阴道微生态失衡与HR-HPV感染及宫颈病变的关系  

Relationship between vaginal microecological imbalance and HR-HPV infection and cervical lesions

作　　者：智艳芳[1] 刘慧[1] 张婷[1] 班振英[1] 张威[1] 曾宪旭[1] ZHI Yanfang;LIU Hui;ZHANG Ting;BAN Zhenying;ZHANG Wei;ZENG Xianxu(The Third Affiliated Hospital of Zhengzhou University,Henan Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院,河南郑州450052

出　　处：《中国妇幼健康研究》2022年第9期90-96,共7页Chinese Journal of Woman and Child Health Research

摘　　要：目的 探讨阴道微生态各项指标变化与高危型人乳头瘤病毒(HR-HPV)感染及宫颈病变的关系。方法 在2018年7月到2021年3月就诊于郑州大学第三附属医院妇科门诊的患者中,选取宫颈薄层液基细胞学检查(TCT)结果阳性者600例为阳性组,另选取TCT结果阴性者600例为阴性组,对阳性组与阴性组患者进行阴道微生态各项指标检测及HR-HPV(16、18/45)检测,比较并分析阳性组与阴性组阴道微生态各项指标改变情况及HR-HPV感染率的差异。结果 阳性组乳酸杆菌(χ^(2)=54.194,P=0.000)、过氧化氢(χ^(2)=38.732,P=0.000)、白细胞酯酶(χ^(2)=98.714,P=0.000)的异常率及HR-HPV感染率(χ^(2)=243.892,P=0.000)均显著高于阴性组;随着宫颈病变级别的升高,乳酸杆菌(趋势χ^(2)=22.201,P=0.000)、过氧化氢(趋势χ^(2)=115.863,P=0.010)、白细胞酯酶(趋势χ^(2)=40.662,P=0.000)的异常率及HR-HPV阳性率(趋势χ^(2)=32.512,P=0.000)均呈上升趋势。在宫颈病变的发生、发展过程中,HR-HPV感染与乳酸杆菌异常(OR=6.769,95%CI:3.737~12.260,P=0.000)、过氧化氢异常(OR=53.881,95%CI:25.786~112.586,P=0.000)、白细胞酯酶异常(OR=13.157,95%CI:6.118~29.866,P=0.000)均存在交互作用。结论 阴道微生态的改变,特别是乳酸杆菌、过氧化氢、白细胞酯酶的异常与HR-HPV感染存在交互作用,与宫颈病变发生密切相关。Objective To investigate the relationship between changes in various vaginal microecological indicators and high-risk human papilloma virus(HR-HPV) infection and cervical lesions.Methods From July 2018 to March 2021,among patients who visited the gynecology clinic of the Third Affiliated Hospital of Zhengzhou University, 600 patients with positive cervical thinprep cytologic test(TCT) results were selected as the positive group and 600 patients with negative TCT results were selected as the negative group.The positive group and negative group of patients were tested for various vaginal microecological indicators and HR-HPV(16,18/45),and the differences between the two groups were compared and analyzed in terms of the changes in various vaginal microecological indicators and the rate of HR-HPV infection.Results The abnormal rates of Lactobacillus(χ^(2)=54.194,P=0.000),hydrogen peroxide(χ^(2)=38.732,P=0.000),leukocyte esterase(χ^(2)=98.714,P=0.000) and infection rate of HR-HPV(χ^(2)=243.892,P=0.000) were significantly higher in the positive group than those in the negative group.As the increase of grade of cervical lesions, the abnormal rates of Lactobacillus(trend χ^(2)=22.201,P=0.000),hydrogen peroxide(trend χ^(2)=115.863,P=0.010),leukocyte esterase(trend χ^(2)=40.662,P=0.000) and positive rate of HR-HPV(trend χ^(2)=32.512,P=0.000) all showed increasing trends.During the process of occurrence and development of cervical lesions, HR-HPV infection interacted with Lactobacillus abnormalities(OR=6.769,95%CI:3.737-12.260,P=0.000),hydrogen peroxide abnormalities(OR=53.881,95%CI:25.786-112.586,P=0.000),and leukocyte esterase abnormalities(OR=13.157,95%CI:6.118-29.866,P=0.000).Conclusion Vaginal microecological alterations, particularly the interactions of Lactobacillus, hydrogen peroxide, and leukocyte esterase abnormalities with HR-HPV infection, are closely associated with the development of cervical lesions.

关 键 词：乳酸杆菌 过氧化氢 白细胞酯酶 高危型人乳头瘤病毒 阴道微生态 宫颈病变 

分 类 号：R173[医药卫生—妇幼卫生保健]