Zeng Baojin, Ren Xiuling, Cheng Yali, Wang Chunhua, Li Jiawei, Jiang Li, Zhang Shuai, Chen Sisi, Yu Danjun, Lin Jingjing
Department of Gynecology, Taizhou Hospital of Zhejiang Province, Linhai City, Zhejiang Province, China.
Department of Gynecology, En Ze Medical Center (Group), En Ze Hospital, Taizhou City, Zhejiang Province, China.
Medicine (Baltimore). 2025 Jul 4;104(27):e42914. doi: 10.1097/MD.0000000000042914.
This study is aimed to investigate the correlation between vaginal microecology and high-risk human papillomavirus (HR-HPV)-positive cervical squamous intraepithelial lesions (SIL) using the regression analysis. Patients (n = 372) with HR-HPV-positive from January 2020 to June 2022 were recruited after preliminary confirmation by colposcopy, HPV test, and typing, as well as loop electrosurgical excision procedure. Based on the pathological results, the recruited subjects were divided into 3 groups, that is, negative for intraepithelial lesion or malignancy, low-grade SIL, and high-grade SIL (HSIL). Finally, the clinical factors, virological data, and vaginal microecological changes of the 3 experimental groups were analyzed. Age was identified as a significant risk factor for HSIL, with an OR of 1.048 (95% CI: 1.006-1.094 and P = .026). Various HR-HPV types (HPV16, HPV18, and HPV52) were closely associated with HSIL, with multiple infections significantly increasing the risk (odds ratio, OR: 5.810, P = .04). The changes in the vaginal microecology were strongly associated with HSIL, including elevated pH (>4.5), reduced hydrogen peroxide levels, and increased bacterial vaginosis (BV) prevalence. BV demonstrated a sensitivity of 66.10% and a specificity of 70.31% for predicting HSIL. Furthermore, decreased Lactobacillus levels (OR: 3.20, P < .001) showed their protective role, while elevated sialidase activity (OR: 5.610, P = .002) emerged as a significant risk factor. Accordingly, the key independent predictors for low-grade SIL and HSIL included age, infection type, pH, microbiome density, BV, and sialidase activity. The mixed infection of HPV16, HPV18, HPV52, and HPV resulting in cervical SILs could be closely related to the vaginal microecology.
本研究旨在通过回归分析探讨阴道微生态与高危型人乳头瘤病毒（HR-HPV）阳性宫颈鳞状上皮内病变（SIL）之间的相关性。选取2020年1月至2022年6月期间经阴道镜检查、HPV检测及分型以及环形电切术初步确诊为HR-HPV阳性的患者（n = 372例）。根据病理结果，将入选对象分为3组，即上皮内病变或恶性病变阴性、低级别SIL和高级别SIL（HSIL）。最后，分析3个试验组的临床因素、病毒学数据及阴道微生态变化。年龄被确定为HSIL的一个显著危险因素，比值比（OR）为1.048（95%置信区间：1.006 - 1.094，P = 0.026）。多种HR-HPV类型（HPV16、HPV18和HPV52）与HSIL密切相关，多重感染显著增加风险（比值比，OR：5.810，P = 0.04）。阴道微生态变化与HSIL密切相关，包括pH值升高（>4.5）、过氧化氢水平降低以及细菌性阴道病（BV）患病率增加。BV预测HSIL的敏感性为66.10%，特异性为70.31%。此外，乳酸杆菌水平降低（OR：3.20，P < 0.001）显示出其保护作用，而唾液酸酶活性升高（OR：5.610，P = 0.002）成为一个显著危险因素。因此，低级别SIL和HSIL的关键独立预测因素包括年龄、感染类型、pH值、微生物密度、BV和唾液酸酶活性。HPV16、HPV18、HPV52和HPV混合感染导致宫颈SILs可能与阴道微生态密切相关。
