Correlation Analysis Between Vaginal Microbiota And Outcome Of HPV Infection After Cervical Conization In Patients Infected By High-risk HPV Infection With HSIL

Objective:1.To evaluate the vaginal microbiota status of patients with high-risk human papillomavirus（Human Papillomavirus,HPV）infection and high-grade cervical squamous intraepithelial lesion（High-grade Squamous Intraepithelial Lesion,HSIL）one year after conization,and to explore the relationship between vaginal microbiota and high-risk HPV infection in HSIL patients one year after conization.2.To explore the influence of multi-factor imbalance of vaginal microbiota environment on the prognosis of high-risk HPV in patients with HSIL after cervical conization,so as to provide new ideas for clinical diagnosis and treatment,so as to reduce the postoperative recurrence rate and improve the long-term prognosis of the patients.Research methods:From January 2017 to December 2018,HSIL complicated with high-risk HPV infection was diagnosed by colposcopy cervical biopsy in the outpatient clinic of Shenyang Women’s And Children’s Hospital and was treated with cervical conization（including circular loop electrosuigical excision procedure or cold knife conization）.One year after operation,396 patients returned to our outpatient clinic for follow-up,87 patients with pregnancy,hysterectomy and menopause were excluded.A total of 318cases were included in this study.HPV typing and vaginal microbiota examination were performed in 318 patients,and the general data of the patients were collected,including 68 high-risk HPV positive patients as the study group,and 250 HPV negative patients were randomly selected as the control group.To analysis the correlation between the test item of vaginal microbiota and the positive for high-risk HPV in patients with HSIL one year after conization.Results:1.Of the 318 patients,68 were positive for high-risk HPV one year after conization,and the positive rate of high-risk HPV was 21.38%.2.The results of univariate analysis showed that there were significant differences in the proportion of Lactobacillus,abnormal vaginal cleanliness,inflammation,bacterial vaginosis,p H value and H₂O₂ concentration between the two groups（P<0.05）,indicating that whether these indexes were abnormal or not had a significant effect on the positive rate of high-risk HPV one year after cervical conization.3.The results of multivariate Logistic regression analysis showed that vaginal cleanliness,inflammation and abnormal p H value were not independent risk factors for high-risk HPV in HSIL patients one year after cervical conization（P>0.05）.BV（OR3.789,95%CI:1.207-11.896）,decreased proportion of Lactobacillus（OR2.842,95%CI:1.236-6.538） and the concentration of H₂O₂ decreased（OR2.270,95%CI:1.064-4.841） was an independent risk factor for positive high-risk HPV in HSIL patients one year after cervical conization（P<0.05）.Conclusion:1.The decreased of the proportion of lactobacilli in vagina,the decrease of H₂O₂ concentration and BV infection were the independent risk factors of positive high-risk HPV positive in patients with HSIL one year after cervical conization.2.During the follow-up of high-risk HPV infected HSIL patients,we should pay attention to the vaginal microbiota and timely intervention,especially for the decrease of the proportion and function of Lactobacillus and BV infection.Maintaining vaginal microbiotal balance is of positive significance in promoting HPV clearance and reducing HPV infection in patients with HSIL after cervical conization,which can improve the prognosis of patients with HSIL.