宫颈上皮内瘤变患者阴道微生态状况与LEEP术后预后关系

目的 研究宫颈上皮内瘤变（CIN）患者阴道微生态状况及LEEP术后阴道微生态状况的变化特点，分析阴道微生态状况与CIN患者预后的关系。方法 回顾性分析2016年1月至2018年1月温州医科大学定理临床学院122例高危型人乳头瘤病毒（hr-HPV）阳性的CIN患者LEEP术治疗前后阴道微生态的变化特点。结果 LEEP术后菌群密集度Ⅱ~Ⅲ级（74.59%）、多样性Ⅱ~Ⅲ级（68.03%）、乳酸分级Ⅰ~Ⅱa级（70.49%）出现增多，需氧菌性阴道病（AV）（9.84%）、细菌性阴道病（BV）（14.75%）、外阴阴道假丝酵母菌病（VVC）（12.30%）以及滴虫性阴道炎（2.46%）的检出率降低和pH值（4.2±0.5）降低，与术前比较差异具有统计学意义（均P<0.05）；术后复诊hr-HPV阳性CIN患者菌群密集度Ⅱ~Ⅲ级（35.00%）、多样性Ⅱ~Ⅲ级（40.00%）、乳酸分级Ⅰ~Ⅱa级（25.00%）低于hr-HPV阴性CIN患者，AV（30.00%）、BV（35.00%）、VVC（30.00%）检出率，pH值（4.9±0.4）高于hr-HPV阴性CIN患者，差异有统计学意义（均P<0.05）。结论 阴道微生态失衡可降低宫颈免疫力，促进CIN进展、癌变，改善阴道微生态可抑制hr-HPV的感染，抑制宫颈细胞的异常增生、癌变。

Relationship between vaginal microecology and prognosis after LEEP inpatients with cervical intraepithelial neoplasia

Abstract: Objective To study the vaginal microecology of patients with cervical intraepithelial neoplasia (CIN) and the changes of vaginal microecology after LEEP, and analyze the relationship between vaginal microecology and prognosis of CIN patients. Methods The changes of vaginal microecology in 122 patients with high risk human papillomavirus (hr-HPV) positive CIN in our hospital from January 2016to January 2018 were analyzed retrospectively. Results After LEEP, the floral abundance of grade II-III (74.59%), diversity of grade II-III (68.03%) and lactic acid grade I-IIa (70.49%) increased. The detection rates of AV (9.84%), BV (14.75%), VVC (12.30%) and trichomonad vaginitis (2.46%) decreased, and pH (4.2±0.5) decreased. The differences were statistically significant compared with those before operation (all P<0.05). The floral abundance of grade II-III (35.00%), diversity of grade II-III (40.00%) and lactic acid grade I-II (25.00%) in CIN patients with positive hr-HPV were lower, while the detection rates of AV (30.00%), BV (35.00%) and VVC (30.00%) as well as pH value (4.9±0.4) were higher than in those with negative hr-HPV, respectively (all P<0.05). Conclusion Microecological imbalance of vagina can reduce the immunity of the cervix, and promote the progression and canceration of CIN. Improvement of the microecology of vagina can inhibit hr-HPV infection, and prevent abnormal hyperplasia and canceration of cervical cells.