不同HPV感染亚型对不孕女性阴道微生态及辅助生殖助孕结局的影响

Effects of different HPV infection subtypes on vaginal microbiome and assisted reproductive outcomes in infertile women

摘要

目的 探讨不同人乳头瘤病毒(HPV)感染亚型对不孕女性阴道微生态及辅助生殖(ART)助孕结局的影响。方法 选取2020年1月至2022年3月期间于宝鸡市中心医院进行ART助孕的HPV阳性不孕女性190例,对所有患者均进行了HPV分型检查,根据患者感染HPV的不同亚型将其分为高危组(151例)与低危组(39例),选取同期进行ART助孕的HPV阴性不孕女性纳入对照组(95例).检查患者阴道微生态情况及阴道病原菌感染情况,记录患者ART助孕结局(获卵数、可移植胚胎数及优质胚胎数)和妊娠结局(临床妊娠率、活产分娩率及流产率),并对各组数据进行统计分析。结果 高危组、低危组、对照组的H₂O₂阳性率比较差异无统计学意义(P＞0.05);高危组、低危组、对照组的乳酸杆菌、唾液酸苷酶、白细胞酯酶的阳性率及阴道微生态失衡率比较差异均有统计学意义(χ²值分别为7.604、9.086、6.825、8.502,P＜0.05);高危组的乳酸杆菌、唾液酸苷酶、白细胞酯酶的阳性率及阴道微生态失衡率均明显高于对照组,经比较差异均有统计学意义(χ²值分别为7.087、9.038、6.767、8.373,P＜0.05).高危组、低危组、对照组的外阴阴道假丝酵母菌病(VVC)、细菌性阴道病(BV)的感染率比较差异均无统计学意义(P＞0.05),高危组、低危组、对照组的混合型阴道感染率比较差异有统计学意义(χ²＝15.258,P＜0.05);高危组的混合型阴道感染率均明显高于低危组和对照组,经比较差异均有统计学意义(χ²值分别为4.808、12.002,P＜0.05).高危组、低危组、对照组患者的获卵数、可移植胚胎数及优质胚胎数比较差异均无统计学意义(P＞0.05).高危组、低危组、对照组患者的临床妊娠率比较差异无统计学意义(P＞0.05),三组的活产分娩率和流产率比较差异均有统计学意义(χ²值分别为2.841、2.936,P＜0.05);高危组的活产分娩率明显低于对照组,流产率明显高于对照组,经比较差异均有统计学意义(χ²值分别为7.981、5.123,P＜0.05)。结论 不同HPV感染亚型对不孕患者阴道微生态情况、ART助孕结局、临床妊娠率及活产分娩率的影响较小,但高危HPV感染会增加不孕患者混合型阴道感染的风险.

Abstract

Objective To investigate the effects of different human papillomavirus (HPV) infection subtypes on vaginal microbiome and assisted reproductive technology (ART) outcomes in infertile women. Methods A total of 190 infertile women who tested positive for HPV and underwent ART at Baoji Central Hospital from January 2020 to March 2022 were selected. All patients underwent HPV genotyping and were divided into a high-risk group (151 cases) and a low-risk group (39 cases) according to different subtypes of HPV. Infertile women who were HPV-negative and underwent ART during the same period were selected as the control group (95 cases). Vaginal microbiome and vaginal pathogen infections of patients were examined, and the outcomes of ART (number of retrieved oocytes, number of transferable embryos, and number of high-quality embryos) and pregnancy outcomes (clinical pregnancy rate, live birth rate and miscarriage rate) were recorded. Statistical analysis was conducted on the data from each group. Results The differences in the hydrogen peroxide (H₂O₂) positive rates among the high-risk group, low-risk group, and control group were not statistically significant (P＞0.05). The positive rates of lactobacillus, sialidase, leukocyte esterase and the rate of vaginal microbiome imbalance among the high-risk group, low-risk group, and control group were statistically significant (χ² values were 7.604, 9.086, 6.825 and 8.502, respectively, P＜0.05). The positive rates of lactobacillus, sialidase, leukocyte esterase and the rate of vaginal microbiome imbalance in the high-risk group were significantly higher than those in the control group, with statistically significant differences (χ² values were 7.087, 9.038, 6.767 and 8.373, respectively, P＜0.05). The differences in the infection rates of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) among the high-risk group, low-risk group, and control group were not statistically significant (P＞0.05). The differences in the mixed vaginal infection rates among the high-risk group, low-risk group and control group were statistically significant (χ²＝15.258, P＜0.05). The mixed vaginal infection rate in high-risk group was significantly higher than that in low-risk group and control group, with statistically significant differences (χ² values were 4.808 and 12.002, respectively, P＜0.05). There were no statistically significant differences in the number of retrieved oocytes, the number of transferable embryos and the number of high-quality embryos among the high-risk group, low-risk group and control group (P＞0.05). There was no significant difference in the clinical pregnancy rate among the high-risk group, low-risk group, and control group (P＞0.05). The differences in the live birth rate and miscarriage rates among the three groups were statistically significant (χ² values were 2.841 and 2.936, respectively, P＜0.05). The live birth rate in the high-risk group was significantly lower than that in the control group, and the miscarriage rate was significantly higher than that in the control group, with statistically significant differences (χ² values were 7.981 and 5.123, respectively, P＜0.05). Conclusion The impact of different HPV infection subtypes on the vaginal microbiome, ART outcomes, clinical pregnancy rate and live birth rate in infertile patients is minimal, but high-risk HPV infection increases the risk of mixed vaginal infections in infertile patients.

关键词

人乳头瘤病毒 / 亚型 / 不孕症 / 阴道微生态 / 辅助生殖 / 助孕结局

Key words

human papillomavirus / subtype / infertility / vaginal microbiome / assisted reproductive technology / assisted pregnancy outcome

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基金资助

宝鸡市中心医院科研基金项目(BZXJJQN20208)

2018年度宝鸡市卫生健康委员会科研计划立项课题(201809)