高危型HPV感染宫颈上皮内瘤变患者阴道微生态及T细胞亚群变化  

Changes of vaginal microecology and T cell subsets in patients with high-risk HPV infection and cervical intraepithelial neoplasia

作　　者：赵海丽[1,2] 陈华 怡萍[3] 靳生艳[1] 刘菊年 ZHAO Hai-li;CHEN Hua;YI Ping;JIN Sheng-yan;LIU Ju-nian(Affiliated Hospital of Qinghai University,Xining,Qinghai 810001,China;不详)

机构地区：[1]青海大学附属医院肿瘤妇科,青海西宁810001 [2]青海大学附属肿瘤医院肿瘤妇科,青海西宁810001 [3]青海大学附属医院护理部,青海西宁810001

出　　处：《中华医院感染学杂志》2021年第17期2633-2637,共5页Chinese Journal of Nosocomiology

基　　金：青海省卫生计生委指导性科研基金资助项目(2015-028)。

摘　　要：目的探讨高危型人乳头瘤病毒(HR-HPV)感染及宫颈上皮内瘤样病变(CIN)患者阴道菌群多样性及宫颈局部免疫功能变化。方法选取2018年1月-2019年12月青海大学附属肿瘤医院收治的90例人乳头瘤病毒(HPV)感染患者作为研究对象,均行宫颈组织活检及HPV分型检测,比较不同HPV分型、不同宫颈良性病变患者阴道菌群密集度、多样性及宫颈分泌物T细胞亚群(CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))水平。结果不同宫颈病变患者HPV分布比较差异有统计学意义(χ^(2)=17.444,P<0.05),CINⅡ~Ⅲ级患者HR-HPV占比高于宫颈炎组(χ^(2)=15.396,P<0.001)和CINⅠ级组(χ^(2)=13.662,P<0.001);不同宫颈病变阴道菌群密集度比较差异有统计学意义(χ^(2)=6.321,P=0.042)、多样性比较差异有统计学意义(χ^(2)=8.789,P=0.012);不同宫颈病变HR-HPV感染和LR-HPV感染患者阴道菌群密集度、多样性比较差异均无统计学意义;不同宫颈病变患者CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平比较差异有统计学意义(P<0.05),HR-HPV感染患者CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平低于LR-HPV感染患者(P<0.05)。结论高级别CIN患者阴道微生态及宫颈局部免疫异常,HR-HPV感染可加重宫颈局部免疫紊乱,HR-HPV感染、阴道菌群、宫颈局部免疫紊乱可能相互作用促进宫颈上皮瘤变,相关机制还需进一步研究。OBJECTIVE To explore the diversity of vaginal flora and changes of local cervical immune function in patients with high-risk human papillomavirus(HR-HPV)infection and cervical intraepithelial neoplasia(CIN).METHODS A total of 90patients with HPV infection who were treated in the Affiliated Tumor Hospital of Qinghai University from Jan 2018to Dec 2019were recruited as the study subjects and underwent cervical tissue biopsy and HPV typing detection.The density and diversity of vaginal flora and levels of cervical secretions T cell subsets(CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+))were observed and compared among the patients with different subtypes of HPV and the patients with different benign cervical lesions.RESULTS There was significant difference in the distribution of HPV among the patients with different cervical lesions(χ^(2)=17.444,P<0.05),the proportion of the patients with HR-HPV was significantly higher in the CINⅡ~Ⅲpatients than in the cervicitis group(χ^(2)=15.396,P<0.001)and the CINⅠgroup(χ^(2)=13.662,P<0.001).There was significant difference in the density of vaginal flora among the patients with different cervical lesions(χ^(2)=6.321,P=0.042),there was significant difference in the diversity(χ^(2)=8.789,P=0.012).There were no significant differences in the density and diversity of vaginal flora between the patients with HR-HPV infection and the patients with LR-HPV infection.There were significant differences in the levels of CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)among the patients with different cervical lesions(P<0.05),and the levels of CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)of the patients with HR-HPV infection were significantly lower than those of the patients with LR-HPV infection(P<0.05).CONCLUSIONThe high-grade CIN patients have abnormal vaginal microecology and local cervical immunity.The HR-HPV infection can aggravate the cervical immunologic derangement,and the interaction among the HR-HPV infection,vaginal flora and local cervical immunologic derangement may promote the cervical ep

关 键 词：人乳头瘤病毒 高危型 宫颈上皮内瘤样病变 阴道菌群 宫颈免疫功能 

分 类 号：R711.74[医药卫生—妇产科学]