摘要
目的评估阴道微生态环境失衡对高危型人乳头瘤病毒(HR-HPV)感染、宫颈上皮内瘤变(CIN)及子宫颈癌的影响。方法对接受检查的2469名女性的宫颈脱落细胞进行HPV基因分型检测、阴道微环境常见菌群革兰染色镜检、液基薄层细胞学检测(TCT)和病理活检观察病变组织及细胞形态,根据是否感染HPV、发生CIN或癌变分组,采用χ^(2)或Fisher精确检验及多因素logistics回归分析探讨阴道微环境与HR-HPV感染、CIN的发展以及子宫颈癌之间的关系。结果单一HR-HPV型的阳性率为12.31%,两种及以上的混合感染率为3.85%,以HPV16、HPV52和HPV58亚型多见,38~47岁人群阳性率最高(P<0.05);乳酸杆菌的减少、细菌性阴道病(BV)和杂菌感染在HPV阳性组中的检出率显著高于HPV阴性组(P<0.01),乳酸杆菌的减少和BV是HPV感染的独立危险因素(P<0.05);乳酸杆菌减少、清洁度异常、BV、滴虫和pH异常检出率,CIN或癌变组高于宫颈正常组(P<0.05),乳酸杆菌的减少和清洁度异常是宫颈发生CIN或癌变的独立危险因素(P<0.05)。结论阴道微生物种群的异常,特别是乳酸杆菌数量的减少,可能会增加HR-HPV感染的风险,并促进CIN或癌变的发展。
Objective To assess the effect of the imbalance in vaginal micro-ecological environment on high-risk human papillomavirus(HR-HPV)infection and cervical intraepithelial neoplasia(CIN)or cervical cancer(CC).Methods Genotyping was used to detect HPV genotypes in cervical exfoliated cells of 2469 women.Microscopic examination was performed to detect common vaginal microenvironment microbiota after Gram staining.Liquid-based thin-layer cytology technique(TCT)was used to examine pathological biopsy for observing lesion tissues and cell morphology.Grouping was performed based on whether the samples had HPV infection,CIN or cancer.χ^(2) test,Fisher exact test,and multivariate logistics regression analysis were applied to explore the association of vaginal microenvironment with HR-HPV infection,CIN development and CC.Results The positive rate of single HR-HPV type was 12.31%.The mixed infection rate of two or more types was 3.85%.HPV16,HPV52,and HPV58 subtypes were very common.The positive rate was the highest in the population aged 38-47(P<0.05).The detection rates of Lactobacillus,bacterial vaginosis(BV)and miscellaneous infection were significantly higher in HPV positive group than those in HPV negative group(P<0.01).Lactobacillus reduction and BV were independent risk factors for HPV infection(P<0.05).The detection rates of lactobacilli reduction,abnormal cleanliness,BV,trichomonas and pH abnormalities were higher in CIN or cancer group than those in normal cervical group(P<0.05).Lactobacillus reduction and abnormal cleanliness were independent risk factors for CIN or cervix cancer(P<0.05).Conclusion Vaginal microbial population abnormality,especially a decrease in lactobacilli,may increase the risk of HR-HPV infection and promote the development of CIN or cancer.
作者
谯坤
闵少菊
侯丽
黄进友
田茂丫
谭玉洁
QIAO Kun;MIN Shaoju;HOU Li;HUANG Jinyou;TIAN Maoya;TAN Yujie(Clinical Laboratory Center,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;School of Clinical Laboratory Science,Guizhou Medical University,Guiyang 550004,Guizhou,China;Departiment of Clinical Laboratory Science,Baiyun Hospital Affiliated to Guizhou Medical University,Guiyang 550004,Guizhou,China)
出处
《贵州医科大学学报》
CAS
2024年第6期859-865,共7页
Journal of Guizhou Medical University
基金
国家自然科学基金(81960473)
贵州省卫生健康委科学技术基金(gzwkj2020-184)
贵阳市科技计划项目([2019]-9-14-2)
贵阳市白云区科技计划项目([2019]-39)。
关键词
阴道菌群
乳酸杆菌
人乳头瘤病毒
宫颈上皮内瘤变
宫颈癌
薄层细胞学检查
vaginal flora
Lactobacillus
human papillomavirus
cervical intraepithelial neoplasia
cervical cancer
thin-layer cytology examination
