阴道微环境失衡与高危型人乳头瘤病毒持续感染

doi:10.3877/cma.j.issn.1673-5250.2021.06.017

目的

探讨阴道微生态失衡与高危型人乳头瘤病毒(HR-HPV)持续感染的关系。

方法

选择2014年1月至2015年12月，在四川省科学城医院妇科诊断为HR-HPV感染的240例患者为研究对象，年龄为19~73岁。根据HR-HPV感染状态，将其分为研究组(n＝121，HR-HPV持续感染者)和对照组(n＝119，HR-HPV复查呈阴性者)。采用成组t检验，对2组患者的体重、人体质量指数(BMI)、孕次、产次等进行统计学分析。采用χ²检验，对2组患者的细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)、滴虫性阴道炎(TV)、需氧菌性阴道炎(AV)发生率等进行统计学分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

①2组受试者体重、BMI、孕次和产次等一般临床资料比较，差异均无统计学意义(P>0.05)。②研究组患者BV、VVC检出率分别为43.0%(52/121)、38.0%(46/121)，明显高于对照组的20.2%(24/119)、15.1%(18/119)，2组比较，差异均有统计学意义(χ²＝14.422、16.075，P＝0.002、<0.001)。研究组和对照组患者的TV、AV和混合性感染患者检出率比较，差异均无统计学意义(P>0.05)。

结论

BV、VVC与HR-HPV持续性感染密切相关，改善阴道微生态环境可能有助于降低HR-HPV的发生率。

关键词: 阴道, 人乳头瘤病毒, 感染, 阴道病，细菌性, 念珠菌病，外阴阴道, 滴虫性阴道炎, 女(雌)性

Objective

To investigate relationship between vaginal microecological imbalance and persistent high-risk human papillomavirus (HR-HPV) infection.

Methods

From January 2014 to December 2015, a total of 240 patients, aged 19-73 years old, diagnosed with HR-HPV infection in Department of Gynecology, Science City Hospital of Sichuan. According to HR-HPV infection statuses, they were divided into study group (n=121, those who with persistent HR-HPV infection) and control group (n=119, those who with negative HR-HPV retest). Independent-samples t test was used to statistically analyze weight, body mass index (BMI), gravidity and parity between two groups. The incidence of bacterial vaginosis (BV), vulvovaginal pseudo vaginosis (VVC), trichomoniasis vaginosis (TV), and aerobic vaginitis (AV) between 2 groups were statistically analyzed by chi-square test. The procedures followed in this study were in accordance with the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

Results

① There were no statistically significant differences in general clinical data such as weight, BMI, gravidity and parity between 2 groups (P>0.05). ②The detection rates of BV and VVC in study group were 43.0% (52/121) and 38.0% (46/121), respectively, which were significantly higher than those 20.2% (24/119) and 15.1% (18/119) in control group, and differences were statistically significant (χ²=14.422, 16.075; P=0.002, <0.001). Besides, the differences were not statistically significant in detection rates of TV, AV between 2 groups (P>0.05).

Conclusions

BV and VVC are closely associated with persistent HR-HPV infection, and improving the vaginal microecological environment may help to reduce the incidence of HR-HPV.

Key words: Vagina, Human papillomavirus, Infection, Vaginosis, bacterial, Candidiasis, vulvovaginal, Trichomonas vaginitis, Female

表1 2组患者一般临床资料比较(±s)

组别	例数	体重(kg)	BMI(kg/m²)	孕次(次)	产次(次)
研究组	121	61.1±6.5	23.7±2.0	2.12±0.03	1.31±0.03
对照组	119	61.0±6.3	23.5±2.4	2.15±0.01	1.33±0.02
t值		0.121	0.702	<0.001	<0.001
P值		0.452	0.242	0.999	0.999

表1 2组患者一般临床资料比较(±s)

组别	例数	体重(kg)	BMI(kg/m²)	孕次(次)	产次(次)
研究组	121	61.1±6.5	23.7±2.0	2.12±0.03	1.31±0.03
对照组	119	61.0±6.3	23.5±2.4	2.15±0.01	1.33±0.02
t值		0.121	0.702	<0.001	<0.001
P值		0.452	0.242	0.999	0.999

