Li L, Ding L, Lyu Y J, Wang M, Liu C L, Han Y, Wang J T
Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2018 Nov 10;39(11):1486-1490. doi: 10.3760/cma.j.issn.0254-6450.2018.11.013.
To explore the effect of vaginal micro-environment alterations and HPV16 infection and their interaction in the progression of cervical intraepithelial neoplasia. The participants of this study came from the cervical lesions study cohort in Shanxi province, including 623 women with normal cervical (NC), 303 patients with pathogenically diagnosed low-grade cervical intraepithelial neoplasia (CINⅠ) and 93 patients with pathogenically diagnosed high-grade cervical intraepithelial neoplasia (CINⅡ/Ⅲ). The data of the demographic characteristics of the study subjects and factors related to cervical intraepithelial neoplasia were collected, and HPV16 infection were detected by using flow-through hybridization technology and H(2)O(2), β-glucuronidase, clotting enzyme, neuraminidase and leucocyte esterase in vaginal secretions were detected by using the combined detection kit of aerobic vaginitis and bacterial vaginosis. pH value and vaginal cleanliness were also detected at the same time. The database was established and analyzed by SPSS statistical software (version 22.0). The HPV16 infection rate (trend (2)=55.45, <0.001) and the abnormal rates of H(2)O(2) (trend (2)=26.19, <0.001), pH (trend (2)=5.06, =0.024), vaginal cleanliness (trend (2)=19.55, <0.001), β-glucuronidase (trend (2)=17.52, <0.001) and neuraminidase (trend (2)=14.90, <0.001) increased gradually along with the severity of cervical intraepithelial neoplasia, but the abnormal rates of clotting enzyme and leucocyte esterase showed no same trend. The results of GMDR model analysis showed that there was interaction between HPV16 infection and abnormalities of H(2)O(2), β-glucuronidase, clotting enzyme and neuraminidase in CINⅠ group, and the interaction between HPV16 infection and the abnormalities of vaginal cleanliness, H(2)O(2), β-glucuronidase and neuraminidase in CIN Ⅱ/Ⅲ group. Our findings indicated that the vaginal micro-environment alterations and HPV16 infection could increase the risk of cervical intraepithelial neoplasia, and they might have an important synergistic effect in the progression of cervical intraepithelial neoplasia.
探讨阴道微环境改变及人乳头瘤病毒16型(HPV16)感染及其相互作用在宫颈上皮内瘤变进展中的作用。本研究的参与者来自山西省宫颈病变研究队列,包括623例宫颈正常(NC)女性、303例经病理诊断为低级别宫颈上皮内瘤变(CINⅠ)的患者和93例经病理诊断为高级别宫颈上皮内瘤变(CINⅡ/Ⅲ)的患者。收集研究对象的人口统计学特征数据及与宫颈上皮内瘤变相关的因素,采用导流杂交技术检测HPV16感染情况,采用需氧性阴道炎和细菌性阴道病联合检测试剂盒检测阴道分泌物中的过氧化氢(H₂O₂)、β-葡萄糖醛酸酶、凝血酶、神经氨酸酶和白细胞酯酶。同时检测pH值和阴道清洁度。使用SPSS统计软件(版本22.0)建立数据库并进行分析。HPV16感染率(趋势检验(2)=55.45,P<0.001)、H₂O₂异常率(趋势检验(2)=26.19,P<0.001)、pH值(趋势检验(2)=5.06,P=0.024)、阴道清洁度(趋势检验(2)=19.55,P<0.001)、β-葡萄糖醛酸酶(趋势检验(2)=17.52,P<0.001)和神经氨酸酶(趋势检验(2)=14.90,P<0.001)随着宫颈上皮内瘤变严重程度的增加而逐渐升高,但凝血酶和白细胞酯酶的异常率未显示出相同趋势。多因素降维回归(GMDR)模型分析结果显示,在CINⅠ组中,HPV16感染与H₂O₂、β-葡萄糖醛酸酶、凝血酶和神经氨酸酶异常之间存在相互作用,在CINⅡ/Ⅲ组中,HPV16感染与阴道清洁度、H₂O₂、β-葡萄糖醛酸酶和神经氨酸酶异常之间存在相互作用。我们的研究结果表明,阴道微环境改变和HPV16感染可增加宫颈上皮内瘤变的风险,且它们在宫颈上皮内瘤变的进展中可能具有重要的协同作用。