宫颈不同疾病患者合并HPV感染的病原菌感染状况及免疫功能
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摘要
目的调查分析宫颈不同疾病患者合并人乳头瘤病毒(HPV)感染的病原菌感染状况及免疫功能。方法选择2015年3月至2018年1月在我院就诊的96例宫颈不同疾病患者为研究组,其中宫颈炎组18例,宫颈上皮内瘤变组54例(CINⅠ组15例,CINⅡ组17例,CINⅢ组22例),宫颈癌组24例;并以同期在我院进行体检的80例健康女性为对照组,检测所有研究对象的HPV感染、阴道菌群情况和宫颈分泌物CD_4~+、CD_8~+细胞数。结果研究组HPV感染率明显高于对照组(P<0.05);宫颈炎组、CIN组、宫颈癌组HPV感染率呈上升趋势,组间两两比较差异均有统计学意义(Ps<0.05)。宫颈炎组、CINⅠ组、CINⅡ组、CINⅢ组、宫颈癌组细菌性阴道病(BV)、解脲支原体(UU)和衣原体(CT)感染率呈上升趋势,宫颈癌组与宫颈炎组比较差异有统计学意义(P<0.05);各组间人型支原体(MH)、滴虫和霉菌的感染率差异无统计学意义(P>0.05)。宫颈炎组、CINⅠ组、CINⅡ组、CINⅢ组、宫颈癌组CD_4~+T细胞表达阳性率呈下降趋势,宫颈癌组与宫颈炎组、CINⅠ组比较差异有统计学意义(P<0.05),CINⅢ组与宫颈炎组比较差异有统计学意义(P<0.05);CD_8~+T细胞表达阳性率呈上升趋势,组间比较差异无统计学意义(P>0.05);CD_4~+/CD_8~+<1患者所占比例呈上升趋势,宫颈癌组、CINⅢ组、CINⅡ组与宫颈炎组比较差异有统计学意义(P<0.05)。结论 HPV感染、病原菌感染及免疫功能下降与宫颈病变发生发展密切相关,临床中应给予足够重视并及时进行有效干预。
Objective To explore and analyze the pathogen infection status and immune function of patients with different cervical diseases combined with human papillomavirus(HPV)infection.Methods 96 patients with different cervical diseases who received treatment in our hospital from March 2015 to January 2018 were collected as the observation group,including 18 cases in cervicitis group,54 cases in CIN group(15 cases of CIN I grade,17 cases of CIN II grade,22 cases of CIN III grade)and 24 cases in cervical cancer group.In addition,80 healthy women who underwent physical examination in our hospital at the same period were enrolled into the control group.The status of HPV infection,vaginal microflora and levels of CD_4~+and CD_8~+in cervical secretions were tested.Results The HPV infection rate in the observation group was significantly higher than that of the control group(P<0.05).The HPV infection rates in the cervical group,CIN group and cervical cancer group showed an upgoing trend,with statistically significant differences between the two groups(Ps<0.05).The infection rates of bacterial vaginosis(BV),Ureaplasma urealyticum(UU)and Chlamydia trachomatis(CT)showed an upgoing trend in the cervicitis group,CIN I group,CIN II group,CIN III group and cervical cancer group,and the difference between cervical cancer group and cervicitis group was statistically significant(P<0.05).The infection rates of Mycoplasma hominis(MH),Trichomonas and Mucedinein each group were not statistically significant(Ps>0.05).The positive rate of CD_4~+T cell expression showed a downgoing trend in the cervicitis group,CIN I group,CIN II group,CIN III group and cervical cancer group;the differences between cervical cancer group and cervicitis group/CIN I group were statistically significant(Ps<0.05),so was the difference between CIN III group and cervicitis group(P<0.05).The positive rate of CD_8~+T cell expression showed an upgoing trend in the cervicitis group,CIN I group,CIN II group,CIN III group and cervical cancer group;there were no statistically significant differences between groups(Ps>0.05).The proportion of patients with CD_4~+/CD_8~+ <1 showed an upgoing trend in the cervicitis group,CIN I group,CIN II group,CIN III group and cervical cancer group,and the differences between cervicitis group and cervical cancer group/CIN III group/CIN II group were statistically significant(Ps<0.05).Conclusion HPV infection,pathogen infection and immune function decline are closely related to the occurrence and development of cervical lesions;adequate attention and effective intervention should be given in clinical practice.
