摘要
目的探讨宫颈锥切术后阴道微生态动态演变与高危型人乳头瘤病毒(HPV)清除及病变转归的关联。方法采用前瞻性队列设计,纳入120例高级别鳞状上皮内病变或宫颈上皮内瘤变2级及以上锥切术后患者,于术后2~4周(T0)、6个月(T1)和12个月(T2)进行随访。采用16SrRNA基因测序技术动态监测阴道菌群,同时进行HPV分型检测、Nugent评分及pH值测定,评估菌群变化与HPV清除及病变转归的关系。结果完成T2随访108例(90.00%)。T2时HPV清除比例为79.63%(86/108),HPV16/18感染者清除率显著低于其他高危型(68.75%vs 85.71%,P=0.038),多重感染者清除率低于单一感染者(68.89%vs86.76%,P=0.024)。Nugent评分从基线的(4.82±2.36)分降至T2时(2.97±2.05)分(P<0.01),乳杆菌为优势菌比例从35.83%升至64.81%(P<0.01)。多因素分析显示,基线乳杆菌为优势菌是HPV清除的独立保护因素(OR=3.842,95%CI:1.287-11.476,P=0.016),基线Nugent评分≥7分是独立危险因素(OR=0.298,95%CI:0.106-0.835,P=0.021)。病变消退率为78.70%,基线细菌性阴道病菌群(OR=4.287,95%CI:1.635-11.245,P<0.01)和持续菌群失衡(OR=3.615,95%CI:1.247-10.478,P=0.018)是病变持续/进展的独立危险因素。结论宫颈锥切术后阴道菌群呈自发恢复趋势,乳杆菌优势菌群与HPV清除及病变消退密切相关,动态监测阴道微生态有助于识别高危人群。
Objective To characterize longitudinal changes in the vaginal microbiota after cervical conization and examine their association with high-risk human papillomavirus(HR-HPV)clearance and lesion outcomes.Methods In this prospective cohort study,12o women who underwent conization for high-grade squamous intraepithelial lesion or cervical intraepithelial neoplasia grade 2 or worse(CIN2+)were enrolled.Follow-up visits were scheduled at 2-4 weeks postoperatively(T0),6 months(T1),and 12 months(T2).At each time point,the vaginal microbiota was profiled using 16S rRNA gene sequencing,accompanied by HPV genotyping,Nugent scoring,and vaginal pH measurement.Associations between microbiota dynamics,HR-HPV clearance,and lesion regression or persistence/progression were analyzed using multivariable models.R esults A total of 108 women(90.00%)completed follow-up to T2.By T2,the overall HR-HPV clearance rate was 79.63%(86/108).Clearance of HPV16/18 was significantly lower than that of otherhigh-risk types(68.75%vs.85.71%,P=0.038),and women with multiple high-risk HPV infections had a lower clearance rate than those with a single high-risk HPV infection(68.89%vs.86.76%,P=0.024).The mean Nugent score decreased from 4.82±2.36 at baseline to 2.97±2.05 at T2(P<0.01),while the proportion of Lactobacillusdominant communities increased from 35.83%to 64.81%(P<0.01).Multivariable analysis showed that a baseline Lactobacillus-dominant microbiota was an independent protective factor for HR-HPV clearance(OR=3.842,95%CI:1.287-11.476,P=0.016),whereas a baseline Nugent score≥7 was an independent risk factor for persistent HR-HPV infection(OR=0.298,95%CI:0.106-0.835,P=0.021).The overall lesion regression rate was 78.70%.Baseline bacterial vaginosis-like microbiota(OR=4.287,95%CI:1.635-11.245,P<0.01)and persistent microbiota dysbiosis(OR=3.615,95%CI:1.247-10.478,P=0.018)were independent risk factors for lesion persistence or progression.Conclusion After cervical conization,the vaginal microbiota shows a tendency toward spontaneous recovery with a shift to Lactobacillus dominance.Lactobacillus-dominant communities are closely associated with HR-HPV clearance and lesion regression.Dynamic monitoring of the vaginal microbiota may help identify women at higher risk of persistent HR-HPV infection and unfavorable lesion outcomes.
作者
彭燚琼
邱红鑫
卢裕兰
江丽玲
陈静
黄文蓉
PENG Yiqiong;QIU Hongxin;LU Yulan;JIANG Liling;CHEN Jing;HUANG Wenrong(Gynecology Department of Longyan Second Hospital,Longyan 364000,Fujian,China;School of Medicine and Nursing,Minxi Vocational and Technical College)
出处
《中国病原生物学杂志》
北大核心
2026年第3期334-341,共8页
Journal of Pathogen Biology
基金
2023年度福建省中青年教师教育科研项目(No.JAT231278)。
关键词
宫颈上皮内瘤变
人乳头瘤病毒
阴道微生态
宫颈锥切术
乳杆菌
cervical intraepithelial neoplasia
high-risk human papillomavirus
vaginal microbiota
cervical conization
lactobacillus
