摘要
目的探究高危人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)持续感染患者阴道微生态与阴道灌洗液CC趋化因子配体28(CC chemokine ligand 28,CCL28)水平表达的关系。方法选取2021年4月~2023年4月唐山市妇幼保健院的132例HR-HPV感染患者作为研究对象。根据复查结果将HR-HPV感染患者分为单次感染组和持续感染组。比较两组的CCL28和阴道微生态指标。用Logistic回归分析HR-HPV持续感染的风险因素。用Logistic回归拟合限制性立方样条分析CCL28与HR-HPV持续感染的水平效应关系。用Spearman和多元线性回归分析CCL28与阴道微生态指标的关系。结果患者复查后,单次感染84例(63.64%),持续感染48例(36.36%)。持续感染组的菌群密集度Ⅰ级(54.17%比16.67%)、菌群多样性Ⅰ级(47.92%)、pH值>4.5(47.92%)、过氧化氢阳性(54.17%)和阴道微生态失衡(66.67%)的占比及CCL28水平[83.63(77.11,99.62)ng/L]均高于单次感染组[16.76%,21.43%,15.48%,30.95%,41.67%,71.11(58.12,82.16)ng/L],差异具有统计学意义(χ^(2)/Z=5.064~20.338,均P<0.05)。Logistic回归分析结果显示,菌群密集度Ⅰ级(OR=3.556,95%CI:1.241~10.194,P=0.018)、pH值>4.5(OR=4.366,95%CI:1.164~16.380,P=0.029)和高CCL28水平(OR=1.048,95%CI:1.018~1.080,P=0.002)是HR-HPV感染患者持续感染的独立危险因素。Logistic回归拟合限制性立方样条结果显示,CCL28与HR-HPV持续感染呈线性关系(非线性检验χ^(2)=0.61,P=0.437)。Spearman相关分析结果显示,CCL28与年龄(r=0.205,P=0.018)、菌群密集度(r=0.429,P<0.001)、菌群多样性(r=0.389,P<0.001)、pH值(r=0.357,P<0.001)、过氧化氢(r=0.409,P<0.001)、白细胞酯酶(r=0.392,P<0.001)和阴道微生态(r=0.473,P<0.001)均呈正相关关系。线性回归分析结果显示,菌群密集度(β=12.295,P=0.003)和菌群多样性(β=9.196,P=0.032)与CCL28独立相关。结论菌群密集度和菌群多样性与CCL28独立相关。菌群密集度Ⅰ级、pH值>4.5和高CCL28水平提示HR-HPV感染患者持续感染风险增加。
Objective To investigate the relationship between the vaginal microecology and CC chemokine ligand 28(CCL28)expression levels in the vaginal lavage fluid of patients with persistent high-risk human papillomavirus(HR-HPV)infection.Methods A total of 132 patients with HR-HPV infection at Tangshan Maternal and Child Health Hospital from April 2021 to April 2023 were selected as study subjects.Patients with HR-HPV infection were categorized into the single infection group and the persistent infection group according to the review results.The CCL28 and vaginal microecological indicators of the two groups were compared.Logistic regression was used to analyze the risk factors for persistent HR-HPV infection.The dose-response relationship between CCL28 and persistent HR-HPV infection was analyzed by fitting restricted cubic splines with logistic regression.Spearman and multiple linear regression were used to analyze the relationship between CCL28 and vaginal microecological indicators.Results After the reexamination of patients,there were 84(63.64%)cases of single infection and 48(36.36%)cases of persistent infection.The percentage of colony density grade I(54.17%vs 16.67%),colony diversity grade I(47.92%),pH>4.5(47.92%),hydrogen peroxide positivity(54.17%),and vaginal microecological imbalance(66.67%),and the level of CCL28[83.63(77.11,99.62)ng/L]in the persistent infection group were higher than those of the single infection group[16.76%,21.43%,15.48%,30.95%,41.67%,71.11(58.12,82.16)ng/L],and the differences were statistically significant(χ^(2)/Z=5.064~20.338,all P<0.05).Logistic regression analysis showed that colony density grade I(OR=3.556,95%CI:1.241~10.194,P=0.018),PH>4.5(OR=4.366,95%CI:1.164~16.380,P=0.029),and high CCL28 levels(OR=1.048,95%CI:1.018~1.080,P=0.002)were independent risk factors for persistent infection in HR-HPV-infected patients.Logistic regression fitting restricted cubic splines showed a linear relationship between CCL28 and persistent HR-HPV infection(nonlinear testχ^(2)=0.61,P=0.437).Spearman correlation analysis results showed that CCL28 was positively correlated with age(r=0.205,P=0.018),colony density(r=0.429,P<0.001),colony diversity(r=0.389,P<0.001),pH(r=0.357,P<0.001),hydrogen peroxide(r=0.409,P<0.001),leukocyte esterase(r=0.392,P<0.001),and vaginal microecology(r=0.473,P<0.001).Linear regression analysis showed that colony density(β=12.295,P=0.003)and colony diversity(β=9.196,P=0.032)were independently associated with CCL28.Conclusion Colony density and colony diversity were independently correlated with CCL28.Colony density grade I,pH>4.5,and high CCL28 levels suggest an increased risk of persistent infection in patients with HR-HPV infection.
作者
田美月
王源
陈迎弟
刘秀荣
TIAN Meiyue;WANG Yuan;CHEN Yingdi;LIU Xiurong(Department of Gynecology,Tangshan Maternal and Child Health Hospital,Hebei Tangshan 063000,China;Department of Reproductive Genetics,Tangshan Maternal and Child Health Hospital,Hebei Tangshan 063000,China)
出处
《现代检验医学杂志》
CAS
2024年第4期155-160,共6页
Journal of Modern Laboratory Medicine
基金
河北省医学科学研究课题计划项目(20221750)。