Objective To explore and analyze the pathogen infection status and immune function of patients with different cervical diseases combined with human papillomavirus(HPV)infection.Methods 96 patients with different cervical diseases who received treatment in our hospital from March 2015 to January 2018 were collected as the observation group,including 18 cases in cervicitis group,54 cases in CIN group(15 cases of CIN I grade,17 cases of CIN II grade,22 cases of CIN III grade)and 24 cases in cervical cancer group.In addition,80 healthy women who underwent physical examination in our hospital at the same period were enrolled into the control group.The status of HPV infection,vaginal microflora and levels of CD_4~+and CD_8~+in cervical secretions were tested.Results The HPV infection rate in the observation group was significantly higher than that of the control group(P<0.05).The HPV infection rates in the cervical group,CIN group and cervical cancer group showed an upgoing trend,with statistically significant differences between the two groups(Ps<0.05).The infection rates of bacterial vaginosis(BV),Ureaplasma urealyticum(UU)and Chlamydia trachomatis(CT)showed an upgoing trend in the cervicitis group,CIN I group,CIN II group,CIN III group and cervical cancer group,and the difference between cervical cancer group and cervicitis group was statistically significant(P<0.05).The infection rates of Mycoplasma hominis(MH),Trichomonas and Mucedinein each group were not statistically significant(Ps>0.05).The positive rate of CD_4~+T cell expression showed a downgoing trend in the cervicitis group,CIN I group,CIN II group,CIN III group and cervical cancer group;the differences between cervical cancer group and cervicitis group/CIN I group were statistically significant(Ps<0.05),so was the difference between CIN III group and cervicitis group(P<0.05).The positive rate of CD_8~+T cell expression showed an upgoing trend in the cervicitis group,CIN I group,CIN II group,CIN III group and cervical cancer group;there were no statistically significant differences between groups(Ps>0.05).The proportion of patients with CD_4~+/CD_8~+ <1 showed an upgoing trend in the cervicitis group,CIN I group,CIN II group,CIN III group and cervical cancer group,and the differences between cervicitis group and cervical cancer group/CIN III group/CIN II group were statistically significant(Ps<0.05).Conclusion HPV infection,pathogen infection and immune function decline are closely related to the occurrence and development of cervical lesions;adequate attention and effective intervention should be given in clinical practice.
引文
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[13]XIE Jianpin,YANG Zhihong,YI Fang,et al.Relationship between high-risk human papillomavirus infection and vaginal flora and cervical local immune function[J].Chin J Nosocomiol,2017,27(10):2336-2339.(in Chinese)谢建萍,杨志红,伊芳,等.宫颈高危型人乳头瘤病毒感染与阴道菌群及宫颈局部免疫功能的关系[J].中华医院感染学杂志,2017,27(10):2336-2339.
[14]WU Xiaofei,WU Linmin,TAN Qiumei.Research of correlation between HPV infection combined with different cervical lesion and vaginal flora imbalance[J].China Mod Med,2016,23(5):65-67.(in Chinese)伍晓飞,吴灵敏,谭秋梅.HPV感染合并不同宫颈病变与阴道菌群失调关系的研究[J].中国当代医药,2016,23(5):65-67.
[15]WEN Zhenfang,YANG Jun,ZHAO Shuzhen,et al.Changes of HPV infection,vaginal flora and inflammatory factors in patients with cervical cancer[J].Chin J Nosocomiol,2016,26(19):4500-4502.(in Chinese)文政芳,杨君,赵淑珍,等.宫颈癌患者人乳头状瘤病毒感染与阴道菌群及炎性因子变化研究[J].中华医院感染学杂志,2016,26(19):4500-4502.
[16]Chong GO,Lee YH,Han HS,et al.Prognostic value of pretreatment human papilloma virus DNA status in cervical cancer[J].Gynecolog Oncol,2018,148(1):97-102.
[17]Lin YJ,Fan LW,Tu YC.Perceived risk of human papillomavirus infection and cervical cancer among adolescent women in Taiwan[J].Asian Nurs Res,2016,10(1):45-50.
[18]GUO Yanrong,ZHAO Guangchao,LI Wenhua,et al.Impact of human papilloma virus infection on local immune functions of patients with cervical cancer[J].Chin J Nosocomiol,2014,24(13):3333-3334.(in Chinese)郭彦蓉,赵广超,李文华,等.人乳头状瘤病毒感染对宫颈癌局部免疫功能的影响分析[J].中华医院感染学杂志,2014,24(13):3333-3334.
[2]Xu HH,Zheng LZ,Lin AF,et al.Human papillomavirus(HPV)18genetic variants and cervical cancer risk in Taizhou area,China[J].Gene,2018,674(20):192-197.
