HPV持续感染及HPV E6/E7 mRNA表达与宫颈上皮内瘤变患者阴道微环境的关系  

Relationship between HPV persistent infection,HPV E6/E7 mRNA expression and vaginal microenvironment in patients with cervical intraepithelial neoplasia

作　　者：于皓 吕莹莹 刘影 张向东 陈璐 吕清媛 YU Hao;LYU Ying-ying;LIU Ying;ZHANG Xiang-dong;CHEN Lu;LYU Qing-yuan(Lishui Maternal and Child Health Hospital,Lishui,Zhejiang 323000,China;不详)

机构地区：[1]丽水市妇幼保健院妇科,浙江丽水323000 [2]台州市中医院妇产科,浙江台州318000 [3]丽水市妇幼保健院中医妇科,浙江丽水323000 [4]丽水市妇幼保健院院长办公室,浙江丽水323000

出　　处：《中华医院感染学杂志》2023年第7期1080-1084,共5页Chinese Journal of Nosocomiology

基　　金：浙江省卫生健康科技计划基金资助项目(2021ZH018);丽水市科技计划基金资助项目(2020ZDYF14)。

摘　　要：目的分析人乳头瘤病毒(HPV)持续感染状态和HPV E6/E7 mRNA表达与宫颈上皮内瘤变(CIN)患者阴道微环境变化的关系。方法选择2020年9月-2021年9月丽水市妇幼保健院收治的CIN合并HPV感染患者101例(CIN组),依据HPV亚型致病性的差异将101例患者分为高危型组(n=53例,依据病理结果分为CINⅠ级17例,CINⅡ级19例,CINⅢ级17例)和低危型组(n=48例),选择同期于医院妇科门诊行健康检查的HPV阴性的妇女153名为对照组,采集上述不同分组患者的阴道分泌物和宫颈上皮细胞,分析HPV持续感染和HPV E6/E7 mRNA表达与CIN患者病情进展和阴道微环境的关系。结果CIN组阴道菌群失调患者占比为54.46%高于对照组39.87%,且菌群密集度增加与菌群多样性改变患者占比均高于对照组(P<0.05)。HPV感染CIN患者高危型组菌群分布较低危型组广,且乳酸杆菌属比重较低危型组下降,加德纳菌属上升(P<0.05)。高危型HPV感染患者CINⅡ级组和CINⅢ级组HPV E6/E7mRNA阳性率和相对表达量均高于CINⅠ级组,且CINⅢ级组HPV E6/E7mRNA阳性率和相对表达量均高于CINⅡ级组(P<0.05),HPV E6/E7 mRNA相对表达量与CIN严重程度分级呈正相关(r=0.501,P<0.05)。Logistic多因素回归分析结果显示,HPV持续感染、不同类型阴道炎及阴道pH值、HPV E6/E7 mRNA相对表达量的增加均是加重高危型HPV感染患者CIN病变的危险因素(P<0.05)。结论高危型HPV持续感染CIN患者阴道菌群失调、微环境变化及HPV E6/E7 mRNA表达增加能够促进CIN进展并增加癌变风险。OBJECTIVE To analyze the relationship between human papillomavirus(HPV)persistent infection status and HPV E6/E7 mRNA expression and vaginal microenvironment changes in patients with cervical intraepithelial neoplasia(CIN).METHODS Total of 101 patients with CIN complicated with HPV infection(CIN group)who were admitted to Lishui Maternal and Child Health Hospital between Sep 2020 and Sep 2021 were enrolled.Based on the differences in pathogenicity of HPV subtypes,101 patients were divided into the high-risk group(n=53,17 cases of CIN Ⅰ grade,19 cases of CINⅡgrade and 17 cases of CIN III grade by pathological results)and low-risk group(n=48).Another 153 HPV-negative women under health examination in the gynecological clinic of the hospital during the same period were enrolled as control group.The vaginal secretions and cervical epithelial cells of patients in different groups were collected,and the relationship of HPV persistent infection and HPV E6/E7 mRNA expression with disease progression and vaginal microenvironment was analyzed among patients with CIN.RESULTS The proportion of patients with vaginal flora imbalance in the CIN group was 54.46%,which was higher than that of 39.87%in the control group.And the proportions of patients with increased flora density and flora diversity change were higher than those in the control group(P<0.05).The flora distribution in the high-risk HPV infection group of patients with CIN was broader than that in the low-risk group,and the proportion of Lactobacillus was significantly decreased while the proportion of Gardnerella was significantly increased when compared with the low-risk group(P<0.05).The positive rate and relative expression levels of HPV E6/E7 mRNA in the high-risk HPV infection CINⅡand CINⅢgroups were higher than those in the CIN I group;the positive rate and relative expression level of HPV E6/E7 mRNA in the CINⅢgroup were higher than those in the CINⅡgroup(P<0.05).The relative expression level of HPV E6/E7 mRNA was positively correlated with the se

关 键 词：宫颈上皮内瘤变 人乳头瘤病毒持续感染 HPV E6/E7 mRNA 阴道微环境 

分 类 号：R711.74[医药卫生—妇产科学]