基于门诊患者阴道微生态与HPV感染的相关性研究

doi:10.12280/gjfckx.20210221

摘要/Abstract

摘要：

目的: 分析以外阴阴道瘙痒、干涩、疼痛和（或）分泌物异常为主诉就诊患者的阴道微生态及宫颈人乳头瘤病毒（human papilloma virus,HPV）分布特点,探讨阴道微生态失调与HPV感染的关系。方法: 选取2019年2月1日—2019年12月31日,因外阴阴道瘙痒、干涩、疼痛和（或）分泌物异常就诊于天津中医药大学第二附属医院妇科门诊的483例患者为研究对象,同时进行阴道微生态检测和宫颈HPV检测,对检测结果进行分析。结果: 483例患者中,阴道微生态正常者仅有4例,占0.8%,微生态失调者479例,占99.2%,其中有明确致病菌的微生态失调（即阴道感染）者350例（73.1%）,无明确致病菌的微生态失调者129例（26.9%）;在350例阴道感染患者中,单一感染287例（82.0%）,混合感染63例（18.0%）。外阴阴道假丝酵母菌病（vulvovaginal candidiasis,VVC）单一感染（38.7%,111/287）及含VVC的混合感染（79.4%,50/63）发生率最高。阴道感染者中乳杆菌减少者、H₂O₂含量减少者占比高于无明确致病菌的阴道微生态失调者,差异有统计学意义（P<0.05）。在483例患者中,HPV感染162例,感染率为33.5%,而阴道感染患者的HPV感染率（37.1%,130/350）明显高于无明确致病菌的阴道微生态失调患者（24.0%,31/129）,其中滴虫性阴道炎（trichomonal vaginitis,TV）、细菌性阴道病（bacterial vaginosis,BV）、需氧菌性阴道炎（aerobic vaginitis,AV）、VVC、BV中间型患者HPV感染率分别为73.3%（11/15）、52.9%（72/136）、34.5%（10/29）、29.2%（47/161）和 27.4%（20/73）。多因素回归分析结果显示,TV、BV与HPV感染正相关（OR分别为5.325和3.298,均P<0.05）。结论: 外阴阴道瘙痒、干涩、疼痛和（或）分泌物异常的患者常存在阴道微生态失调,而且容易合并HPV感染,当发生阴道感染时（特别是TV及BV）,HPV感染的风险显著增加。

关键词: 阴道微生态, 阴道, 念珠菌病,外阴阴道, 阴道病,细菌性, 人乳头状瘤病毒科

Abstract:

Objective:To analyze the distribution characteristics of vaginal microecology and cervical human papilloma virus (HPV) in patients with vulvovaginal pruritus, dryness, pain and/or abnormal secretion, and to explore the relationship between vaginal microecology disorders and HPV infection.Methods: From February 1, 2019 to December 31, 2019, 483 patients with vulvovaginal pruritus, dryness, pain and/or abnormal secretion in the gynecological clinic of the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine were selected as the study subjects. Simultaneously, vaginal microecology and cervical HPV were detected and the results were analyzed.Results: Among the 483 patients, only 4 cases had normal vaginal microecology (0.8%) and 479 cases had microecology disorders (99.2%). of which 350 cases (73.1%) had microecological disorders (i.e. vaginal infections) with clear pathogens and 129 cases (26.9%) without clear pathogens. Among 350 cases of vaginal infection, 287 cases (82.0%) were single infection and 63 cases (18.0%) were mixed infection. The single infection of VVC (38.7%, 111/287) and mixed infection (79.4%, 50/63) with VVC had the highest incidence. The proportion of patients with decreased Lactobacillus and decreased H₂O₂ in vaginal infection was higher than that in vaginal microecological disorder without clear pathogens, and the difference was statistically significant (P<0.05). Of the 483 patients, 162 were infected with HPV, at a rate of 33.5%. The HPV infection rate in vaginal infection (37.1%, 130/350) was significantly higher than that in vaginal microecological disorders without clear pathogens (24.0 %, 31/129). Among them, the HPV infection rate of patients with trichomonal vaginitis (TV), bacterial vaginosis (BV), aerobic vaginitis (AV), VVC, and BV intermediate were 73.3% (11/15), 52.9% (72/136), 34.5% (10/29), 29.2% (47/161) and 27.4% (20/73), respectively. Multivariate regression analysis showed that TV and BV were positively correlated with HPV infection (OR were 5.325 and 3.298, respectively, P<0.05 ).Conclusions: Vaginal microecological disorders are common in patients with vulvovaginal pruritus, dryness, pain, and/or abnormal secretion, and they are susceptible to HPV infection. When vaginal infection occurs (especially TVand BV), the risk of HPV infection is greatly increased.

Key words: Vaginal microecology, Vagina, Candidiasis,vulvovaginal, Vaginosis,bacterial, Papillomaviridae

程倩倩, 宋殿荣, 王雅楠, 郭洁, 赵琳, 陈秀杰, 张倩玉, 王嫱. 基于门诊患者阴道微生态与HPV感染的相关性研究[J]. 国际妇产科学杂志, 2021, 48(6): 704-709.

CHENG Qian-qian, SONG Dian-rong, WANG Ya-nan, GUO Jie, ZHAO Lin, CHEN Xiu-jie, ZHANG Qian-yu, WANG Qiang. Study on the Relationship between Vaginal Microecology and HPV Infection in Outpatients[J]. Journal of International Obstetrics and Gynecology, 2021, 48(6): 704-709.

图/表 8

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感染分类	n	阴道感染的分布
感染分类	n	具体感染类型	例数	百分比（%）
单一感染	287	VVC	111	38.7
		BV	105	36.6
		BV中间型	46	16.0
		AV	22	7.7
		TV	3	1.0
混合感染	63	BV中间型+VVC	27	42.9
		BV+VVC	23	36.5
		BV+TV	6	9.5
		AV+TV	5	7.9
		BV+AV	1	1.6
		BV+AV+TV	1	1.6

感染分类	n	阴道感染的分布
感染分类	n	具体感染类型	例数	百分比（%）
单一感染	287	VVC	111	38.7
		BV	105	36.6
		BV中间型	46	16.0
		AV	22	7.7
		TV	3	1.0
混合感染	63	BV中间型+VVC	27	42.9
		BV+VVC	23	36.5
		BV+TV	6	9.5
		AV+TV	5	7.9
		BV+AV	1	1.6
		BV+AV+TV	1	1.6

组别	n	乳杆菌减少	H₂O₂含量减少	白细胞增多
阴道感染	350	206（58.9）	243（69.4）	261（74.6）
无明确致病菌的微生态失调	129	42（32.6）	68（52.7）	89（69.0）
χ²		11.565	26.110	1.491
P		0.001	0.000	0.222

组别	n	乳杆菌减少	H₂O₂含量减少	白细胞增多
阴道感染	350	206（58.9）	243（69.4）	261（74.6）
无明确致病菌的微生态失调	129	42（32.6）	68（52.7）	89（69.0）
χ²		11.565	26.110	1.491
P		0.001	0.000	0.222

组别	n	乳杆菌减少	H₂O₂含量减少	白细胞增多
单一感染	287	166（57.8）	188（65.5）	204（71.1）
混合感染	63	40（63.5）	55（87.3）	57（90.5）
χ²		0.682	11.563	10.249
P		0.409	0.001	0.001