[3]Wentzensen N,Schiffman M,Palmer T,et al.Triage of HPVpositive women in cervical cancer screening[J].J Clin Virol,2016,76(1):S49-S55.
[4]王鹏程,宋静慧.宫颈病变患者治疗前后阴道微生态变化与HPV感染的关系研究进展[J].中国妇产科临床杂志,2015,16(5):473-475.
[5]TAN Hongying,MA Jianting.Progress on the correlation between vaginal ecological alteration and cervical human papillomavirus infection[J].Reproduc&Contracep,2017,37(5):418-422.(in Chinese)谈红英,马建婷.阴道微生态变化与宫颈人乳头瘤病毒感染的相关性研究进展[J].中华生殖与避孕杂志,2017,37(5):418-422.
[6]Sankaranarayanan R.HPV vaccination:The most pragmatic cervical cancer primary prevention strategy[J].Int J Gynecol&Obstetr,2015,131(1):S33-S35.
[7]Mahantshetty U,Teni T,Naga P,et al.Impact of HPV 16/18infection on clinical outcomes in locally advanced cervical cancers treated with radical radio(chemo)therapy?A prospective observational study[J].Gynecolog Oncol,2018,148(2):299-304.
[8]Chen L,Luan SH,Xia BG,et al.Integrated analysis of HPV-mediated immune alterations in cervical cancer[J].Gynecolog Oncol,2018,149(2):248-255.
[9]王美藏,高建宏,杨雅琴,等.HPV感染患者阴道菌群与宫颈局部免疫功能的相关性研究[J].河北医科大学学报,2018,39(1):104-107.
[10]Johnson HC,Lafferty EI,Eggo RM,et al.Effect of HPVvaccination and cervical cancer screening in England by ethnicity:A modelling study[J].Lancet Public Health,2018,3(1):e44-e51.
[11]El-Zein M,Richardson L,Franco EL.Cervical cancer screening of HPV vaccinated populations:Cytology,molecular testing,both or none[J].J Clin Virol,2016,76(1):S62-S68.
[12]ZHANG Yawen,CAI Yun.Analysis of pathogen distribution in patients with cervical cancer[J].Chin J Clin Pharmacol,2015,31(11):957-959.(in Chinese)章亚文,蔡芸.宫颈癌患者的病原菌分布分析[J].中国临床药理学杂志,2015,31(11):957-959.
[13]XIE Jianpin,YANG Zhihong,YI Fang,et al.Relationship between high-risk human papillomavirus infection and vaginal flora and cervical local immune function[J].Chin J Nosocomiol,2017,27(10):2336-2339.(in Chinese)谢建萍,杨志红,伊芳,等.宫颈高危型人乳头瘤病毒感染与阴道菌群及宫颈局部免疫功能的关系[J].中华医院感染学杂志,2017,27(10):2336-2339.
[14]WU Xiaofei,WU Linmin,TAN Qiumei.Research of correlation between HPV infection combined with different cervical lesion and vaginal flora imbalance[J].China Mod Med,2016,23(5):65-67.(in Chinese)伍晓飞,吴灵敏,谭秋梅.HPV感染合并不同宫颈病变与阴道菌群失调关系的研究[J].中国当代医药,2016,23(5):65-67.
[15]WEN Zhenfang,YANG Jun,ZHAO Shuzhen,et al.Changes of HPV infection,vaginal flora and inflammatory factors in patients with cervical cancer[J].Chin J Nosocomiol,2016,26(19):4500-4502.(in Chinese)文政芳,杨君,赵淑珍,等.宫颈癌患者人乳头状瘤病毒感染与阴道菌群及炎性因子变化研究[J].中华医院感染学杂志,2016,26(19):4500-4502.
[16]Chong GO,Lee YH,Han HS,et al.Prognostic value of pretreatment human papilloma virus DNA status in cervical cancer[J].Gynecolog Oncol,2018,148(1):97-102.
[17]Lin YJ,Fan LW,Tu YC.Perceived risk of human papillomavirus infection and cervical cancer among adolescent women in Taiwan[J].Asian Nurs Res,2016,10(1):45-50.
[18]GUO Yanrong,ZHAO Guangchao,LI Wenhua,et al.Impact of human papilloma virus infection on local immune functions of patients with cervical cancer[J].Chin J Nosocomiol,2014,24(13):3333-3334.(in Chinese)郭彦蓉,赵广超,李文华,等.人乳头状瘤病毒感染对宫颈癌局部免疫功能的影响分析[J].中华医院感染学杂志,2014,24(13):3333-3334.