宫颈高危HPV感染与阴道病原体感染的相关性分析

Correlation analysis of cervical high-risk HPV infection and vaginal pathogen infection

摘要

目的 探讨高危型人乳头瘤病毒(HR-HPV)与阴道炎病原体(加德纳菌、念珠菌、滴虫)的相关性,为宫颈癌防治提供新思路。方法 回顾性分析2023年1月至2025年3月华中科技大学同济医学院附属协和医院6393例25~65岁女性的HPV分型检测及阴道病原体检测结果。采用卡方检验或Fisher精确检验进行组间比较,并采用Logistic回归分析评估阴道病原体感染与HR-HPV感染的相关性。进一步采用纵向研究设计评估阴道病原体转归(持续或转阴)对HR-HPV感染结局的潜在影响。结果 加德纳菌阳性率在HR-HPV阳性组及低危型HPV(LR-HPV)阳性组均高于HPV阴性组(χ²=36.751,P<0.05),念珠菌与阴道毛滴虫三组阳性率差异无统计学意义(P>0.05);单因素Logistic回归分析显示,加德纳菌检测阳性是HR-HPV感染的危险因素(OR=1.416,95%CI:1.243~1.614,P<0.05),滴虫、念珠菌感染及年龄因素与HR-HPV感染无显著相关性;多因素Logistic回归分析结果显示,加德纳菌感染使HR-HPV感染风险升高41.8%(OR=1.418,95%CI:1.243~1.616,P<0.05);共339名女性符合纵向研究纳入标准,结果显示仅在46~65岁女性中,阴道加德纳菌转阴组HR-HPV阴性率更高(P_Fisher=0.039)。结论 加德纳菌可能增加HR-HPV感染风险,其转阴可能促进HR-HPV消退。阴道病原体与HR-HPV感染显示出复杂的相关性,有待大样本多中心研究。

Abstract

Objective To explore the correlation between high-risk human papilloma virus (HR-HPV) and vaginal pathogenic microorganisms (Gardnerella,Candida,Trichomonas),and to provide new ideas for the prevention and treatment of cervical cancer. Methods A retrospective analysis was conducted on the HPV typing test and vaginal pathogen test results of 6 393 women aged 25-65 years from Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2023 to March 2025.Chi-square test or Fisher's exact test was used for intergroup comparisons,and logistic regression analysis was performed to evaluate the association between vaginal pathogen infection and HR-HPV infection.Further,a longitudinal study design was used to assess the potential impact of vaginal pathogen outcome (persistent or clearance) on the outcome of HR-HPV infection. Results The positive rate of Gardnerella was higher in the HR-HPV positive group and the low-risk human papilloma virus (LR-HPV) positive group than in the HPV negative group (χ ²=36.751,P<0.05),while there was no statistically significant difference in the positive rates of Candida and Trichomonas among the three groups (P>0.05);Univariate logistic regression analysis showed that positive detection of Gardnerella was a risk factor for HR-HPV infection (OR=1.416,95%CI:1.243-1.614,P<0.05),and there was no significant correlation between Trichomonas,Candida infection,and age factors and HR-HPV infection;Multivariate logistic regression analysis results showed that Gardnerella infection increased the risk of HR-HPV infection by 41.8% (OR=1.418,95%CI:1.243-1.616,P<0.05);A total of 339 women met the inclusion criteria for the longitudinal study,and the results showed that only in women aged 46-65,the negative rate of vaginal Gardnerella in the negative HR-HPV group was higher (P_Fisher=0.039). Conclusion Gardnerella may increase the risk of HR-HPV infection,and its negative conversion may promote the regression of HR-HPV.Vaginal pathogens and HR-HPV infection show a complex correlation,and large-sample multicenter studies are needed.

关键词

高危型人乳头瘤病毒感染 / 阴道病原体 / 宫颈癌预防 / 加德纳菌

Key words

high risk human papilloma virus infection / vaginal pathogen / cervical cancer prevention / Gardnerella

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