高危HPV感染伴宫颈高级别鳞状上皮内病变宫颈锥切术后阴道微生态特征  

Analysis of vaginal microecological characteristics after cone biopsy in patients with high-risk HPV infection accompanied by high-grade squamous intraepithelial lesions

作　　者：李小超 张家弘 刘明雷 李文彪 王颖[1] 吴景华 LI Xiao-chao;ZHANG Jia-hong;LIU Ming-lei;LI Wen-biao;WANG Ying;WU Jing-hua(Department of Clinical Laboratory,Tangshan Maternal and Clild Health Hospital,Tangshan Key Laboratory of Molecular Medicine of Developmental Abnormalities and Related Diseases,Tangshan 063000,Hebei,China;不详)

机构地区：[1]唐山市妇幼保健院医学检验科、唐山市发育异常与相关疾病分子医学重点实验室,河北唐山063000 [2]唐山市妇幼保健院妇科,河北唐山063000

出　　处：《广东医学》2025年第1期83-90,共8页Guangdong Medical Journal

基　　金：河北省2023年度医学科学研究课题计划(20231758)。

摘　　要：目的分析因高危人乳头瘤病毒(HR-HPV)感染引起宫颈高级别鳞状上皮内病变进行宫颈锥切术后阴道微生态特征,为术后患者阴道微生态及病情恢复情况的评估提供依据。方法选取2023年因高危HPV感染引起宫颈高级别鳞状上皮内病变而进行宫颈锥切术的160例患者为观察组,收集并统计患者术前、术后阴道微生态特征及宫颈锥切患者年龄、HPV感染亚型、术后复查时间及HPV再次感染等资料;另选择同期体检科进行妇科检查的健康女性200例为健康对照组,分析阴道微生态情况以及对比两组患者阴道微生态、阴道菌群变化。结果宫颈锥切患者在术前有较高的阴道微生态失衡率(81.88%),术后微生态失衡率为60.63%,与健康对照组比较差异有统计学意义(P<0.01);同时在革兰阳性大杆菌比例、阴道pH值、阴道白细胞数量、清洁度上,宫颈锥切组术后与术前及健康对照组比较,宫颈锥切组术前与健康对照组比较差异均有统计学意义(P<0.01);宫颈锥切术的患者年龄主要集中在31~50岁,占70.63%,阴道微生态平衡与失衡率较一致,>51岁的患者阴道微生态失衡率较高(χ^(2)=11.157,P<0.05)。分析患者术前HPV亚型,单一型别感染的16亚型最多,但术前不同HPV亚型阴道微生态失衡率差异无统计学意义(χ^(2)=2.404,P>0.05)。术后85例患者进行HPV检测,HPV复阳率为34.12%(29/85),复阳与转阴患者进行阴道微生态比较发现差异无统计学意义(χ^(2)=0.03,P>0.05)。在术后复查时间上,在1个月内复查的人数最多,占36.87%,阴道微生态失衡率较高(79.66%);随着术后时间的延长,阴道微生态失衡率逐渐降低。在术后不同复查时间上,菌群密度、菌群多样性、阴道白细胞数量及VVC等方面,不同术后复查时间差异无统计学意义(P>0.05),而在革兰阳性大杆菌比例、阴道pH值、清洁度、AV、BV等方面,差异有统计学意义(P<0.05)。结论行宫颈锥切术的患者�Objective To analyze the vaginal microecological characteristics following cone biopsy in patients with high-grade squamous intraepithelial lesions due to high-risk HPV infection,providing a basis for assessing vaginal microecology and recovery post-surgery.Methods A total of 160 patients who underwent cone biopsy due to high-risk HPV infection resulting in high-grade squamous intraepithelial lesions were selected as the observation group.Preoperative and postoperative vaginal microecological characteristics were collected and analyzed,alongside patient age,HPV subtype,postoperative follow-up time,and reinfection rates.Additionally,200 healthy women undergoing gynecological examinations in the same period served as the healthy control group.The vaginal microecological conditions and changes in bacterial flora among the three groups were compared.Results The rate of vaginal microecological imbalance in cone biopsy patients preoperatively was 81.88%,decreasing to 60.63%postoperatively,which was significantly different from the healthy control group(P<0.01).Statistically significant differences were also noted in the proportions of Gram-positive bacilli,vaginal pH,leukocyte counts,and cleanliness across the three groups(P<0.01).Most patients in the cone biopsy group were aged 31-50 years(70.63%),with vaginal microecological balance rates correlating with age;patients over 51 years had a higher imbalance rate(χ^(2)=11.157,P<0.05).The analysis of preoperative HPV subtypes revealed that subtype 16 was the most common;however,there was no significant difference in the imbalance rate among different HPV subtypes(χ^(2)=2.404,P>0.05).Of the 85 patients tested postoperatively for HPV,the reinfection rate was 34.12%(29/85),with no significant difference in microecological characteristics between reinfected and negative cases(χ^(2)=0.03,P>0.05).The highest number of follow-ups occurred within one month post-surgery(36.87%),where the imbalance rate was notably high(79.66%).With time,the imbalance rate decreased.No significa

关 键 词：高危型人乳头瘤病毒 高级别鳞状上皮内病变 宫颈锥切术 阴道微生态 

分 类 号：R713.4[医药卫生—妇产科学] R446[医药卫生—临床医学]