子宫切除术后患者阴道微生态平衡状态与免疫系统的关系  

Relationship between vaginal microecological balance and immune system after hysterectomy

作　　者：贺笑茜 郅玲玲 马丽丽 宋风丽 He Xiaoqian;Zhi Lingling;Ma Lili;Song Fengli(Department of Obstetrics and Gynecology,Daxing Teaching Hospital of Capital Medical University,Beijing 102600,China)

机构地区：[1]首都医科大学大兴教学医院妇产科,北京102600

出　　处：《海军医学杂志》2025年第4期368-372,共5页Journal of Navy Medicine

基　　金：北京市自然科学基金(7204283)。

摘　　要：目的研究子宫切除术后阴道微生态平衡状态与血清T细胞亚群、Toll样受体2(TLR2)、Toll样受体4(TLR4)表达情况的关系。方法回顾性分析2020年6月至2022年6月首都医科大学大兴教学医院收治的120例行腹腔镜全子宫切除术患者的临床资料,依据患者术后阴道微生态变化情况分为正常组(n=50)和失衡组(n=70)。比较2组基础资料和临床资料[年龄、体重指数(BMI)、疾病类型、CD^(+)_(4)、CD^(+)_(8)、CD^(+)_(4)/CD^(+)_(8)、TLR2、TLR4表达]差异,采用多因素Logistic回归分析影响子宫切除术后阴道微生态失衡的危险因素,绘制受试者操作特征(ROC)曲线评估血清T细胞亚群、TLR2、TLR4表达预测子宫切除术后阴道微生态失衡的效能。结果术后失衡组CD^(+)_(4)、CD^(+)_(4)/CD^(+)_(8)水平低于正常组,而CD8+、TLR2、TLR4水平高于正常组(P<0.05)。经多因素Logistic回归分析证实,CD^(+)_(4)、CD^(+)_(8)、CD^(+)_(4)/CD^(+)_(8)、TLR2、TLR4水平均是子宫切除术后阴道微生态失衡的影响因素(P<0.05)。经ROC曲线分析证实,血清T细胞亚群CD^(+)_(4)、CD^(+)_(8)、CD^(+)_(4)/CD^(+)_(8)及TLR2、TLR4水平可用于子宫切除术后阴道微生态失衡的预测,曲线下面积分别为0.718、0.813、0.785、0.851、0.945(均P<0.05)。结论血清T细胞亚群CD^(+)_(4)、CD^(+)_(8)、CD^(+)_(4)/CD^(+)_(8)及TLR2、TLR4是子宫切除术后阴道微生态失衡的影响因素,可作为评估子宫切除术后阴道微生态平衡状态的生物学指标,为临床防治阴道微生态失衡提供参考。Objective To study the relationship between vaginal microecological balance and serum T cell subsets,Toll⁃like receptor 2(TLR2)and Toll⁃like receptor 4(TLR4)after hysterectomy.Methods The clinical data of 120 patients who underwent laparoscopic total hysterectomy in Daxing Teaching Hospital of Capital Medical University from June 2020 to June 2022 were retrospectively analyzed.The patients were assigned to normal group(n=50)and unbalanced group(n=70)according to postoperative vaginal microecological changes.General information,such as age,body mass index(BMI),disease type,expression of CD^(+)_(4),CD^(+)_(8),CD^(+)_(4)/CD^(+)_(8),TLR2,and TLR4 were compared between the two groups.The risk factors affecting vaginal microecological balance after hysterectomy were analyzed by multivariate Logistic regression.Receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of serum T cell subsets,TLR2,and TLR4 in predicting vaginal microecological imbalance after hysterectomy.Results The levels of CD^(+)_(4) and CD^(+)_(4)/CD^(+)_(8) in the unbalanced group were significantly lower than those in the normal group,while the levels of CD^(+)_(8),TLR2 and TLR4 in the unbalanced group were significantly higher than those in the normal group(P<0.05).Multivariable Logistic regression analysis showed that CD^(+)_(4),CD^(+)_(8),CD^(+)_(4)/CD^(+)_(8),TLR2 and TLR4 expression were the influence factors of vaginal microecological imbalance after hysterectomy(P<0.05).ROC analysis confirmed that the expression of CD^(+)_(4),CD^(+)_(8) and CD^(+)_(4)/CD^(+)_(8) and the levels of TLR2 and TLR4 could be used to predict vaginal microecological imbalance after hysterectomy,and the areas under the curve were 0.718,0.813,0.785,0.851,and 0.945,respectively(all P<0.05).Conclusion CD^(+)_(4),CD^(+)_(8),CD^(+)_(4)/CD^(+)_(8),TLR2 and TLR4 expression levels are the influence factors of vaginal microecological imbalance after hysterectomy.They can be used as biological indicators for evaluating vaginal microecological balance

关 键 词：阴道微生态 子宫切除术 T细胞亚群 TOLL样受体2 TOLL样受体4 

分 类 号：R713.4[医药卫生—妇产科学]