阴道微生物代谢产物及酶改变与高危型人乳头瘤病毒感染和宫颈上皮内瘤变发生风险的关系  

Role of vaginal microbial metabolites and enzymes and high risk HPV in the development of cervical intraepithelial neoplasia

作　　者：朱若熙 郝敏[1] 赵卫红[1] 王伟[1] 王志莲[1] 王金桃 冯波[1] 杨婧[1] 王哲 牛晓芬[1] ZHU Ruo-xi;HAO Min;ZHAO Wei-hong;WANG Wei;WANG Zhi-lian;WANG Jin-tao;FENG Bo;YANG Jing;WANG Zhe;NIU Xiao-fen(Department of Obstetrics and Gynecology,Second Hospital of ShanxiMedical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院妇产科,山西太原030001 [2]山西医科大学公共卫生学院流行病学教研室,山西太原030001

出　　处：《中国实用妇科与产科杂志》2019年第7期797-802,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家卫计委公益性行业科研专项(201402010);山西省重点研发计划项目(201803D31121);山西省面上自然基金项目(201601D011086);山西省卫计委科研课题(2018GW04));山西省卫计委科研课题(2017056);山西省卫计委科研课题(2015038)

摘　　要：目的探讨阴道微生物代谢产物及酶改变与高危型人乳头瘤病毒(HR-HPV)感染在宫颈上皮内瘤变(CIN)中的作用及其交互效应。方法于2014年6月至12月,由山西医科大学第二医院妇产科对山西省两地区符合标准的40000名社区现场人群,行人口学特征、CIN相关因素、宫颈薄层液基细胞学检查(TCT),对符合入组条件者进一步行阴道微生态、HPV分型检测及阴道镜和病理组织检查。共检出782例CIN作为病例组,1503例病理结果正常者作为对照组,对队列人群中阴道微生物代谢产物及酶的数据进行横断面分析,评价其改变与CIN风险的关联性。结果过氧化氢(H2O2)、β-葡萄糖醛酸酶(GUS)、唾液酸苷酶(SNA)与CIN的发生风险具有统计学关联性,风险比值比分别为1.60(95%CI 1.30~1.96),1.58(95%CI 1.30~1.92),1.45(95%CI 1.18~1.79)。乙酰氨基葡萄糖苷酶(NAG)、白细胞酯酶(LE)与CIN无统计学关联。交互作用分析显示,H2O2、GUS、SNA和HR-HPV感染在CIN发生发展中存在交互作用。结论 H2O2、GUS、SNA阳性与CIN的风险升高相关,且与HR-HPV感染存在交互作用,增加CIN的发生风险。Objective To investigate the role of vaginal microbial metabolites and enzyme changes and high-risk human papillomavirus(HR-HPV)infection in cervical intraepithelial neoplasia(CIN)and their interaction effects.Methods From June 2014 to December 2014,demographic characteristics and CIN-related factors and cervical liquid-based cytology(TCT)examination results were collected from 40 000 community-based populations from two regions of Shanxi Province by the Second Hospital of Shanxi Medical University.Patients who meet the criteria for enrollment were further tested for vaginal microecology,HPV testing,and colposcopic and pathologic examination.A total of 782 cases with pathological diagnosis of CIN were chosen as the case group;1503 patients with normal pathological results were chosen as a control group.A multivariate logistic regression model was established to analyze the vaginal microbial metabolic enzymes cross-sectionally,then the association between vaginal microbial metabolic changes and CIN risk was evaluated.Results The expression of hydrogen peroxide(H2 O2),β-glucuronidase(GUS)and sialidase(SNA)was statistically correlated with CIN risk,and the odd ratios were 1.60(95% CI 1.30-1.96),1.58(95% CI 1.30-1.92),and 1.45(95% CI1.18-1.79),respectively.The expression of acetylglucosaminidase(NAG)and leukocyte esterase(LE)had no statistical association with CIN risk.Interaction analysis showed that there were positive multiplicative interactions among H2 O2,GUS,SNA and HR-HPV infections in the occurrence of CIN.Conclusion Positive H2 O2,GUS,and SNA is associated with increased risk of CIN,and they have positive interaction with HR-HPV infection,which increases the risk of CIN.

关 键 词：宫颈上皮内瘤变 阴道微生物 代谢产物及酶 人乳头瘤病毒 

分 类 号：R737.3[医药卫生—肿瘤]