不同等级宫颈病变患者炎性因子、T细胞亚群、阴道菌群情况研究  

Relationship between HPV infection and inflammatory cytokines,T cell subsets and vaginal flora

作　　者：韩志娟[1] 刘世菊[1] 徐俊昌[2] 李刚[3] 

机构地区：[1]襄阳市中心医院传染病分院医务科,湖北襄阳441003 [2]湖北医药学院附属襄阳医院骨科,湖北襄阳441003 [3]襄阳市中心医院皮肤科,湖北襄阳441021

出　　处：《中国性科学》2017年第4期54-57,共4页Chinese Journal of Human Sexuality

基　　金：湖北省自然科学基金面上项目(2014CFC1151)

摘　　要：目的:探究CIN或宫颈癌患者阴道菌群、宫颈局部T细胞亚群以及血清炎性因子的组成,为宫颈癌的防治提供新的思路。方法:选取2013年8月至2015年7月我院收治的HPV阳性且病理活检确诊为CIN或宫颈癌的患者200例作为观察组,同时选取HPV阴性且宫颈活检正常者120例作为对照组。两组患者均于初诊时留取阴道分泌物、宫颈分泌物及脱落细胞、宫颈组织标本,采用液基薄层细胞学检查法(TCT)检测宫颈病变程度,采用悬滴湿片法检测滴虫,革兰氏染色检测霉菌、淋球菌和乳酸杆菌等;采用免疫组化法检测宫颈CD4^+和CD8^+T淋巴细胞的表达;采用酶联免疫吸附法(ELISA)检测血清炎性因子IL-2、IL-4、IL-10、IFN-γ和TNF-α。结果:两组患者在解脲支原体、衣原体的感染率以及乳酸杆菌的阴性感染率之间差异具有统计学意义(P<0.05),且随着病变程度的加重,其感染率也存在明显差异,而其它病原体感染在两组间无统计学差异(P>0.05);在对照组、CINⅠ~CINⅢ以及宫颈癌患者的宫颈分泌物中CD4^+T细胞表达率呈下降趋势,而CD8^+T细胞表达率无明显差异(P>0.05),但CD4^+/CD8^+的比值呈下降趋势;在对照组、CINⅠ~CINⅢ及宫颈癌患者的血清IFN-γ和IL-2水平呈下降趋势,IL-4的含量呈上升趋势,而TNF-α和IL-10的含量无明显差别(P>0.05)。结论:解脲支原体、衣原体感染的增加、乳酸杆菌的减少、CD4^+T细胞表达减少可能促进宫颈病变的发生发展。Objectives：To explore the vaginal flora,cervical local T cell subsets and serum inflammatory cytokines in patients with CIN or cervical cancer,in order to provide new ideas for the prevention and treatment ofcervical cancer. Methods：200 HPV-positive patients with biopsy confirmed CIN or cervical cancer in our hospital from August 2013 to July 2015 were selected as the observation group,and 120 HPV-negative patients with normal cervical biopsy were selected as control group. Specimens from vaginal secretions,cervical secretions in newly diagnosed and exfoliated cells and cervical tissue were taken and detected by Thin Prep cytology method（TCT） to determine the cervical lesions. The wet sheet hanging drop method was used to detect Trichomonas,Gram staining fungi,lactic acid bacteria and Neisseria gonorrhoeae and streaming immunohistochemical method was adopted to detect cervical expression of CD4^＋and CD8^＋T lymphocytes,and serum inflammatory cytokines IL-2,IL-4,IL-10,IFN-γ and TNF-α was detected using enzyme-linked immunosorbent assay（ELISA）. Results：There were statistically significant differences between the two groups in UU,chlamydia infection and lactobacilli negative infection rate（P〈0. 05）,with varied prevalence with the severity of disease. Difference in other pathogens between the two groups was not significant（P〈0. 05）. In the control group,expression of CD4^＋T cells in the cervical secretions of patients with CINⅠ-CINⅢ cervical cancer decreased,and the expression of CD8^＋T cells was not significantly different（P〈0. 05）,but CD4^＋/CD8^＋ratio decreased. In the control group,the serum IFN-γ and IL-2 levels decreased and IL-4 content increased in patients with CINⅠ-CINⅢ and cervical cancer,without significant difference in the content of TNF-α and IL-10（P〈0. 05）. Conclusion：The increase in UU and chlamydia infection and decrease in lactobacilli and CD4^＋T cells contributes to reducing the occurrence and development of cervical lesions.

关 键 词：人乳头瘤状病毒 炎性因子、T细胞亚群、阴道菌群 宫颈癌 

分 类 号：R711.74[医药卫生—妇产科学]