高危型HPV持续感染女性HPV转归与阴道微生态的关系一项前瞻性队列研究  

Association between HPV outcome and vaginal microecology in women with persistent high-risk HPV infection:a prospective cohort study

作　　者：张展 宗晓楠 白会会 范琳媛 李婷 刘朝晖 Zhang Zhan;Zong Xiaonan;Bai Huihui;Fan Linyuan;Li Ting;Liu Zhaohui(Department of Gynecology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院,北京妇幼保健院妇科,北京100026

出　　处：《中华妇产科杂志》2025年第2期121-127,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：首都卫生发展科研专项(首发2024-4-2119);首都医科大学附属北京妇产医院中青年学科骨干培养专项(FCYY201916);首都医科大学附属北京妇产医院“优青人才”项目(YQRC201906)。

摘　　要：目的探讨高危型人乳头状瘤病毒(HPV)感染妇女HPV转归与阴道微生态的关系。方法纳入2020年1月至2021年1月期间就诊于首都医科大学附属北京妇产医院妇科门诊的妇女共53例,其中7例HPV阴性的健康体检妇女为HPV阴性对照组;46例为高危型HPV阳性者,其中24例为观察组(不使用任何药物),其余22例为药物组(规范干扰素阴道上药3个月)。所有妇女均在入组时及第4、8、12个月随访时取阴道分泌物进行革兰染色微生态检测并复查HPV,以HPV转阴作为随访终点,持续1年未转阴者定义为高危型HPV持续感染。结果(1)观察组及药物组中的高危型HPV持续感染妇女相比于HPV转阴者正确使用安全套比例有所降低(P=0.595),流产次数有所增加(P=0.180)。(2)观察组HPV转阴率为17%(4/24),药物组HPV转阴率为36%(8/22),两组比较,差异无统计学意义(P=0.183);观察组及药物组HPV中位转阴时间分别为11.0和7.5个月,两组比较,差异有统计学意义(P=0.001)。(3)观察组HPV转阴(自然转阴)妇女在入组时及随访结束时阴道微生态均大致正常(分别为3/4、4/4);观察组及药物组中的高危型HPV持续感染者入组时阴道微生态失调的比例偏高,包括阴道pH值较高、清洁度较差、乳杆菌分级较高及阴道内杂菌增多,在随访结束时阴道微生态失调情况并未好转。(4)药物组的HPV转阴妇女中,半年内转阴者其初始阴道优势菌均为乳杆菌,乳杆菌分级均≤Ⅱa级,初始微生态结果均正常(为5/5);半年后转阴者其初始阴道杂菌比例较高(2/3),乳杆菌分级较差(2/3),微生态失调者比例高(2/3)。结论(1)干扰素治疗缩短了高危型HPV转阴时间;(2)阴道微生态正常的妇女有高危型HPV自然转阴的能力;(3)阴道微生态革兰染色检测方法对预测高危型HPV是否能够转阴的价值有限,可能与革兰染色检测无法区分乳杆菌属的细致亚型有关。ObjectiveTo investigate the association between high-risk human papillomavirus(hrHPV)persistent infection and vaginal microecology.MethodsA total of 53 women were enrolled in the gynecological clinic of Beijing Obstetrics and Gynecology Hospital from January 2020 to January 2021,including 7 women without HPV and 46 women with hrHPV infection.Among the hrHPV infected women,24 woemn who did not use any drugs were classified as the observation group and the other 22 women who were given standardized interferon vaginal administration for 3 months were regarded as the treatment group.Vaginal secretions of all women were taken for Gram-stained microecological test at the time of enrollment and at the 4,8,and 12 month follow-up.HPV turning negative was taken as the end point of follow-up.Results(1)Women of hrHPV persistent infection in the observation and treatmnet groups had more times of abortions(P=0.180).(2)The hrHPV negative conversion rate was 17%(4/24)in the observation group and 36%(8/22)in the treatment group,but the difference was not significant(P=0.183).The median hrHPV negative conversion time were 11.0 months and 7.5 months in the observation and treatment groups,respectively,and the difference was statistically significant(P=0.001).(3)Vaginal microecology was generally normal at the time of enrollment and at the end of follow-up in women with HPV natural negative conversion in the observation group.While vaginal microecological disorders were more common in women with hrHPV persistent infection in the observation and treatmnet groups,including high vaginal pH value,poor vaginal cleanliness,poor grade of Lactobacillus and increased vaginal clutter bacteria,and the vaginal microecological situation did not improve after the 12-month follow-up.(4)In the treatment group,women who turned HPV negative within six months all had normal vaginal microecology when enrollment(5/5).While those who turned negative six months later had a higher proportion of vaginal clutter bacteria(2/3),a poor grade of Lactobacillus(2/

关 键 词：乳头状瘤病毒科 乳头状瘤病毒感染 阴道 微生物群 阴道微生态 

分 类 号：R711[医药卫生—妇产科学]