中国女性宫颈高危型HPV感染与阴道微生态关系的Meta分析
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摘要
目的持续性高危型人乳头瘤病毒(high risk-human papillomavirus,HR-HPV)感染是宫颈癌发生的高危因素,而阴道微生态与宫颈HR-HPV感染相关。本文拟通过文献分析对宫颈HR-HPV感染与阴道微生态的关联做一全面的系统评价。方法检索CNKI、万方、Pubmed等数据库,利用文献追溯等途径收集国内外公开发表的关于中国女性宫颈HR-HPV感染与阴道微生态的关联研究,收集病例-对照研究的原始文献,并根据文献中的原始资料评价HR-HPV感染与滴虫性阴道炎(trichomonal vaginitis,TV)、细菌性阴道病(bacterial vaginosis,BV)、外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)感染率及乳酸杆菌异常率的关联,采用STATA14. 0软件对研究资料进行Meta分析,利用Egger's test评价发表偏倚。结果总计纳入文献20篇,共20项病例-对照研究,采用随机效应模型进行计算,结果显示,中国女性中宫颈HR-HPV感染与BV、VVC和乳酸杆菌异常关联,综合OR值分别为2. 23(95%CI:0. 99～2. 13)、1. 55(95%CI:1. 12～2. 12)和3. 55(95%CI:2. 21～5. 71),差异有统计学意义,且无发表偏倚。HR-HPV感染与TV的关联尚待讨论,综合OR值为1. 45(95%CI:0. 99～2. 13),但无统计学意义,且存在发表偏倚。结论宫颈HR-HPV感染与阴道微生态存在密切关联,尤其是BV、VVC和乳酸杆菌异常是宫颈HR-HPV感染的高危因素。
Objective To conduct a comprehensive and systematic review concerning the relationship between cervical high riskhuman papillomavirus( HR-HPV) infection and vaginal microecology,as there are inconsistent conclusions about epidemiological studies among Chinese women. Methods CNKI,Wanfang,Pubmed and other databases were retrieved. The correlation between cervical HRHPV infection and vaginal microecology in Chinese female was collected by literature retrospective method. The original literatures of casecontrol studies were collected. The infection rates of HR-HPV and trichomonal vaginitis( TV),bacterial vaginosis( BV),vulvovaginal candidiasis( VVC) and lactobacillus abnormalities were evaluated according to the original data in the literature. Stata 14. 0 software was used to analyze the data,and Egger's test was used to evaluate the publication bias. Results A total of 20 literatures and 20 case-control studies were included. The results showed that cervical HR-HPV infection was associated with BV,VVC and lactobacillus abnormalities in Chinese women. The odds ratios( ORs) were 2. 23 [95% confidence interval( CI) : 0. 99-2. 13],1. 55( 95% CI: 1. 12-2. 12) and3. 55( 95% CI: 2. 21-5. 71),respectively. It is statistically significant and has no publication bias. The association between HR-HPV infection and TV remains to be discussed. The combined OR value was 1. 45( 95% CI: 0. 99-2. 13),but there was no statistical significance and had publication bias. Conclusion Cervical HR-HPV infection is closely related to vaginal microecology. BV,VVC and lactobacillus abnormalities are high-risk factors for cervical HR-HPV infection.
Objective To conduct a comprehensive and systematic review concerning the relationship between cervical high riskhuman papillomavirus( HR-HPV) infection and vaginal microecology,as there are inconsistent conclusions about epidemiological studies among Chinese women. Methods CNKI,Wanfang,Pubmed and other databases were retrieved. The correlation between cervical HRHPV infection and vaginal microecology in Chinese female was collected by literature retrospective method. The original literatures of casecontrol studies were collected. The infection rates of HR-HPV and trichomonal vaginitis( TV),bacterial vaginosis( BV),vulvovaginal candidiasis( VVC) and lactobacillus abnormalities were evaluated according to the original data in the literature. Stata 14. 0 software was used to analyze the data,and Egger's test was used to evaluate the publication bias. Results A total of 20 literatures and 20 case-control studies were included. The results showed that cervical HR-HPV infection was associated with BV,VVC and lactobacillus abnormalities in Chinese women. The odds ratios( ORs) were 2. 23 [95% confidence interval( CI) : 0. 99-2. 13],1. 55( 95% CI: 1. 12-2. 12) and3. 55( 95% CI: 2. 21-5. 71),respectively. It is statistically significant and has no publication bias. The association between HR-HPV infection and TV remains to be discussed. The combined OR value was 1. 45( 95% CI: 0. 99-2. 13),but there was no statistical significance and had publication bias. Conclusion Cervical HR-HPV infection is closely related to vaginal microecology. BV,VVC and lactobacillus abnormalities are high-risk factors for cervical HR-HPV infection.
