摘要
目的研究阴道微环境改变与高迁移率蛋白A2(HMGA2)水平变化与人乳头瘤病毒(HPV)感染及宫颈癌病变之间的关系。方法将本院2018年1月-2021年1月269例行宫颈癌筛查的门诊病例纳为研究对象,检测患者阴道微环境改变(阴道pH值、乳酸杆菌含量、白细胞分度、病原体感染与否)、HPV感染情况以及阴道分泌物中HMGA2水平,通过阴道镜宫颈组织病理学检查判断患者宫颈病变程度。分析阴道微环境、高危HPV(HR-HPV)感染、HMGA2水平以及宫颈癌病变程度之间的关系。结果HR-HPV阳性与阴性组患者比较,阴道pH、乳酸杆菌量、白细胞分度及念珠菌感染率差异均有统计学意义(P<0.05或P<0.01),HR-HPV阳性组阴道分泌物HMGA2水平显著高于阴性组(P<0.05)。正常宫颈组、低级别变组、高级别病变组以及宫颈癌组患者阴道pH、乳酸杆菌量、白细胞分度、念珠菌感染率差异均有统计学意义(P<0.05或P<0.01);正常宫颈组、低级别病变组、高级别病变组以及宫颈癌组患者阴道分泌物HMGA2水平依次呈上升趋势,两两比较差异均有统计学意义(均P<0.05)。阴道pH>4.6、乳酸杆菌少量或无、白细胞3~4度及念珠菌感染者阴道分泌物HMGA2水平均显著高于其相对应的阴性组(均P<0.01),正常宫颈组、低级别病变组、高级别病变组以及宫颈癌组患者HR-HPV感染率依次呈上升趋势,组间差异均有统计学意义(均P<0.05)。结论阴道pH>4.6、乳酸杆菌少量或无、白细胞3~4度、念珠菌感染等阴道微生态改变均可增加HR-HPV感染风险,并与宫颈病变关系密切;阴道分泌物HMGA2水平升高与阴道微环境改变、HR-HPV感染及宫颈病变有关,而HR-HPV感染将增加宫颈恶性病变的风险。
Objective To investigate the relationship of changes in vaginal microenvironment and high-mobility group A2(HMGA2)levels with human papillomavirus(HPV)infection and cervical carcinoma.Methods A total of 269 outpatients who underwent cervical cancer screening in our hospital from January 2018 to January 2021 were enrolled.Vaginal microenvironmental changes(vaginal PH,Lactobacillus content,grades of leukopenia,pathogen infection status),HPV infection and HMGA2 level in vaginal secretions were examined in each case.Histopathological evaluation of colposcopic biopsies was carried out to assess the severity of cervical lesions.Then the relationship between the vaginal microenvironment,high-risk HPV(HR-HPV)infection,HMGA2 levels and the grades of cervical lesions were discussed.Results The vaginal pH,amount of Lactobacillus,leukopenia grade and Candida infection demonstrated significant difference between HR-HPV positive and negative groups(P<0.05).The level of HMGA2 in vaginal secretion of HR-HPV positive group was(293.15±36.79)ng/L,which was significantly higher than(210.16±41.16)ng/L of negative group,with statistical difference(t=14.902,P<0.05).Pairwise comparison among normal cervical group,low-grade lesion group,high-grade lesion group and cervical cancer group yielded statistical difference in vaginal pH,amount of Lactobacillus,leukopenia grade and Candida infection(P<0.05).The vaginal secretion HMGA2 levels were(194.15±25.64)ng/L in normal cervical group,(247.13±32.15)ng/L in low-grade lesion group,(322.15±34.11)ng/L in high-grade lesion group and(377.69±46.51)ng/L in cervical cancer group,showing a sequential increase trend,and the pairwise comparison had statistical difference(all P<0.05).The levels of HMGA2 in vaginal secretions of patients with vaginal pH>4.6,less or no Lactobacillus,leukopenia of grade 3-4 or candida infection were significantly higher than those of patents in the corresponding negative subgroup(P<0.05).The prevalence of HR-HPV infection was 16.02%in normal cervical group,12.90%in low-grade lesion group,45.71%in high-grade lesion group and 95.45%in cervical cancer group,presenting an increase trend(P<0.05).Conclusion Vaginal microenvironment alterations such as vaginal pH>4.6,less or no Lactobacillus,leukopenia of grade 3-4 and candida infection will increase the risk of HR-HPV infection and are strongly associated with severity degrees of cervical lesions,moreover,elevated levels of HMGA2 in vaginal secretions are associated with altered vaginal microenvironment,HR-HPV infection and cervical lesions,meantime,HR-HPV infection will increase the risk of cervical malignant lesions.
作者
云红叶
程虹
于欣荣
林莉香
YUN Hong-ye;CHENG Hong;YU Xin-rong;LIN Li-xiang(Department of Gynaecology and Obstetrics,Haikou Affiliated Hospital of Central South University Xiangya School of Medicine,Haikou,Hainan 570203,China)
出处
《中国病原生物学杂志》
CSCD
北大核心
2022年第8期955-959,共5页
Journal of Pathogen Biology
