LEEP术后阴道微环境的随访观察及HPV持续感染风险因素分析  

Follow-Up Observation of Vaginal Microenvironment after LEEP and Analysis of Risk Factors for Persistent HPV Infection

作　　者：王小丽[1] 闫益芬 WANG Xiaoli;YAN Yifen(Shiyan People's Hospital,Hubei Shiyan 442000,China)

机构地区：[1]湖北省十堰市人民医院妇科,湖北十堰442000

出　　处：《河北医学》2023年第4期641-647,共7页Hebei Medicine

基　　金：湖北省卫生健康委员会联合基金项目,(编号:WJ2019H179)。

摘　　要：目的:探讨宫颈环形电切术(LEEP)术后阴道微环境的随访观察及人乳头瘤病毒(HPV)持续感染的影响因素。方法:选取2019年1月至2021年9月在我院行LEEP患者98例,根据LEEP术后1年复诊情况,其中HPV持续感染者20例,分析HPV持续感染和HPV阴性者临床资料差异;同时分析患者LEEP术前及术后1周阴道微环境差异,以及HPV持续感染者和HPV阴性者复诊时阴道微环境差异。结果:HPV持续感染者年龄≥40岁、病变累及阴道壁、术前HPV多重感染、术前HPV病毒载量≥100RLU/CO、切缘阳性比例分别为80.00%、65.00%、60.00%、65.00%和65.00%,明显高于HPV阴性者(P<0.05);HPV持续感染者术后使用避孕套、术后使用抗HPV药物比例分别为40.00%和35.00%,明显低于HPV阴性者(P<0.05)。Logistic回归显示:年龄、术前HPV多重感染、术前HPV病毒载量、切缘情况、术后使用抗HPV是HPV持续感染的影响因素(P<0.05)。LEEP术后菌群密集度Ⅲ~Ⅳ比例、菌群多样性Ⅲ~Ⅳ比例、pH值>4.5比例、唾液酶苷酶阳性比例、过氧化氢阳性比例、白细胞酯酶阳性比例分别为21.43%、26.53%、32.65%、37.76%、31.63%和25.51%,较术前明显降低(P<0.05)。HPV持续感染复诊时阴道微环境菌群密集度Ⅲ~Ⅳ比例、菌群多样性Ⅲ~Ⅳ比例、pH值>4.5比例、唾液酶苷酶阳性比例、过氧化氢阳性比例、白细胞酯酶阳性比例分别为60.00%、55.00%、60.00%、55.00%、50.00%和60.00%,明显高于HPV阴性者(P<0.05)。结论:HPV持续感染受患者年龄、HPV多重感染等因素的影响;LEEP术后阴道微环境有明显改善,同时HPV持续感染者复诊时阴道微环境明显差于HPV阴性者。Objective:To investigate the follow-up observation of vaginal microenvironment after loop electrosurgical excision procedure(LEEP)and the influencing factors of persistent human papillomavirus(HPV)infection.Methods:From January 2019 to September 2021,98 patients with LEEP in our hospital were selected,according to the return visit of one year after LEEP,20 patients with persistent HPV infection,the differences of clinical data between persistent HPV infection and HPV negative patients were analyzed,and the differences of vaginal microenvironment before and 1 week after LEEP were analyzed,and the differences of vaginal microenvironment between patients with persistent HPV infection and those with negative HPV during follow-up visit were also analyzed.Results:Compared with negative HPV patients,the age≥40 years old,vaginal wall involvement,multiple infection of HPV before operation,HPV viral load≥100 RLU/CO before operation,and positive rate of incisional marginof patients with persistent HPV infection were 80.00%,65.00%,60.00%,65.00%and 65.00%respectively,which were significantly higher(P<0.05).Compared with negative HPV patients,the rates of condom use and anti HPV drugs use in patients with persistent HPV infection were 40.00%and 35.00%,respectively,which were significantly lower(P<0.05).Logistic regression showed that age,multiple infection of HPV before operation,load of HPV virus before operation,incision margin,and use of anti HPV after operation were the influencing factors of persistent infection of HPV(P<0.05).After LEEP,the proportion of colony densityⅢ~Ⅳ,flora diversityⅢ~Ⅳ,pH>4.5,salivary glycosidase positive,hydrogen peroxide positive,leukocyte esterase positive were 21.43%,26.53%,32.65%,37.76%,31.63%and 25.51%respectively,which were significantly lower than those before LEEP(P<0.05).Compared with negative HPV patients,the proportion of vaginal microenvironment flora density III-IV,flora diversity III-IV,pH>4.5,salivary glycosidase positive,hydrogen peroxide positive,and leukocyte esterase

关 键 词：宫颈环形电切术 阴道微环境 人乳头瘤病毒持续感染 影响因素 

分 类 号：R737.33[医药卫生—肿瘤]