摘要
目的:探讨子宫颈高级别鳞状上皮内病变(HSIL)患者阴道微生态变化与人乳头瘤病毒(HPV)感染的亚型分布,并分析HPV转归的影响因素。方法:选取2021年1月—2022年12月于宜春市妇幼保健院经病理检查确诊的150例子宫颈HSIL患者设为疾病组,另择同期门诊体检的100例健康妇女设为对照组;根据治疗1年后HPV是否转阴将疾病组分为HPV持续感染组与HPV转阴组。对比疾病组和对照组的阴道微生态,分析高危HPV(HR-HPV)感染亚型分布,并分析HPV转归的影响因素。结果:疾病组正常菌群密集度、正常菌群多样性及正常菌群患者占比均低于对照组,过氧化氢(H_(2)O_(2))缺乏、唾液酸苷酶(SNa)阳性、白细胞酯酶(LE)阳性、N-乙酰氨基己糖苷酶(NAG)阳性及pH值>4.5患者占比均高于对照组,差异均有统计学意义(P<0.05)。150例子宫颈HSIL患者中,HPV16感染率最高,其次是HPV18。同HPV转阴组比较,HPV持续感染组年龄及感染亚型为16/18、病理诊断宫颈上皮内瘤变(CIN)为Ⅲ级、异常菌群密集度构成、异常菌群多样性构成、菌群失调、H_(2)O_(2)缺乏、SNa(+)及pH>4.5患者占比均更高,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄、感染亚型为16/18、病理诊断CIN为Ⅲ级、异常菌群密集度、异常菌群多样性、菌群失调、H_(2)O_(2)缺乏、SNa(+)及pH>4.5是HPV持续感染的独立危险因素(P<0.05)。结论:子宫颈HSIL患者会出现阴道微生态改变,年龄、感染亚型、病理分级、菌群密集、菌群多样性、优势菌及H_(2)O_(2)、SNa及pH变化等是HPV持续性感染独立危险因素。
Objective:To explore the vaginal microecology changes and the subtype distribution of human papilloma virus(HPV)infection in patients with cervical high-grade squamous intraepithelial lesion(HSIL),and to analyze the influencing factors of HPV outcome.Method:A total of 150 patients with cervical HSIL diagnosed by pathological examination in Yichun Maternal and Child Health Center from January 2021 to December 2022 were selected as the disease group,and another 100 healthy women who underwent physical examinations at the Outpatient Department during the same period were selected as the control group.The disease group was divided into the HPV persistent infection group and the HPV negative conversion group based on whether HPV turned negative after one year of treatment.The vaginal microecology of the disease group and the control group was compared,the distribution of high-risk HPV(HR-HPV)infection subtypes was analyzed,and the influencing factors of HPV outcome were analyzed.Result:The proportions of patients with density of normal flora,the diversity of normal flora and normal flora in the disease group were all lower than those in the control group,the proportions of patients with hydrogen peroxide(H_(2)O_(2))deficiency,sialidase(SNa)positive,leukocyte esterase(LE)positive,N-acetylaminohexosidase(NAG)positive and pH value>4.5 in the disease group were all higher than those in the control group,the differences were all statistically significant(P<0.05).Among the 150 patients with cervical HSIL,the infection rate of HPV16 was the highest,followed by HPV18.Compared with the HPV negative conversion group,age,infection subtype 16/18,pathological diagnosis of cervical intraepithelial neoplasia(CIN)at gradeⅢ,and the proportions of patients with abnormal flora density,abnormal flora diversity,flora imbalance,H_(2)O_(2) deficiency,SNa(+),and pH>4.5 in the HPV persistent infection group were all higher,the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that age,infection subtype 16/18,pathological diagnosis of CIN gradeⅢ,abnormal flora density,abnormal flora diversity,flora dysbiosis,H_(2)O_(2) deficiency,SNa(+),and pH>4.5 were independent risk factors for persistent HPV infection(P<0.05).Conclusion:Patients with cervical HSIL may present vaginal microecological changes.Age,infection subtype,pathological grade,microbiota density,microbiota diversity,dominant bacteria,and changes in H_(2)O_(2),SNa and pH are independent risk factors for persistent HPV infection.
作者
袁爱琴
徐美华
余佳美
YUAN Aiqin;XU Meihua;YU Jiamei(Department of Obstetrics and Gynecology,Yichun Maternal and Child Health Center,Yichun 336000,China;不详)
出处
《中国医学创新》
2025年第18期157-162,共6页
Medical Innovation of China
基金
江西省卫生健康委科技计划项目(202312229)。
关键词
子宫颈高级别鳞状上皮内病变
阴道微生态
人乳头状瘤病毒
Cervical high-grade squamous intraepithelial lesion
Vaginal microecology
Human papilloma virus
作者简介
通信作者:袁爱琴。