引文
[1]连利娟.林巧稚妇科肿瘤学[M].北京:人民卫生出版社,2010:278-285.
[2]Mitra A,MacIntyre D A,Marchesi J R,et al.The vaginal microbiota,human papillomavirus infection and cervical intraepithelial neoplasia:what do we knowand where are we going next?[J].Microbiome,2016,4(1):58.
[3]Dareng E O,Ma B,Famooto A O,et al.Prevalent highrisk HPV infection and vaginal microbiota in Nigerian women[J].Epidemiol Infect,2016,144(1):123-137.
[4]Lee J E,Lee S,Lee H,et al.Association of the vaginal microbiota with human papillomavirus infection in a Korean twin cohort[J].PLo S One,2013,8(5):e63514.
[5]Guo Y L,You K,Qiao J,et al.Bacterial vaginosis is conducive to the persistence of HPV infection[J].Int J STDAIDS,2012,23(8):581-584.
[6]李桂军,赵蔚,周建娟.Nugent及Donders评分在细菌性阴道病合并需氧菌性阴道炎患者诊治中的临床应用[J].中国卫生检验杂志,2016,26(9):1270-1272.
[7]甘妙芳,贺东生,刘建平.106例子宫颈病变高危型HPV感染情况分析[J].齐齐哈尔医学院学报,2016,37(10):1335-1336.
[8]Meng L T,Xue Y,Yue T,et al.Relationship of HPV infection and BV,VVC,TV:a clinical study based on 1 261cases of gynecologic outpatients[J].Zhonghua Fu Chan Ke Za Zhi,2016,51(10):730-733.
[9]钱芳,余进胜,陈建华,等.HPV感染者阴道微生态状况及与宫颈异常上皮细胞病变之间关系[J].深圳中西医结合杂志,2017,27(20):19-20.
[10]王宝晨,夏玉洁,王辰,等.高危型人乳头瘤病毒感染子宫颈上皮内瘤变患者阴道微生态分析[J].中国妇产科临床杂志,2016,11(6):486-489.
[11]于妍妍,金哲,刘艳霞,等.宫颈高危HPV感染与阴道内环境相关因素分析[J].疑难病杂志,2011,10(9):673-675.
[12]杨莉.宫颈人乳头瘤病毒感染的阴道微生态特点分析[J].哈尔滨医药,2017,37(6):559-560.
[13]赵文华.宫颈人乳头瘤病毒感染与阴道微生态的相关性研究[J].内蒙古医科大学学报,2018,40(2):136-138.
[14]林顺粦,周惠洁.宫颈炎伴HPV感染患者阴道微生态特征分析[J].医学临床研究,2017,34(9):1833-1835.
[15]罗雯薇.人乳头瘤病毒(HPV)感染患者阴道菌群与宫颈局部免疫功能分析[J].吉林医学,2018,39(7):1220-1223.
[16]陈婉珍,吴林玲,闫颖.人乳头瘤病毒HPV感染与阴道微生态的相关性研究[J].中国微生态学杂志,2017,29(7):832-834.
[17]郑美云,赵荷兰,狄君平,等.人乳头状瘤病毒与妇科其他常见病原微生物感染关系的调查[J].中华妇产科杂志,2010,45(6):424-428.
[18]孟龄婷,高丽,岳婷,等.生殖道HPV感染与阴道混合性感染相关危险因素的研究[J].实用妇产科杂志,2018,34(1):30-34.
[19]韩华,陈闻月.阴道菌群与CIN、宫颈癌伴HPV感染相关性的研究[J].浙江医学,2018,40(7):745-755.
[20]钟阳青,陈艳清,肖翔,等.阴道微环境改变与高危型人乳头瘤病毒感染的相关性[J].检验医学与临床,2018,15(13):1960-1962.
[21]李东燕,郝敏.阴道微生态平衡与高危型HPV感染分析[J].中国微生态学杂志,2016,28(5):594-597.
[22]张莉,许继芹,王泓沄,等.阴道微生态失衡与高危型HPV感染及宫颈上皮内瘤变的研究[J].现代养生,2018(5):55-57.
[23]夏玉洁,王辰,王颖梅,等.阴道微生态异常与高危型人乳头瘤病毒感染的相关性研究[J].中国妇产科临床杂志,2017,18(2):131-133.
[24]张旭梅,李芹,柳露,等.阴道微生态与高危型HPV感染和宫颈病变的关系[J].中国妇幼保健,2018,33(8):1730-1741.
[25]刘海霞,司百会,吴建龙,等.阴道炎对宫颈HPV感染的影响[J].中国现代药物应用,2018,12(10):72.