表2 2组患者阴道分泌物检测异常情况比较[例数(%)]

组别	例数	BV	VVC	TV	AV	混合性感染
研究组	121	52(43.0)	46(38.0)	13(10.7)	19(15.7)	15(12.4)
对照组	119	24(20.2)	18(15.1)	10(8.4)	10(8.4)	10(8.4)
χ²值		14.422	16.075	0.379	3.009	1.025
P值		0.002	<0.001	0.538	0.083	0.311

表2 2组患者阴道分泌物检测异常情况比较[例数(%)]

组别	例数	BV	VVC	TV	AV	混合性感染
研究组	121	52(43.0)	46(38.0)	13(10.7)	19(15.7)	15(12.4)
对照组	119	24(20.2)	18(15.1)	10(8.4)	10(8.4)	10(8.4)
χ²值		14.422	16.075	0.379	3.009	1.025
P值		0.002	<0.001	0.538	0.083	0.311

[1]	Li T, Liu ZH, Li K, et al. Evaluation of the vaginal microbiome in clinical diagnosis and management of vaginal infectious diseases[J]. Chin Med J (Engl), 2019, 132(9)：1100-1103. DOI: 10.1097/CM9.0000000000000211.
[2]	Lu Y, Xu X, Nong XH, et al. Detection of high-risk human papillomavirus DNA in sentinel lymph nodes of patients with cervical cancer[J]. Oncol Lett, 2020, 19(3)：2317-2325. DOI: 10.3892/ol.2020.11337.
[3]	Chao X, Sun T, Wang S, et al. Research of the potential biomarkers in vaginal microbiome for persistent high-risk human papillomavirus infection[J]. Ann Transl Med, 2020, 8(4)：100. DOI: 10.21037/atm.2019.12.115.
[4]	Weston G, Dombrowski C, Harvey MJ, et al. Use of the Aptima mRNA high-risk human papillomavirus (HR-HPV) assay compared to a DNA HR-HPV assay in the English cervical screening programme: a decision tree model based economic evaluation[J]. BMJ Open, 2020, 10(3)：e031303. DOI: 10.1136/bmjopen-2019-031303.
[5]	Vos RA, Pasmans H, Tymchenko L, et al. High seroprevalence of multiple high-risk human papillomavirus types among the general population of Bonaire, St. Eustatius and Saba, Caribbean Netherlands[J]. Vaccine, 2020, 38(13)：2816-2826. DOI: 10.1016/j.vaccine.2020.02.017.
[6]	Castle PE, Varallo JE, Bertram MM, et al. High-risk human papillomavirus prevalence in self-collected cervicovaginal specimens from human immunodeficiency virus (HIV)-negative women and women living with HIV living in Botswana[J]. PLoS One, 2020, 15(2)：e0229086. DOI: 10.1371/journal.pone.0229086.
[7]	Pańczyszyn A, Boniewska-Bernacka E, Gīąb G. Telomere length in leukocytes and cervical smears of women with high-risk human papillomavirus (HR HPV) infection[J]. Taiwan J Obstet Gynecol, 2020, 59(1)：51-55. DOI: 10.1016/j.tjog.2019.11.007.
[8]	Manley KM, Luker R, Park C. An audit of liquid-based cytology samples reported as high-risk human papillomavirus and borderline nuclear change in endocervical cells[J]. Cytopathology, 2020, 31(2)：130-135. DOI: 10.1111/cyt.12803.
[9]	Sangpichai S, Patarapadungkit N, Pientong C, et al. Chlamydia trachomatis infection in high-risk human papillomavirus based on cervical cytology specimen[J]. Asian Pac J Cancer Prev, 2019, 20(12)：3843-3847. DOI: 10.31557/APJCP.2019.20.12.3843.
[10]	Zhao S, Zhao XL, Hu SY, et al.Comparison of high-risk human papillomavirus infection rate and genotype distribution between Han and Mongolian women[J]. Chin J Epidemiol, 2019, 40(11)：1439-1444. DOI: 10.3760/cma.j.issn.0254-6450.2019.11.018.
