce the incidence of cervical lesions.