不同程度宫颈病变患者阴道微生态变化及与HPV-DNA的关系  

Changes of vaginal microecology and its relationship with HPV-DNA in patients with different degrees of cervical lesions

作　　者：林蓉蓉 刘佳[1] 邱德稳 曾俊萍 LIN Rongrong;LIU Jia;QIU Dewen;ZENG Junping(Department of Clinical Laboratory,Jiangxi Maternal and Child Health Hospital,Nanchang,Jiangxi 330006,China)

机构地区：[1]江西省妇幼保健院检验科,江西南昌330006

出　　处：《检验医学与临床》2021年第19期2866-2869,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨不同程度宫颈病变患者阴道微生态变化情况及与人乳头瘤病毒DNA(HPV-DNA)之间的关系。方法选取2018年6月至2020年6月该院收治的经病理活检或宫颈液基薄层细胞学检查诊断为宫颈上皮内瘤变及宫颈鳞状细胞癌(CSCC)的患者509例为研究对象,并将其分为低度鳞状上皮内病变(LSIL)组217例、高度鳞状上皮内病变(HSIL)组209例及CSCC组83例。同时选取未发生宫颈病变的健康育龄女性272例为对照组,分别检测4组的阴道微生态各项指标[包括加德纳菌、滴虫、孢子、乳酸杆菌、pH值、白细胞酯酶(LE)、唾液酸苷酶(SNA)],计算Nugent评分,检测HPV-DNA载量。从所有研究对象中随机选取261例,根据HPV-DNA检测结果分为HPV阴性组(100例)、HPV阳性组(161例),分析2组阴道微生态各项指标的情况。结果4组加德纳菌、滴虫、乳酸杆菌检出率,阴道pH值≥4.6的受试者比例,以及LE、SNA阳性率比较,差异均有统计学意义(P<0.05);4组孢子检出率差异无统计学意义(P>0.05)。两两比较,HSIL组加德纳菌检出率高于LSIL组及对照组;对照组滴虫检出率高于HSIL组及LSIL组;CSCC组乳酸杆菌检出率低于HSIL组、LSIL组及对照组,HSIL组低于对照组;CSCC组阴道pH值≥4.6的受试者比例高于HSIL组、LSIL组及对照组,HSIL组高于LSIL组及对照组;LSIL组LE阳性率低于CSCC组、HSIL组及对照组;HSIL组SNA阳性率高于LSIL组及对照组,差异均有统计学意义(P<0.05)。HPV阳性组Nugent评分≥7分(细菌性阴道炎)、阴道pH值≥4.6的受试者比例,LE阳性率、SNA阳性率均高于HPV阴性组,乳酸杆菌检出率则低于HPV阴性组,差异均有统计学意义(P<0.05),而孢子和滴虫的检出率差异无统计学意义(P>0.05)。结论阴道微生态变化可能是导致宫颈病变的主要原因,也可能是HPV持续感染及宫颈病变发生、发展的潜在因素。Objective To investigate the changes of vaginal microecology and its relationship with human papillomavirus DNA(HPV-DNA)in patients with different degrees of cervical lesions.Methods A total of 509 patients with cervical intraepithelial neoplasia and cervical squamous cell carcinoma(CSCC)diagnosed by pathological biopsy or cervical thinprep cytologic test in the hospital from June 2018 to June 2020 were selected as the study subjects,and they were divided into low-grade squamous intraepithelial lesion(LSIL)group(217 cases),high-grade squamous intraepithelial lesion(HSIL)group(209 cases)and CSCC group(83 cases).And 272 healthy women of reproductive age without cervical intraepithelial lesion were taken as the control group.Detected the indicators of vaginal microecology[Gardnerella,trichomonas,spores,Lactobacillus,pH value,leukocyte esterase(LE),sialidase(SNA)],calculated Nugent score and detected HPV-DNA viral load of 4 groups.In addition,261 cases were randomly selected from all study subjects and divided into HPV negative group(100 cases)and HPV positive group(161 cases)according to the results of HPV-DNA,the changes of various indicators of vaginal microecology in the two groups were analyzed.Results The detection rates of Gardnerella,trichomonas and Lactobacillus,the proportion of subjects with vaginal pH value≥4.6,and the positive rates of LE and SNA were significantly different among the 4 groups(P<0.05).There was no significant difference in the detection rate of spores in the 4 groups(P>0.05).Pairwise comparison,the detection rate of Gardnerella in the HSIL group was higher than that in the LSIL group and the control group;the detection rate of trichomonas in the control group was higher than that in the HSIL group and the LSIL group;the detection rate of Lactobacillus in the CSCC group was lower than that in the HSIL group,the LSIL group and the control group,and the detection rate of Lactobacillus in the HSIL group was lower than that in the control group;the proportion of subjects with vaginal pH≥4

关 键 词：阴道微生态 人乳头瘤病毒 低度鳞状上皮内病变 高度鳞状上皮内病变 宫颈鳞状细胞癌 

分 类 号：R737.33[医药卫生—肿瘤]