阴道微生态与人乳头瘤病毒感染及宫颈病变的相关性  

Correlations of vaginal microecology with human papillomavirus infection and cervical lesions

作　　者：刘慧 赵华 李洋 LIU Hui;ZHAO Hua;LI Yang(Health Management Department,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Reproductive Center,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院,郑州大学人民医院健康管理学科,河南郑州450003 [2]河南省人民医院,郑州大学人民医院生殖医学中心,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2024年第2期195-200,共6页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的观察女性阴道微生态情况,探讨其与人乳头瘤病毒(HPV)感染及HPV阴性时宫颈病变的关系。方法2019年1月—2023年7月河南省人民医院行阴道分泌物、HPV及液基薄层细胞学检查(TCT)的体检女性16775例,采用PCR法+膜杂交法检测HPV感染情况,记录HPV感染率,根据HPV感染情况分为高危型阳性组1714例和阴性组15061例、低危型阳性组849例和阴性组15926例,比较高、低危型阳性组与阴性组阴道微生态情况[乳酸杆菌异常率、细菌性阴道病(BV)阳性率、假丝酵母菌阳性率、滴虫阳性率、白带清洁度异常率、阴道pH值异常率]。采用多因素logistic回归分析女性高危型、低危型HPV感染的影响因素。HPV阴性女性14254例根据TCT是否阳性[宫颈细胞学病变分级≥未明确诊断意义的不典型鳞状细胞(ASC-US)]分为TCT阳性组351例和TCT阴性组13903例,比较TCT阳性组与TCT阴性组阴道微生态情况,采用多因素logistic回归分析HPV阴性女性TCT阳性的影响因素。TCT阳性者351例根据TCT结果分为ASC-US组273例、不能排除高级别鳞状上皮内病变的不典型鳞状细胞(ASC-H)组10例、低级别鳞状上皮内病变(LSIL)组60例、高级别鳞状上皮内病变(HSIL)组8例,比较4组乳酸杆菌异常率、BV阳性率和假丝酵母菌阳性率。结果(1)16775例体检女性HPV感染2521例(15.03%),其中高危型HPV感染1714例(10.22%),低危型HPV感染849例(5.06%),高危型与低危型HPV混合感染42例(0.25%);乳酸杆菌异常5695例(33.95%),BV阳性1639例(9.77%),假丝酵母菌阳性1119例(6.67%),滴虫阳性60例(0.36%),白带清洁度异常7910例(47.15%),阴道pH值异常484例(2.89%)。(2)高危型、低危型阳性组乳酸杆菌异常率(67.91%、64.78%)、BV阳性率(14.18%、16.96%)、假丝酵母菌阳性率(8.17%、9.89%)均高于阴性组(30.08%、32.31%,9.27%、9.39%,6.50%、6.50%)(P<0.05),滴虫阳性率、白带清洁度异常率与阴性组比较差异均无统计学意义(P>0.05);低危型Objective To observe the vaginal microecological status,and to investigate its correlations with human papillomavirus(HPV)infection and HPV-negative cervical lesions.Methods From January 2019 to July 2023,16775 women received vaginal secretion test,HPV detection and ThinPrep cytologic test(TCT)in Henan Provincial People's Hospital.The HPV infection was detected by PCR+membrane hybridization to record HPV infection rate.According to the HPV infection,16775 women were divided into high-risk HPV-positive group(n=1714)and high-risk HPV-negative group(n=15061),as well as low-risk HPV-positive group(n=849)and low-risk HPV-negative group(n=15926).The vaginal microecological conditions[abnormal rate of Lactobacillus,positive rate of bacterial vaginosis(BV),positive rate of Candida,positive rate of Trichomonas,abnormal leucorrhea cleanliness rate,abnormal rate of vaginal pH]were compared between high-risk and low-risk HPV-positive groups and-negative groups.Multivariate logistic regression was used to analyze the influencing factors of high-risk and low-risk HPV infection in women.Totally 14254 HPV-negative women were divided into TCT-positive group(n=351)and TCT-negative group(n=13903)according to cervical cytological lesions classification≥atypical squamous cell of undetermined significance(ASC-US),and the vaginal microecological status was compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of positive TCT in HPV-negative women.Totally 351 patients with positive TCT were divided into ASC-US group(n=273),atypical squamous cell-cannot exclude high-grade squamous intraepithelial lesion(ASC-H)group(n=10),low-grade squamous intraepithelial lesion(LSIL)group(n=60)and high-grade squamous intraepithelial lesion(HSIL)group(n=8),and the abnormal rate of Lactobacillus,positive rate of BV and positive rate of Candida were compared among four groups.Results(1)Among 16775 women,2521(15.03%)were infected with HPV,including 1714(10.22%)with high-risk HPV infection,849(5.06%)with l

关 键 词：阴道微生态 人乳头瘤病毒 宫颈病变 乳酸杆菌 细菌性阴道病 假丝酵母菌性阴道炎 液基薄层细胞学检查 

分 类 号：R711[医药卫生—妇产科学]