妇科感染 BV、VVC 和 TV 与宫颈 HR-HPV 感染的相关性研究

A study on the correlation between BV,VVC,and TV infections and cervical HR-HPV infection

摘要

目的 基于全国宫颈癌筛查大样本数据,探讨妇科常见感染与高危型人乳头瘤病毒(HR-HPV)感染风险及其主要型别(HPV16/52/58)之间的关联,为宫颈癌预防提供参考依据。方法 采用横断面研究设计,纳入2021年全国11个省份39个区县113 149名接受 HR-HPV 分型检测的35~64岁女性。通过多因素logistic回归分析三种不同妇科感染与 HR-HPV 感染的关联,并进一步分析其与 HPV16/52/58型别的特异性关联。结果 患有细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)及滴虫性阴道炎(TV)的女性,其 HR-HPV 感染率(分别为15.22%、20.28%、21.16%)均显著高于未患相应感染的女性(9.88%、9.91%、9.89%),差异具有统计学意义(χ²=124.889、211.466、252.304,P＜0.05)。BV、VVC和 TV 与 HR-HPV 感染均呈正相关,校正后比值比(aOR)及95%置信区间(CI)分别为1.69(1.54~1.84)、2.16(1.92~2.43)和2.22(1.98~2.50)。型别特异性分析发现,BV 和 TV 与 HPV16、52、58三种型别感染均显著相关;而 VVC 表现出型别特异性,与 HPV52(aOR=1.89,95%CI:1.50~2.39)和 HPV58(aOR=2.94,95%CI:2.30~3.77)感染风险显著相关,但与 HPV16 感染无关(aOR=0.97,95%CI:0.68~1.36)。结论 细菌性阴道病、外阴阴道假丝酵母菌病和滴虫性阴道炎与高危型人乳头瘤病毒感染呈正相关,且其影响存在型别特异性模式,在宫颈癌防控中应重视下生殖道感染的协同管理。

Abstract

Objective Based on large-scale national cervical cancer screening data,this study aims to explore the association between common gynecological infections and the risk of HR-HPV infection and its major genotypes (HPV16/52/58),providing evidence for cervical cancer prevention. Methods A cross-sectional study design was adopted, including 113 149 women aged 35-64 years who underwent HR-HPV genotyping tests in 39 districts across 11 provinces in 2021.Multivariate logistic regression was used to analyze the association between different gynecological infections and HR-HPV infection,and further to analyze the specific association with HPV16/52/58 types. Results The HR-HPV infection rates among women with bacterial vaginosis,vulvovaginal candidiasis,and trichomonal vaginitis were 15.22%,20.28%,and 21.16%,respectively,all significantly higher than those among women without the corresponding infections (9.88%,9.91%,9.89%) (χ²=124.889,211.466,252.304,all P＜0.05).Bacterial vaginosis,vulvovaginal candidiasis,and trichomonal vaginitis were positively associated with HR-HPV infection.After full adjustment,the adjusted odds ratios (aOR) and 95% confidence intervals (CI) were 1.69(1.54-1.84),2.16(1.92-2.43),and 2.22(1.98-2.50),respectively.Type-specific analysis revealed that BV and TV were significantly associated with infections of HPV16,52,and 58;however,VVC showed significant type-specific association,being significantly associated with HPV52 (aOR=1.89,95%CI:1.50-2.39) and HPV58 (aOR=2.94,95%CI:2.30-3.77) infections,but not with HPV16 infection (aOR=0.97,95%CI:0.68-1.36). Conclusion BV,VVC,and TV are positively correlated with HR-HPV infection,and their effects show type-specific patterns.In cervical cancer prevention and control,the co-management of lower genital tract infections should be emphasized.

关键词

高危型人乳头瘤病毒 / 妇科感染 / 细菌性阴道病 / 外阴阴道假丝酵母菌病 / 滴虫性阴道炎

Key words

high-risk human papillomavirus / gynecological infection / bacterial vaginosis / vulvovaginal candidiasis / trichomonal vaginitis

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基金资助

国家重点研发项目(2023YFC2705501)