[11]	Cao M, Wang Y, Wang D, et al. Increased high-risk human papillomavirus viral load is associated with immunosuppressed microenvironment and predicts a worse long-term survival in cervical cancer patients[J]. Am J Clin Pathol, 2020, 153(4)：502-512. DOI: 10.1093/ajcp/aqz186.
[12]	Negi SS, Bhargava A, Singh P, et al. Predominance of high-risk human papillomavirus genotype 16 and 39 in women with premalignant and malignant cervical pathology from Raipur, Chhattisgarh: clinical evaluation of tagging oligonucleotide cleavage and extension mediated genotyping assay[J]. Indian J Med Microbiol, 2019, 37(2)：255-262. DOI: 10.4103/ijmm.IJMM_19_162.
[13]	Nikouyan N, Farhadi A, Gorzin AA, et al. A fluorometric hybridization assay for detecting and genotyping high-risk human papillomavirus 16 and 18 in archival tissues of cervical specimens[J]. Braz J Microbiol, 2020, 51(1)：161-168. DOI: 10.1007/s42770-019-00137-8.
[14]	Kim J, Jun SY. Analytic performance of PANArray HPV and HPV 9G DNA chip tests for genotyping of high-risk human papillomavirus in cervical ThinPrep PreservCyt samples[J]. PLoS One, 2019, 14(10)：e0224483. DOI: 10.1371/journal.pone.0224483.
[15]	Schiffman M, Kjaer SK. Chapter 2: Natural history of anogenital human papillomavirus infection and neoplasia[J]. J Natl Cancer Inst Monogr, 2003, (31)：14-19. DOI: 10.1093/oxfordjournals.jncimonographs.a003476.
[16]	周芳芳，史娜娜. 妊娠期糖尿病孕妇阴道微生态变化及其对妊娠结局的影响[J/CD]. 中华妇幼临床医学杂志(电子版), 2020, 16(6): 714-719. DOI: 10.3877/cma.j.issn.1673-5250.2020.06.014.
[17]	Surriabre P, Torrico A, Vargas T, et al. Assessment of a new low-cost, PCR-based strategy for high-risk human papillomavirus DNA detection for cervical cancer prevention[J]. BMC Infect Dis, 2019, 19(1)：842. DOI: 10.1186/s12879-019-4527-9.
[18]	张碧云，肖小敏，钟兴明，等. 肠道菌群紊乱与女性生殖内分泌疾病相关性研究现状[J/CD]. 中华妇幼临床医学杂志(电子版), 2021, 17(4): 488-491. DOI: 10.3877/cma.j.issn.1673-5250.2021.04.017.
[19]	Siegler E, Reichman Y, Kugelman N, et al. Low-risk human papillomavirus types in cervical intraepithelial neoplasia 2-3 and in invasive cervical cancer patients[J]. J Low Genit Tract Dis, 2019, 23(4)：248-252. DOI: 10.1097/LGT.0000000000000486.
[20]	Salambanga C, Zohoncon TM, Traoré I, et al. High prevalence of high-risk human papillomavirus (HPV) infection among sexually active women in Ouagadougou[J]. Med Sante Trop, 2019, 29(3)：302-305. DOI: 10.1684/mst.2019.0920.
[21]	Luckett R, Mogowa N, Li HJ, et al. Performance of two-stage cervical cancer screening with primary high-risk human papillomavirus testing in women living with human immunodeficiency virus[J]. Obstet Gynecol, 2019, 134(4)：840-849. DOI: 10.1097/AOG.0000000000003496.
[22]	杨少岩，赵卫东. 阴道微环境改变与宫颈癌相关性的研究进展[J]. 深圳中西医结合杂志，2017, 27(6)：4.

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Vaginal microenvironmental imbalance and persistent infection with high-risk human papillomavirus

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Vaginal microenvironmental imbalance and persistent infection with high-risk human papillomavirus