接受抗病毒治疗的女性HIV感染者阴道菌群健康状况  

Status of vaginal microbiota in HIV-infected women receiving anti-retroviral therapy

作　　者：张展 白会会 宗晓楠 李婷 范琳媛 孙丽君[2] 刘朝晖 ZHANG Zhan;BAI Huihui;ZONG Xiaonan;LI Ting;FAN Linyuan;SUN Lijun;LIU Zhaohui(Department of Gynecology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China;不详)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院,北京100026 [2]首都医科大学附属北京佑安医院感染性疾病门诊

出　　处：《中国微生态学杂志》2024年第9期1079-1085,1091,共8页Chinese Journal of Microecology

基　　金：首都卫生发展科研专项(首发2024-4-2119)。

摘　　要：目的了解规范抗反转录治疗(ART)的人类免疫缺陷病毒(HIV)感染的中国女性阴道菌群健康状况及其相关因素。方法纳入首都医科大学附属北京佑安医院感染性疾病门诊HIV阳性女性16位,首都医科大学附属北京妇产医院妇科门诊健康体检女性11位,进行问卷调查,并留取阴道分泌物进行Illumina NovaSeq平台宏基因组测序和菌群分析,留取宫颈分泌物进行性传播感染病原体检测。结果(1)HIV感染女性普遍受教育程度偏低(P=0.001)且卫生健康习惯存在误区,习惯于进行阴道冲洗(P<0.001)且不规范使用安全套比例增加(P=0.048),HIV阳性者的高危型HPV和支原体阳性率较高(P=0.001)。(2)尽管接受规范ART治疗且病毒载量得到良好控制,HIV感染者免疫重建程度即外周血CD4^(+)T细胞数仍存在个体差异,HIV感染者阴道菌群多样性显著增加,且菌群多样性增加与外周血CD4^(+)T细胞数<500/μL显著相关,而与HPV感染和ART年限无关。(3)HIV阳性者尤其是CD4^(+)T细胞数<500/μL者阴道乳杆菌属降低而加德纳菌属、普雷沃菌属、阿托波菌属、链球菌属、巨球菌属、厌氧球菌属及棒状杆菌属等厌氧菌增多。(4)放线菌属这一机会性致病菌在HIV阳性的绝经女性和外周血CD4^(+)T细胞数偏低者的阴道中显著增加。结论HIV阳性者免疫重建程度即外周血CD4^(+)T细胞数与阴道微生态健康状态密切相关,阴道菌群健康干预十分必要。Objective To learn the status of vaginal flora and its associated factors in HIV-infected Chinese women on standard anti-retroviral therapy(ART).Methods A total of 16 HIV-positive women in the infectious disease clinic of Beijing You'an Hospital and 11 healthy women in the gynecological clinic of Beijing Obstetrics and Gynecology Hospital were enrolled for questionnaire survey,and the vaginal secretions were collected for Illumina NovaSeq platform metagenomic sequencing and microbiota analysis.Cervical secretions were collected for testing for sexually transmitted infections.Results(1)HIV-infected women generally had lower educational level(P=0.001)and misunderstandings about hygienic habits.They were used to vaginal douching(P<0.001)and incorrect condom use(P=0.048).(2)The counts of peripheral CD4^(+)T cells varied among HIV(+)individuals despite receiving standard ART and having well-controlled viral loads.Diversity of vaginal microbiota in HIV(+)women was significantly higher,especially in women with CD4^(+)T cells<500/μL.Vaginal microbial diversity had no relation with HPV infection or ART duration.(3)Vaginal Lactobacillus were lower,while anaerobic bacteria such as Gardnerella,Prevotella,Atopotella,Streptococcus,Macrococcus,Anaerococcus and Corynebacterium were higher in HIV(+)women,especially those with CD4^(+)T cells<500/μL.(4)Actinomycetes,an opportunistic pathogen,was significantly higher in the vagina of HIV(+)menopausal women and those with lower CD4^(+)T cell count in peripheral blood.Conclusion The degree of immune reconstitution and the count of peripheral CD4^(+)T cells are closely related to the vaginal microecological health in HIV(+)women.Healthy intervention of vaginal microbiota is necessary.

关 键 词：人类免疫缺陷病毒 阴道菌群 免疫重建 

分 类 号：R446[医药卫生—诊断学]