16S RRNA Sequencing Of The Microbial Flora Of The External Cervix In Patients With Endometriosis And Adenomyosis

Part 1 Cervical external os microbiota of adenomyosisObjectivesTo explore and compare the microbiota composition of cervical external os in adenomyosis patients and the others.To explore the value of cervical external os microbiome on the diagnosis of adenomyosis.MethodsWe included patients with adenomyosis,patients with synchronous adenomyosis and uterine myoma,adenomyosis patients with GnRHa(gonadotropin-releasing hormone agonist)treatment for three months and healthy women,and classified them as four groups.Samples from cervical external os of each patient were collected.16S ribosomal-RNA gene sequencing and bioinformatic analyses were performed.Discriminative microbial species between groups were identified by linear discriminant analysis effect size.Receiver operating characteristic curve of each microorganism genus was performed to explore the diagnostic value of microbiota.ResultsWe included 23 patients.Microbiota composition at cervical external os of four different groups was different.Discriminative species were identified between adenomyosis patients with GnRHa treatment and patients with synchronous adenomyosis and uterine myoma.We also demonstrated the diagnostic value on adenomyosis of some microorganism,especially Ralstonia.ConclusionsMicrobiota composition of cervical external os between adenomyosis patients and the others is different.Ralstonia at cervical external os has some value on the diagnosis of adenomyosis.Exploring microbiota of cervical external os could be used to diagnose adenomyosis and excavate biomarkers.Part 2 Cervical external os microbiota of ovarian endometrioma patients with and without dysmenorrhealObjectivesTo explore and compare the micribiota composition of cervical external os in ovarian endometrioma patients with and without dysmenorrheal.MethodsWe included ovarian endometrioma patients with and without dysmenorrheal.Samples from cervical external os of each patient were collected.16S ribosomal-RNA gene sequencing and bioinformatic analyses were performed.Relative abundance figure and Heatmap of two groups were drawn.Discriminative microbial species between groups were identified by linear discriminant analysis effect size,which could also discover the biomarkers of disease.ResultsWe included 14 patients,which contained 7 ovarian endometrioma patients with dysmenorrheal and 7 ovarian endometrioma patients without dysmenorrheal.Microbiota composition at cervical external os of the two groups was different.Discriminative microbial species were identified between the ovarian endometrioma patients with and without dysmenorrheal.ConclusionsMicrobiota composition of cervical external os between ovarian endometrioma patients with and without dysmenorrheal is different.Propionibacteriaceae could be used as the biomarker of the ovarian endometrioma patients without dysmenorrheal and Xanthomonadaceae could be used as the biomarker of the ovarian endometrioma patients with dysmenorrheal.Part 3 Clinical characteristics of ovarian endometrioma patients without dysmenorrhealObjectiveTo describe the clinical characteristics of ovarian endometrioma patients without dysmenorrheal and identify the risk factors of postoperative recurrence.MethodsPatients with pathologically diagnosed ovarian endometrioma and without dysmenorrheal were included.Preoperative information,operative information and postoperative information were collected.Statistical analyses were performed using SPSS.Cox’s proportional hazard univariate and multivariate analyses were performed to identify the risk factors of postoperative recurrence.ResultsTotally 85 patients were included.Although they had no dysmenorrheal,they could still have dyspareunia,chronic pelvic pain,dyschezia and so on.Concomitant deep infiltrating endometriosis or adenomyosis is less.Postoperative recurrence rate was 4.7%.Results of univariate analysis showed that pelvic surgery history is the risk factor of recurrence.ConclusionOvarian endometrioma patients without dysmenorrheal accompanied by lower proportion of deep infiltrating endometriosis or adenomyosis.Postoperative medication may decrease the postoperative recurrence rate and pelvic surgery history may be the risk factor of recurrence.