阴道微生态改变与高危型人乳头瘤病毒感染的相关性研究

李莉; 马莹; 付玉荣; 于东渤; 王铭洋; 郑文瑾; 翟青枝

doi:10.3969/j.issn.2095-5227.2023.03.004

阴道微生态改变与高危型人乳头瘤病毒感染的相关性研究

Association between vaginal microecological changes and high-risk human papillomavirus infection

摘要

摘要:
背景高危型人乳头瘤病毒(high risk human papillomavirus，HR-HPV)感染并不一定会导致癌前病变或宫颈癌，阴道微生物多样性的改变可能是造成HPV持续感染继而发生宫颈病变的伴随因素。
目的探讨阴道微生态改变与HR-HPV感染的相关性，为宫颈癌的防治提供参考。
方法选取2021年10月- 2022年3月就诊于解放军总医院第一医学中心妇产科门诊，同时行阴道分泌物微生态检测及人乳头瘤病毒基因分型检测的324例患者(年龄21 ~ 72岁)为研究对象，分析阴道微生态异常与HR-HPV感染的相关性。
结果 324例患者中HR-HPV阳性71例，阳性率21.91%(71/324)；阴道微生态正常的178例中HR-HPV阳性43例，阳性率24.16%(43/178)；阴道微生态异常的146例中HR-HPV阳性28例，阳性率19.18%(28/146)。阴道微生态异常结果中细菌性阴道病(bacterial vaginosis，BV)及BV中间型37例，HR-HPV阳性率40.54%(15/37)；菌群抑制32例，HR-HPV阳性率18.75%(6/32)；阴道菌群正常存在炎症反应77例，HR-HPV阳性率9.09%(7/77)。阴道微生态正常组与菌群抑制组HPV阳性率差异无统计学意义(P＞0.05)；与BV及BV中间型组、阴道菌群正常存在炎症反应组的HPV阳性率差异均有统计学意义(P＜0.05)。Logistic回归分析显示，BV及BV中间型发生HR-HPV感染的概率更高(OR=2.240，P=0.030)、阴道菌群正常存在炎症反应者HR-HPV感染的概率更低(OR=0.329，P=0.009)。
结论 BV及单纯白细胞增多引起的阴道微生态改变与HR-HPV感染密切相关。

Abstract:
Background High-risk human papillomavirus (HR-HPV) infection does not always lead to precancerous lesions or cervical cancer, but changes in vaginal microbial diversity may be a concomitant factor for the development of cervical lesions due to persistent HPV infection.
Objective To investigate the association between vaginal microecological changes and HR-HPV infection, so as to provide a reference for the prevention and treatment of cervical cancer.
Methods A total of 324 patients, aged 21-72 years, who underwent the microecological detection of vaginal discharge and the determination of human papillomavirus genotype at the outpatient service of Department of Obstetrics and Gynecology in the First Medical Center of Chinese PLA General Hospital from October 2021 to March 2022 were enrolled as research subjects, and the association between vaginal microecological abnormalities and HR-HPV infection was analyzed.
Results Among the 324 patients, 71 cases were positive for HR-HPV, with a positive rate of 21.91% (71/324); among the 178 patients with normal vaginal microecology, 43 cases were positive for HR-HPV, with a positive rate of 24.16% (43/178), while among the 146 patients with vaginal microecological abnormalities, 28 cases were positive for HR-HPV, with a positive rate of 19.18% (28/146). Among the patients with abnormal vaginal microecological results, 37 had bacterial vaginosis (BV) or intermediate BV, with a positive rate of HR-HPV of 40.54% (15/37); 32 had flora inhibition, with a positive rate of HR-HPV of 18.75% (6/32); 77 patients had normal vaginal flora with inflammatory reaction, with a positive rate of HR-HPV of 9.09% (7/77). There was no significant difference in the positive rate of HPV between the normal vaginal microecology group and the flora inhibition group (P>0.05), while there was a significant difference between the BV/intermediate BV group and the normal vaginal flora+inflammatory reaction group (P<0.05). The logistic regression analysis showed that patients with BV or intermediate BV were more likely to have HR-HPV infection(OR=2.240, P=0.030); and those with normal vaginal flora with inflammatory reaction were associated with lower probability of HR-HPV infection (OR=0.329, P=0.009) .
Conclusion Vaginal microecological changes caused by BV and simple leukocytosis are significantly associated with HR-HPV infection.

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