阴道微生物菌群及宫颈局部免疫功能与宫颈上皮内瘤变的相关性分析  

Analysis of the correlation between vaginal microbial flora and cervical immune function and cervical intraepithelial neoplasia

作　　者：刘化勇[1] 刘学军[2] 高永丽[1] 张靖 LIU Hua-yong;LIU Xue-jun;GAO Yong-li;ZHANG Jing(Department of Oncology,Linyi Peopled Hospital,Linyi 276000,Shandong,China;Department of Gynecology,Linyi People’s Hospital;Tianjin Binhai New Area Hospital of Traditional Chinese Medicine Obstetrics and Gynecology)

机构地区：[1]临沂市人民医院肿瘤科,山东临沂276000 [2]临沂市人民医院妇科门诊 [3]天津市滨海新区中医医院妇产科

出　　处：《中国病原生物学杂志》2021年第7期805-808,813,共5页Journal of Pathogen Biology

摘　　要：目的分析阴道微生物菌群、宫颈局部免疫功能与宫颈上皮内瘤变(CIN)的相关性。方法选择2018年6月-2020年6月本院收治的CIN患者102例为研究组。根据宫颈脱落细胞学检查及活检病理检查,CINⅠ级36例,CINⅡ级45,CINⅢ级21例。随机选取同期于本院进行阴道分泌物检查的女性100例为对照组。收集入组对象阴道分泌物和宫颈组织标本,检测阴道菌群及宫颈局部T细胞亚群,利用受试者工作特征曲线评价阴道微生物菌群、宫颈局部免疫功能对CIN的预测价值,采用多因素Logistic回归分析影响CIN发生的危险因素。结果研究组HPV阳性率和细菌性阴道病患病率及CD_(8)^(+)T水平均显著高于对照组(P<0.05或P<0.01),乳酸杆菌阳性率、CD_(4)^(+)T水平及CD_(4)^(+)/CD_(8)^(+)值显著低于对照组(均P<0.01);研究组患者随CIN分级增加,细菌性阴道病患病率呈上升趋势,乳酸杆菌阳性率呈下降趋势。CINⅢ级患者细菌性阴道病患病率显著高于CINⅠ级患者(P<0.01),乳酸杆菌阳性率显著低于CINⅠ级患者(P<0.01);CINⅠ—Ⅲ级患者CD_(4)^(+)T水平、CD_(4)^(+)/CD_(8)^(+)值依次呈下降趋势(P<0.05或P<0.01)。阴道菌群、CD_(4)^(+)/CD_(8)^(+)值预测CIN发生的曲线下面积分别为0.674(95%CI:0.605~0.739)、0.818(95%CI:0.758~0.869);二者联合预测CIN发生的曲线下面积为0.864(95%CI:0.809~0.908),灵敏度和特异度分别为82.35%和78.00%。多因素Logistic回归分析HPV感染、细菌性阴道病及CD_(4)^(+)/CD_(8)^(+)值是CIN发生的独立危险因素(P<0.05或P<0.01)。结论阴道菌群失调(包括HPV感染),宫颈局部免疫功能低下是CIN发生的独立危险因素,检测上述指标对诊断CIN的发生有一定的预测价值,两指标联合诊断的效能更高。Objective To explore the correlation between vaginal microbial flora and cervical immune function and cervical intraepithelial neoplasia(CIN). Methods A total of 102 patients with CIN seen at this hospital from June 2018 to June 2020 served as the study group. Based on cervical exfoliative cytology and a biopsy/pathological examination, patients with CIN were divided into 36 patients with grade I CIN, 45 with CIN grade II, and 21 with grade III. One hundred women who underwent a vaginal discharge examination at this hospital during the same period but with a normal pathology served as the control group. Vaginal secretions and cervical tissue specimens were collected from all subjects in the study group. The vaginal flora and local cervical T cell subsets were determined, and the predictive value of vaginal microflora and cervical immune function with regard to CIN was evaluated using the receiver operating characteristic curve. The risk factors affecting the incidence of CIN were analyzed using multivariate logistic regression analysis. Results Positivity for HPV, positivity for bacterial vaginosis, and the level of CD_(8)^(+)T cells in the study group were markedly higher than those in the control group(P<0.05). Positivity for Lactobacillus, the level of CD_(8)^(+)T cells, and the CD_(4)^(+)/CD_(8)^(+) cell ratio were markedly lower than those in the control group(P<0.05). Positivity for bacterial vaginosis in the study group increased and positivity for Lactobacillus tended to decrease with a higher grade of CIN. In addition, pairwise comparison indicated that positivity for bacterial vaginosis in patients with grade III CIN was markedly higher than that in patients with grade I CIN(P<0.05). Positivity for Lactobacillus was markedly lower in patients with grade I CIN(P<0.05). The level of CD_(8)^(+)T cells and the CD_(4)^(+)/CD_(8)^(+) cell ratio in the three groups tended to decrease markedly, and differences between the groups were significant(P<0.05). The area under the curve for vaginal flora and the CD_(4)

关 键 词：宫颈上皮内瘤变 阴道微环境 菌群失调 宫颈病变 

分 类 号：R378[医药卫生—病原生物学]