| 张菲菲,高广云,张海燕,周 莉,李 佳.宫颈上皮内瘤变患者宫颈环形电切术后HPV持续感染的高危因素分析及其对阴道微生态和免疫调节功能的影响[J].,2022,(15):2854-2859 |
| 宫颈上皮内瘤变患者宫颈环形电切术后HPV持续感染的高危因素分析及其对阴道微生态和免疫调节功能的影响 |
| Analysis of Risk Factors for HPV Persistent Infection after Loop Electrosurgical Excision Procedure in Patients with Cervical Intraepithelial Neoplasia (CIN) and its Effect on Vaginal Microecology and Immunomodulatory Function |
| 投稿时间：2022-01-31 修订日期：2022-02-28 |
| DOI：10.13241/j.cnki.pmb.2022.15.010 |
| 中文关键词: 宫颈上皮内瘤变 宫颈环形电切术 人乳头瘤病毒 阴道微生态 免疫 |
| 英文关键词: Cervical intraepithelial neoplasia Loop electrosurgical excision procedure Human papillomavirus Vaginal microecology Immunity |
| 基金项目:上海市科学技术委员会科研计划项目（14ZR1404100） |
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| 中文摘要: |
| 摘要 目的：探讨宫颈上皮内瘤变（CIN）患者宫颈环形电切术（LEEP）后人乳头瘤病毒（HPV）持续感染的高危因素及其对阴道微生态和免疫调节功能的影响。方法：选取2020年1月～2021年1月我院收治的347例行LEEP治疗的CIN患者，根据LEEP后1年是否HPV持续感染分为HPV持续感染组（n=41）和HPV转阴组（n=306）。收集患者临床资料，单因素及多因素Logistic回归分析CIN患者LEEP后HPV持续感染的影响因素。比较1年后复诊时HPV持续感染组与HPV转阴组阴道微生态状况和外周血细胞免疫、体液免疫指标水平。结果：与HPV转阴组比较，HPV持续感染组年龄≥45岁、术前HPV多重感染、术前HPV病毒载量≥100 RLU/CO、手术切缘HPV感染阳性比例更高，初次性生活年龄＜20岁比例更低（P＜0.05）。多因素Logistic回归分析显示，年龄≥45岁（OR=1.034，95%CI：1.009～1.060）、术前HPV多重感染（OR=1.371，95%CI：1.042～1.806）、术前HPV病毒载量≥100 RLU/CO（OR=1.198，95%CI：1.058～1.356）、手术切缘HPV感染阳性（OR=1.313，95%CI：1.144～1.507）为CIN患者LEEP后HPV持续感染的危险因素（P均＜0.05）。复诊时HPV持续感染组阴道优势菌为乳杆菌、菌群密集度和菌群多样性Ⅱ～Ⅲ级比例低于HPV转阴组，pH值高于HPV转阴组（P＜0.05）。复诊时HPV持续感染组外周血CD3+、CD4+、CD4+/CD8+、免疫球蛋白A（IgA）、IgG、IgM水平低于HPV转阴组，CD8+高于HPV转阴组（P＜0.05）。结论：CIN患者LEEP后HPV持续感染与年龄、术前HPV多重感染、术前HPV病毒载量、手术切缘HPV感染有关，LEEP后HPV持续感染可导致CIN患者阴道微生态和免疫调节功能受损。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the analysis of risk factors for human papillomavirus (HPV) persistent infection after loop electrosurgical excision procedure (LEEP) in patients with cervical intraepithelial neoplasia (CIN) and its effects on vaginal microecology and immunomodulatory function. Methods: A total of 347 patients with CIN who were admitted to our hospital for LEEP treatment from January 2020 to January 2021 were selected, and they were divided into HPV persistent infection group (n=41) and HPV conversion group (n=306) according to whether HPV persistence was present 1 year after LEEP. Clinical data of patients were collected, and univariate and multivariate Logistic regression were used to analyze the influencing factors of HPV persistent infection after LEEP in patients with CIN. The vaginal microecological status, peripheral blood cellular immunity and humoral immunity were compared between the HPV persistent infection group and the negative HPV conversion group at the follow-up visit after 1 year. Results: Compared with the HPV conversion group, the HPV persistent infection group had higher proportions of age ≥45 years, preoperative HPV multiple infections, preoperative HPV viral load ≥100 RLU/CO, positive surgical margin HPV infection, and lower proportions of age at first sex <20 years (P＜0.05). Multifactorial Logistic regression analysis showed that age ≥40 years (OR=1.034, 95% CI: 1.009～1.060), preoperative HPV multiple infections (OR=1.371, 95% CI: 1.042～1.806), preoperative HPV viral load ≥100 RLU/CO (OR=1.198, 95% CI: 1.058～1.356), and positive surgical incisional margin HPV infection (OR=1.313, 95% CI: 1.144～1.507) were risk factors for HPV persistent infection after LEEP in patients with CIN (all P＜0.05). The percentage of vaginal predominant bacteria in the HPV persistent infection group was Lactobacillus, flora density and flora diversity grade II～III at follow-up visit was lower than in the HPV conversion group, and pH was higher than in the HPV conversion group (P＜0.05). Peripheral blood levels of CD3+, CD4+, CD4+/CD8+, immunoglobulin A (IgA), IgG and IgM in the HPV persistent infection group were lower than those in the HPV conversion group, and CD8+ was higher than in the HPV conversion group at follow-up visit (P＜0.05). Conclusion: The HPV persistent infection after LEEP in patients with CIN is associated with age, preoperative HPV multiple infections, preoperative HPV viral load, and HPV infection at the surgical incision margin, and HPV persistent infection after LEEP can lead to impaired vaginal microecology and immune regulation in patients with CIN. |
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