阴道微生态与高级别宫颈上皮内瘤变术后HPV转归的关系  

Relationship between vaginal microecology and HPV outcome after high-grade cervical intraepithelial neoplasia surgery

作　　者：王立娟 曹丽娟[1] 吴琼[1] WANG Li-juan;CAO Li-juan;WU Qiong(Department of Gynecology,Chengde Central Hospital,Chengde Hebei 067000,China.)

机构地区：[1]承德市中心医院妇科,河北承德067000

出　　处：《临床和实验医学杂志》2022年第19期2088-2092,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省医学科学研究课题计划项目(编号:20200349);承德市科学技术研究与发展计划项目(编号:202102A011)。

摘　　要：目的探讨阴道微生态与高级别宫颈上皮内瘤变(CINⅡ+)术后人乳头瘤病毒(HPV)转归的关系。方法回顾性选取2019年1月至2021年1月在承德市中心医院行宫颈电环切术(LEEP)及宫颈冷刀锥切术(CKC)治疗的414例CINⅡ+患者为研究对象,另选取同期60例健康女性为对照组。所有患者术前HPV检测均呈阳性,术后随访1年,统计患者HPV转阴率、HPV感染情况。比较HPV16/18感染组、其他HPV感染组、HPV转阴组、对照组阴道微生态情况,采用Logistic回归分析阴道微生态与HPV16/18持续感染的相关性。结果术后1年,414例CINⅡ+患者HPV检测显示,306例为HPV阴性,72例为HPV16/18型,36例为其他HPV型,HPV转阴率为73.91%(306/414)。HPV转阴组与对照组阴道微生态指标[菌群密集度、菌群多样性、霉菌、滴虫、乳酸杆菌、pH值、白细胞酯酶(LE)、过氧化氢(H 2O 2)、唾液酸苷酶(SNA)、葡萄糖醛酸苷酶(GUS)、乙酰氨基葡萄糖苷酶(NAG)]比较,差异无统计学意义(P>0.05);HPV16/18感染组菌群密集度(异常)、菌群多样性(异常)、pH值(<3.8/≥4.6)、LE(+)、SNA(+)比率显著高于HPV转阴组、对照组,乳酸杆菌(+)比率显著低于HPV转阴组、对照组,差异均有统计学意义(P<0.05);HPV16/18感染组LE(+)比率显著高于其他HPV感染组,差异有统计学意义(P<0.05);其他HPV感染组PH值(<3.8/≥4.6)、SNA(+)比率显著高于HPV转阴组、对照组,乳酸杆菌(+)比率显著低于HPV转阴组、对照组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,菌群密集度(异常)、菌群多样性(异常)、LE(+)、SNA(+)是HPV16/18持续感染的独立危险因素(OR=1.252,95%CI为1.105~1.420;OR=1.204,95%CI为1.081~1.342;OR=1.747,95%CI为1.041~2.931;OR=1.430,95%CI为1.047~1.954,P<0.05)。结论CINⅡ+患者术后HPV转归与阴道微生态有关,术后阴道微生态治疗具有重要意义。Objective To investigate the relationship between vaginal microecology and the outcome of human papillomavirus(HPV)after high-level cervical intraepithelial neoplasia(CINⅡ+).Methods A total of 414 patients with CINⅡ+who underwent cervical electrosurgical excision procedure(LEEP)and cervical cold knife conization(CKC)in Chengde Central Hospital from January 2019 to January 2021 were retrospectively selected as the study subjects,and 60 healthy women in the same period were selected as the control group.All patients were positive for HPV detection before operation.After 1 year of follow-up,the negative conversion rate of HPV and HPV infection were counted,and the vaginal microecology of HPV16/18 infection group,other HPV infection groups,HPV negative conversion group and control group was compared.Correlation between vaginal microecology and HPV16/18 persistent infection by Logistic regression model.Results One year after operation,HPV detection in 414 CINⅡ+patients showed that 306 cases were HPV negative,72 cases were HPV16/18,and 36 cases were other HPV types,with HPV negative conversion rate of 73.91%(306/414).There was no statistically significant difference in vaginal microecological indexes between HPV negative conversion group and control group[flora density,flora diversity,mold,trichomonas,lactobacillus,pH value,leukocyte esterase(LE),hydrogen peroxide(H 2O 2),sialoglucosidase(SNA),glucuronidase(GUS),and acetylglucosidase(NAG)](P>0.05).The proportion of bacterial density(abnormal),bacterial diversity(abnormal),pH value(<3.8/≥4.6),LE(+)and SNA(+)in HPV16/18 infection group were significantly higher than those in HPV negative group and control group,and the proportion of Lactobacillus(+)was significantly lower than that in HPV negative group and control group,the differences were statistically significant(P<0.05).The proportion of LE(+)in HPV16/18 infection group was significantly higher than that in other HPV infection groups,the difference was statistically significant(P<0.05).pH value(<3.8/≥4.6)a

关 键 词：宫颈上皮内瘤变 宫颈电环切术 阴道微生态 乳头瘤病毒 

分 类 号：R737.33[医药卫生—肿瘤]