[26]Liu J,Liu W,Liu Y,et al.Prevalence of microorganisms co-infections in human papillomaviruses infected women in Northern China[J].Arch Gynecol Obstet,2016,293(3):595-602.
[27]赵静.人乳头瘤状病毒感染与机体免疫的研究进展[J].中国病毒病杂志,2015,5(2):157-160.
[28]王盼,张梦真.人乳头瘤病毒单一、多重感染与细菌性阴道病的关系研究[J].中国计划生育和妇产科,2018,10(5):42-44.
[29]Zhang D,Li T,Chen L,et al.Epidemiological investigation of the relationship between common lower genital tract infections and high-risk human papillomavirus infections among women in Beijing,China[J].PLo S One,2017,12(5):e0178033.
[30]陈忆,吴丹,李柱南,等.细菌性阴道病和阴道微生态改变与高危型人乳头瘤病毒感染的临床分析[J].中国医药导报,2018,15(21):86-89.
[31]King C C,Jamieson D J,Wiener J,et al.Bacterial vaginosis and the natural history of human papillomavirus[J].Infect Dis Obstet Gynecol,2011,2011:319460.
[32]中华医学会妇产科分会感染协作组.外阴阴道假丝酵母菌病(VVC)诊治规范修订稿[J].中国实用妇科与产科杂志,2012,28(6):401-402.
[33]杨谨,陈洪波,李柱南,等.下生殖道感染与子宫颈高危型HPV感染及转归的相关性[J].中华妇产科杂志,2014,49(3):222-223.
[34]李静,刘海静,韩炜,等.孕期阴道微环境与妊娠结局的关系[J].中国煤炭工业医学杂志,2017,20(7):776-778.
[35]杜丽辉.阴道乳酸杆菌与宫颈人类乳头瘤病毒(HPV)感染及子宫颈癌前病变关系[J].实用妇科内分泌杂志,2016,3(16):197-198.
[36]Coste I,Judlin P,Lepargneur J P,et al.Safety and efficacy of an intravaginal prebiotic gel in the prevention of recurrent bacterial vaginosis:a randomized double-blind study[J].Obstet Gynecol Int,2012,2012:147867.
[37]Verhoeven V,Renard N,Makar A,et al.Probiotics enhance the clearance of human papillomavirus-related cervical lesions:a prospective controlled pilot study[J].Eur JCancer Prev,2013,22(1):46-51.
[2]Mitra A,MacIntyre D A,Marchesi J R,et al.The vaginal microbiota,human papillomavirus infection and cervical intraepithelial neoplasia:what do we knowand where are we going next?[J].Microbiome,2016,4(1):58.
[3]Dareng E O,Ma B,Famooto A O,et al.Prevalent highrisk HPV infection and vaginal microbiota in Nigerian women[J].Epidemiol Infect,2016,144(1):123-137.
[4]Lee J E,Lee S,Lee H,et al.Association of the vaginal microbiota with human papillomavirus infection in a Korean twin cohort[J].PLo S One,2013,8(5):e63514.
[5]Guo Y L,You K,Qiao J,et al.Bacterial vaginosis is conducive to the persistence of HPV infection[J].Int J STDAIDS,2012,23(8):581-584.
[6]李桂军,赵蔚,周建娟.Nugent及Donders评分在细菌性阴道病合并需氧菌性阴道炎患者诊治中的临床应用[J].中国卫生检验杂志,2016,26(9):1270-1272.
[7]甘妙芳,贺东生,刘建平.106例子宫颈病变高危型HPV感染情况分析[J].齐齐哈尔医学院学报,2016,37(10):1335-1336.
[8]Meng L T,Xue Y,Yue T,et al.Relationship of HPV infection and BV,VVC,TV:a clinical study based on 1 261cases of gynecologic outpatients[J].Zhonghua Fu Chan Ke Za Zhi,2016,51(10):730-733.
[9]钱芳,余进胜,陈建华,等.HPV感染者阴道微生态状况及与宫颈异常上皮细胞病变之间关系[J].深圳中西医结合杂志,2017,27(20):19-20.
[10]王宝晨,夏玉洁,王辰,等.高危型人乳头瘤病毒感染子宫颈上皮内瘤变患者阴道微生态分析[J].中国妇产科临床杂志,2016,11(6):486-489.
[11]于妍妍,金哲,刘艳霞,等.宫颈高危HPV感染与阴道内环境相关因素分析[J].疑难病杂志,2011,10(9):673-675.
[12]杨莉.宫颈人乳头瘤病毒感染的阴道微生态特点分析[J].哈尔滨医药,2017,37(6):559-560.
