Analysis Of Cervical HPV Infection And Its Correlation With Vaginal Microecology In 16324 Women

Background:Cervical cancer is the most common malignancy of the female reproductive tract,ranking second only to breast cancer in morbidity and mortality in low-and middle-income countries.Human papillomavirus(HR-HPV)persistent infection is the main cause of cervical cancer.so cervical cancer is identified as a preventable and treatable infectious cancer.It usually takes several years or even decades to develop from cervical HPV infection to cervical cancer,which experiences low-grade squamous intraepithelial lesions(LSIL),high-grade squamous intraepithelial lesions(HSIL),and finally can develop into cervical invasive cancer.At present,the world has developed a relatively perfect cervical cancer prevention system.The primary prevention of cervical cancer is cervical cancer vaccination,and the secondary prevention is cervical cancer screening.The combination of the two is the most effective measure for cervical cancer prevention at present.At present,there is no clear conclusion on the susceptibility factors of cervical HPV infection,the factors of persistent HPV infection and the carcinogenic factors of accelerating HPV.Many studies believe that the occurrence of HPV infection may be related to vaginal microdysbiosis,Maintaining the balance of vaginal microenvironment is conducive to reducing the risk of HPV infection.The improvement of vaginal microecological imbalance is beneficial to the removal of HPV,which provides a new idea for the prevention and treatment of cervical cancer.Objective:1.The cervical HPV infection status and genotype distribution characteristics of 16,324 female patients were analyzed.2.The vaginal microecology of patients with HPV negative,HR-HPV infection,HR-HPV persistent infection and squamous intraepithelial lesion(SIL)were compared,and the correlations between HR-HPV infection and vaginal microdysbiosis and between SIL and vaginal microdysbiosis was analyzed,so as to provide theoretical basis for reducing the risk of HPV infection and prevention and treatment of cervical cancer.Methods:The clinical data of 16324 women who were fist screened for cervical cancer in DeZhou district from October 1,2017 to October 31,2019 were reviewed.All of them was performed HPV examination,some of them were performed liquid-based thin layer cytology(thinprep cytologic test,TCT),and some of them were examined by vaginal microbiological examination.The clinicopathological data of 1006 patients who underwent cervical cancer screening and then underwent colposcopy and cervical biopsy during the above period were analyzed.the status and distribution characteristics of cervical HPV infection in this region were summarized.By referring to the electronic medical record system and telephone follow-up,clinical data of patients who underwent vaginal microecological examination at the same time were collected,and 778 patients who met the inclusion criteria were retrospectively analyzed.The vaginal flora density,flora diversity,lactobacilli semi-quantitative,vaginal pH value,bacterial vaginosis(BV),trichomonal vaginitis(TV),vulvar vaginosis(VVC),hydrogen peroxide(H2O2),sialidinase,leucoesterase,β-glucuronidase in HPV negative group,HR-HPV positive group,HR-HPV persistent positive group,SIL group(including LSIL group and HSIL group)were compared.Chi-square test and Logistic regression analysis were used to determine the correlation between HR-HPV infection,SIL occurrence and vaginal microdysbiosis.Results:1.Among 16324 female patients,2858 were HPV positive,and the HPV infection rate was 17.51%.The infection rate of high-risk HPV was 14.38%.The first six subtypes were HPV16,hpv52,HPV58,hpv61,hpv56 and HPV6.2.Among 1006 patients who underwent colposcopy and cervical biopsy,single HPV infection was more common in all levels of cervical lesions,and the single HPV infection rate was the highest in patients with cervical cancer.3.The infection rate of HPV 16 was the highest in HSIL and cervical cancer patients,followed by HPV18,HPV58 and HPV 52,HPV16 infection rate of LSIL,HSIL and cervical squamous cell carcinoma increased gradually.HPV16 infection rate of cervical squamous cell carcinoma patients was the highest.Patients with squamous cell carcinoma were mainly infected with HPV16 and HPV18.HPV18 infection rate of cervical adenocarcinoma patients was the highest.4.The abnormal rate of vaginal flora density,the detection rate of Lactobacilli reduction,the proportion of pH>4.5,BV positive rate and sialidase positive rate in HR-HPV positive group was higher than those in HPV negative group(P<0.05).There was no significant difference in the positive rate of VVC,TV,H2O2,leukocyte esterase,β-glucuronidase and the abnormal rate of flora diversity between the two groups(P>0.05).5.There were no significant differences between HR-HPV persistent positive group and HPV positive group in the abnormal rate of vaginal flora density,abnormal rate of vaginal flora diversity,the detection rate of Lactobacilli reduction,proportion of pH>4.5,BV,VVC,TV,H2O2,sialidase,leukocyte esterase and β-glucuronidase(P>0.05).6.The positive rate of VVC in SIL group was significantly lower than that in HR-HPV positive group(P<0.05).There was no significant difference in other indexes between the two groups(P>0.05).7.The detection rate of Lactobacilli reduction in HSIL group was higher than LSIL group(P<0.05).There was no significant difference in other indexes between the two groups(P>0.05).8.Multiple regression analysis showed that abnormal concentration of vaginal flora,semi-quantitative reduction of Lactobacillus,pH>4.5 and positive BV associated with HR-HPV positivity were all significant variables(P<0.05).Semi-quantitative reduction of Lactobacillus,pH>4.5,and positive BV associated with HR-HPV continued positivity were all significant variables(P<0.05).Conclusion:1.Among 16324 female patients,the infection rate of cervical HPV was 17.51%.HPV single infection was the most common in all grades of cervical lesions.The infection rate of HPV16 was the highest in HSIL and cervical cancer patients,followed by HPV18,HPV58 and HPV 52.2.Cervical HR-HPV infection was associated with vaginal microdysbiosis.abnormal vaginal flora density,lactobacilli reduction,pH>4.5,and BV were independent risk factors for cervical HR-HPV infection.Lactobacilli reduction,pH>4.5,and BV were independent risk factors for HR-HPV persistent infection.3.The progression of SIL is related to the decrease of vaginal lactobacillus.VVC is a factor that reduces the risk of SIL.