Relationship Between Vaginal Microecology And Cervical Squamous Intraepithelial Lesions With High-risk HPV Positive

Background: Cervical cancer is one of the most common female diseases in the world.Human papillomavirus(HPV)has been identified as the cause of cervical cancer.HPV16 and HPV18 are known as high-risk HPV because of their high carcinogenicity.However,the reverse rate of HPV positive is found to be high,only a few people have persistent infection,and then develop into detectable cervical lesions,such as lowgrade squamous intraepithelial lesion(LSIL),high-grade squamous intraepithelial lesion(HSIL),and even cervical cancer.Many studies believe that this process may be related to the change of vaginal microenvironment.The female vaginal microecology environment which directly affects cervical health,is mainly composed of its anatomical structure,microbial flora,immune cells and endocrine factors.Vaginal flora restrict and coordinate with the host and vaginal microenvironment in order to maintain the dynamic balance of vaginal microenvironment.If the homeostasis of vaginal microecological flora is unbalanced and the immune system is damaged,foreign microorganisms or viruses are more likely to invade the genital tract and cause lesions,thus increasing the risk of cancer.Objective: Investigating the relationship between vaginal microecology and cervical squamous intraepithelial lesion(SIL)in patients with high-risk HPV positive cervical lesions to analyze the correlation between the changes of vaginal microecology and high-risk HPV positive cervicitis and SIL,and to explore the clinical significance of vaginal Microecology in the diagnosis,treatment and prevention of high-risk HPV positive SIL,so that we can prevent and treat SIL more effectively and even help us to draw up the risk assessment plan.The investigation results may even further guide the treatment plan of SIL patients,develop new preparations and / or administration plan.Methods: 719 women with high-risk HPV positive whose cervical pathological results were confirmed by colposcopy,cervical biopsy or LEEP were selected from the Department of Gynecology in Shanghai Tenth People’s Hospital from April 2019 to December 2020.According to the pathological results,the patients were divided into LSIL group(n=183),HSIL group(n=146)as the study groups,and benign cervical pathological changes group(n=390)as the control group.The results of vaginal microecology test before operation were retrospectively analyzed,and the differences of vaginal microecology between the study group and the control group were compared,including flora density,flora diversity,lactobacillus proportion,bacterial vaginitis(BV),vulvovaginal candidiasis(VVC),trichomonas vaginitis(TV),p H,H2O2,sialyl glycosidase and leukocyte esterase.Result:1.In terms of vaginal microecological morphology,compared with the control group,the bacterial diversity of LSIL group and HSIL group increased,the difference was statistically significant(P < 0.05)and had a linear upward trend(P < 0.05).2.In terms of vaginal microecological function,compared with the control group,the content of H2O2 in LSIL group and HSIL group decreased significantly(P < 0.05)and had a linear downward trend(P < 0.05).3.In terms of vaginal pathogens,compared with the control group,the infection rate of BV in LSIL group and HSIL group increased,the difference was statistically significant(P < 0.05)and had a linear upward trend(P < 0.05).4.The ordered logistic regression risk model of high-risk HPV positive SIL showed that the decrease of bacterial diversity was a protective factor for SIL(OR = 0.587,95%CI: 0.368-0.943),BV was a risk factor for the occurrence and development of SIL(OR= 2.564,95% CI: 1.457-4.510)HPV 16 / 18 + other mixed infection(OR = 2.356,95%CI: 1.618-3.429)was a risk factor for the occurrence and development of SIL.Conclusion:1.The imbalance of vaginal microecology,such as the increase of bacterial diversity,the decline of Lactobacillus function and BV infection,is highly correlated with the development of high-risk HPV positive SIL.2.Vaginal microecology test may be used as a potential auxiliary method for diagnosis and treatment of high-risk HPV positive SIL.3.Correcting the imbalance of vaginal microecology can assist the further treatment of high-risk HPV positive SIL.