摘要
目的 观察女性阴道微生态情况,探讨其与人乳头瘤病毒(HPV)感染及HPV阴性时宫颈病变的关系.方法 2019年1月—2023年7月河南省人民医院行阴道分泌物、HPV及液基薄层细胞学检查(TCT)的体检女性16 775例,采用PCR法+膜杂交法检测HPV感染情况,记录HPV感染率,根据HPV感染情况分为高危型阳性组1 714例和阴性组15 061例、低危型阳性组849例和阴性组15 926例,比较高、低危型阳性组与阴性组阴道微生态情况[乳酸杆菌异常率、细菌性阴道病(BV)阳性率、假丝酵母菌阳性率、滴虫阳性率、白带清洁度异常率、阴道pH值异常率].采用多因素logistic回归分析女性高危型、低危型HPV感染的影响因素.HPV阴性女性14 254例根据TCT是否阳性[宫颈细胞学病变分级≥未明确诊断意义的不典型鳞状细胞(ASC-US)]分为TCT阳性组351例和TCT阴性组13 903例,比较TCT阳性组与TCT阴性组阴道微生态情况,采用多因素logistic回归分析HPV阴性女性TCT阳性的影响因素.TCT阳性者351例根据TCT结果分为ASC-US组273例、不能排除高级别鳞状上皮内病变的不典型鳞状细胞(ASC-H)组10例、低级别鳞状上皮内病变(LSIL)组60例、高级别鳞状上皮内病变(HSIL)组8例,比较4组乳酸杆菌异常率、BV阳性率和假丝酵母菌阳性率.结果 (1)16 775例体检女性HPV感染2 521例(15.03％),其中高危型HPV感染1 714例(10.22％),低危型HPV感染849例(5.06％),高危型与低危型HPV混合感染42例(0.25％);乳酸杆菌异常5 695例(33.95％),BV阳性1 639例(9.77％),假丝酵母菌阳性1 119例(6.67％),滴虫阳性60例(0.36％),白带清洁度异常7 910例(47.15％),阴道pH值异常484例(2.89％).(2)高危型、低危型阳性组乳酸杆菌异常率(67.91％、64.78％)、BV 阳性率(14.18％、16.96％)、假丝酵母菌阳性率(8.17％、9.89％)均高于阴性组(30.08％、32.31％,9.27％、9.39％,6.50％、6.50％)(P＜0.05),滴虫阳性率、白带清洁度异常率与阴性组比较差异均无统计学意义(P＞0.05);低危型阳性组阴道pH值异常率(4.36％)高于阴性组(2.81％)(x2=6.923,P=0.009),高危型阳性组阴道pH值异常率与阴性组比较差异无统计学意义(P＞0.05).(3)乳酸杆菌异常(OR=4.918,95％CI:4.418～5.475,P＜0.001)、BV 阳性(OR=1.616,95％CI:1.396～1.871,P＜0.001)、假丝酵母菌阳性(OR=1.278,95％CI:1.062～1.537,P=0.009)是女性高危型HPV感染的危险因素,乳酸杆菌异常(OR=3.854,95％CI:3.335～4.455,P＜0.001)、BV 阳性(OR=2.053,95％CI:1.661～2.538,P＜0.001)、假丝酵母菌阳性(OR=1.569,95％CI:1.240～1.984,P＜0.001)是女性低危型HPV感染的危险因素.(4)HPV阴性女性14 254例,其中TCT阳性351例(2.46％),包括ASC-US 273 例,ASC-H 10 例,LSIL 60 例,HSIL 8 例;TCT 阴性 13 903 例.TCT 阳性组乳酸杆菌异常率(44.73％)、BV阳性率(17.09％)、假丝酵母菌阳性率(11.11％)均高于TCT阴性组(27.66％、8.63％、6.19％)(P＜0.05),滴虫阳性率、白带清洁度异常率、阴道pH值异常率与TCT阴性组比较差异均无统计学意义(P＞0.05).乳酸杆菌异常(OR=1.761,95％CI:1.360～2.281,P＜0.001)、BV 阳性(OR=1.446,95％CI:1.036～2.018,P=0.030)、假丝酵母菌阳性(OR=1.501,95％CI:1.051～2.143,P=0.025)是 HPV 阴性女性 TCT 阳性的危险因素.(5)ASC-H 组、ASC-US 组、HSIL 组、LSIL 组乳酸杆菌异常率(70.00％、49.45％、37.50％、20.00％)依次降低(P＜0.05),ASC-H 组、ASC-US 组、LSIL组、HSIL组BV阳性率(30.00％、20.15％、3.33％、0)依次降低(P＜0.05),4组假丝酵母菌阳性率比较差异无统计学意义(P＞0.05).结论 有乳酸杆菌缺乏、BV、假丝酵母菌性阴道炎的女性易发生高危型、低危型HPV感染及宫颈病变,阴道微生态失衡女性发生HPV感染及宫颈病变的风险增大.