[13]赵文华.宫颈人乳头瘤病毒感染与阴道微生态的相关性研究[J].内蒙古医科大学学报,2018,40(2):136-138.
[14]林顺粦,周惠洁.宫颈炎伴HPV感染患者阴道微生态特征分析[J].医学临床研究,2017,34(9):1833-1835.
[15]罗雯薇.人乳头瘤病毒(HPV)感染患者阴道菌群与宫颈局部免疫功能分析[J].吉林医学,2018,39(7):1220-1223.
[16]陈婉珍,吴林玲,闫颖.人乳头瘤病毒HPV感染与阴道微生态的相关性研究[J].中国微生态学杂志,2017,29(7):832-834.
[17]郑美云,赵荷兰,狄君平,等.人乳头状瘤病毒与妇科其他常见病原微生物感染关系的调查[J].中华妇产科杂志,2010,45(6):424-428.
[18]孟龄婷,高丽,岳婷,等.生殖道HPV感染与阴道混合性感染相关危险因素的研究[J].实用妇产科杂志,2018,34(1):30-34.
[19]韩华,陈闻月.阴道菌群与CIN、宫颈癌伴HPV感染相关性的研究[J].浙江医学,2018,40(7):745-755.
[20]钟阳青,陈艳清,肖翔,等.阴道微环境改变与高危型人乳头瘤病毒感染的相关性[J].检验医学与临床,2018,15(13):1960-1962.
[21]李东燕,郝敏.阴道微生态平衡与高危型HPV感染分析[J].中国微生态学杂志,2016,28(5):594-597.
[22]张莉,许继芹,王泓沄,等.阴道微生态失衡与高危型HPV感染及宫颈上皮内瘤变的研究[J].现代养生,2018(5):55-57.
[23]夏玉洁,王辰,王颖梅,等.阴道微生态异常与高危型人乳头瘤病毒感染的相关性研究[J].中国妇产科临床杂志,2017,18(2):131-133.
[24]张旭梅,李芹,柳露,等.阴道微生态与高危型HPV感染和宫颈病变的关系[J].中国妇幼保健,2018,33(8):1730-1741.
[25]刘海霞,司百会,吴建龙,等.阴道炎对宫颈HPV感染的影响[J].中国现代药物应用,2018,12(10):72.
[26]Liu J,Liu W,Liu Y,et al.Prevalence of microorganisms co-infections in human papillomaviruses infected women in Northern China[J].Arch Gynecol Obstet,2016,293(3):595-602.
[27]赵静.人乳头瘤状病毒感染与机体免疫的研究进展[J].中国病毒病杂志,2015,5(2):157-160.
[28]王盼,张梦真.人乳头瘤病毒单一、多重感染与细菌性阴道病的关系研究[J].中国计划生育和妇产科,2018,10(5):42-44.
[29]Zhang D,Li T,Chen L,et al.Epidemiological investigation of the relationship between common lower genital tract infections and high-risk human papillomavirus infections among women in Beijing,China[J].PLo S One,2017,12(5):e0178033.
[30]陈忆,吴丹,李柱南,等.细菌性阴道病和阴道微生态改变与高危型人乳头瘤病毒感染的临床分析[J].中国医药导报,2018,15(21):86-89.
[31]King C C,Jamieson D J,Wiener J,et al.Bacterial vaginosis and the natural history of human papillomavirus[J].Infect Dis Obstet Gynecol,2011,2011:319460.
[32]中华医学会妇产科分会感染协作组.外阴阴道假丝酵母菌病(VVC)诊治规范修订稿[J].中国实用妇科与产科杂志,2012,28(6):401-402.
[33]杨谨,陈洪波,李柱南,等.下生殖道感染与子宫颈高危型HPV感染及转归的相关性[J].中华妇产科杂志,2014,49(3):222-223.
[34]李静,刘海静,韩炜,等.孕期阴道微环境与妊娠结局的关系[J].中国煤炭工业医学杂志,2017,20(7):776-778.
[35]杜丽辉.阴道乳酸杆菌与宫颈人类乳头瘤病毒(HPV)感染及子宫颈癌前病变关系[J].实用妇科内分泌杂志,2016,3(16):197-198.
[36]Coste I,Judlin P,Lepargneur J P,et al.Safety and efficacy of an intravaginal prebiotic gel in the prevention of recurrent bacterial vaginosis:a randomized double-blind study[J].Obstet Gynecol Int,2012,2012:147867.
[37]Verhoeven V,Renard N,Makar A,et al.Probiotics enhance the clearance of human papillomavirus-related cervical lesions:a prospective controlled pilot study[J].Eur JCancer Prev,2013,22(1):46-51.