Abstract
Objective To observe the vaginal microecological status,and to investigate its correlations with human papillomavirus(HPV)infection and HPV-negative cervical lesions.Methods From January 2019 to July 2023,16 775 women received vaginal secretion test,HPV detection and ThinPrep cytologic test(TCT)in Henan Provincial People's Hospital.The HPV infection was detected by PCR+membrane hybridization to record HPV infection rate.According to the HPV infection,16 775 women were divided into high-risk HPV-positive group(n=1714)and high-risk HPV-negative group(n=15 061),as well as low-risk HPV-positive group(n=849)and low-risk HPV-negative group(n=15 926).The vaginal microecological conditions[abnormal rate of Lactobacillus,positive rate of bacterial vaginosis(BV),positive rate of Candida,positive rate of Trichomonas,abnormal leucorrhea cleanliness rate,abnormal rate of vaginal pH]were compared between high-risk and low-risk HPV-positive groups and-negative groups.Multivariate logistic regression was used to analyze the influencing factors of high-risk and low-risk HPV infection in women.Totally 14 254 HPV-negative women were divided into TCT-positive group(n=351)and TCT-negative group(n=13 903)according to cervical cytological lesions classification≥atypical squamous cell of undetermined significance(ASC-US),and the vaginal microecological status was compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of positive TCT in HPV-negative women.Totally 351 patients with positive TCT were divided into ASC-US group(n=273),atypical squamous cell-cannot exclude high-grade squamous intraepithelial lesion(ASC-H)group(n=10),low-grade squamous intraepithelial lesion(LSIL)group(n=60)and high-grade squamous intraepithelial lesion(HSIL)group(n=8),and the abnormal rate of Lactobacillus,positive rate of BV and positive rate of Candida were compared among four groups.Results(1)Among 16 775 women,2 521(15.03％)were infected with HPV,including 1 714(10.22％)with high-risk HPV infection,849(5.06％)with low-risk HPV infection and 42(0.25％)with mixed high-risk and low-risk HPV infection;there were 5 695(33.95％)with abnormal Lactobacillus,1 639(9.77％)with positive BV,1 119(6.67％)with positive Candida,60(0.36％)with positive Trichomonas,7 910(47.15％)with abnormal leucorrhea cleanliness and 484(2.89％)with abnormal vaginal pH value.(2)The abnormal rates of Lactobacillus(67.91％,64.78％),the positive rates of BV(14.18％,16.96％)and the positive rates of Candida(8.17％,9.89％)in high-risk and low-risk HPV-positive groups were higher than those in high-risk and low-risk HPV-negative groups(30.08％,32.31％;9.27％,9.39％;6.50％,6.50％)(P＜0.05).There were no significant differences in the Trichomonas positive rate and leucorrhea cleanliness abnormal rate(P＞0.05).The abnormal rate of vaginal pH was higher in low-risk HPV-positive group(4.36％)than that in low-risk HPV-negative group(2.81％)(x2=6.923,P=0.009),and showed no significant difference between high-risk HPV-positive group and high-risk HPV-negative group(P＞0.05).(3)Abnormal Lactobacillus(OR=4.918,95％CI:4.418-5.475,P＜0.001),positive BV(OR=1.616,95％CI:1.396-1.871,P＜0.001),and positive Candida(OR=1.278,95％CI:1.062-1.537,P=0.009)were the risk factors of high-risk HPV infection in women.Abnormal Lactobacillus(OR=3.854,95％CI:3.335-4.455,P＜0.001),positive BV(OR=2.053,95％CI:1.661-2.538,P＜0.001)and positive Candida(OR=1.569,95％CI:1.240-1.984,P＜0.001)were also the risk factors of low-risk HPV infection.(4)In 14 254 women with negative HPV,there were 351 with positive TCT(2.46％),including 273 with ASC-US,10 with ASC-H,60 with LSIL,and 8 with HSIL.TCT was negative in 13 903 women.The abnormal rate of Lactobacillus,positive rate of BV and positive rate of Candida were higher in TCT-positive group(44.73％,17.09％,11.11％)than those in TCT-negative group(27.66％,8.63％,6.19％)(P＜0.05),and there were no significant differences in the Trichomonas positive rate,leucorrhea cleanliness abnormal rate and vaginal pH abnormal rate between two groups(P＞0.05).Abnormal Lactobacillus(OR=1.761,95％CI:1.360-2.281,P＜0.001),positive BV(OR=1.446,95％CI:1.036-2.018,P=0.030)and positive Candida(OR=1.501,95％CI:1.051-2.143,P=0.025)were the risk factors of positive TCT in HPV-negative women.(5)The abnormal rate of Lactobacillus decreased sequentially in ASC-H group,ASC-US group,HSIL group and LSIL group(70.00％,49.45％,37.50％,20.00％)(P＜0.05),the positive rate of BV also decreased sequentially in ASC-H group,ASC-US group,LSIL group and HSIL group(30.00％,20.15％,3.33％,0)(P＜0.05),and there was no significant difference in the Candida positive rate among four groups(P＞0.05).Conclusion Lactobacillus deficiency,BV and Candida vaginitis increase the risk of high-risk and low-risk HPV infection and cervical lesions,and the women with vaginal microecological imbalance have an increased risk of HPV infection and cervical lesions.
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