沙眼衣原体感染与生殖道人乳头瘤病毒感染的关系及其与宫颈病变发生的相关性研究

发布时间：2018-08-31 09:19

【摘要】：目的研究女性生殖道人乳头瘤病毒(human papilloma virus,HPV)感染与沙眼衣原体(Chlamydia trachomatis,CT)感染的关系,及其与宫颈癌前病变和宫颈癌发生的相关性。方法以妇产科门诊患者540例为研究对象,所有患者均行HPV、CT和宫颈细胞学检查。对疑似宫颈病变的患者进一步行宫颈活检。根据HPV检测结果,将HPV检测阳性的患者140例设为观察组,HPV检测阴性的患者400例设为对照组,分析生殖道HPV感染与CT感染的相关性,以及其与宫颈病变发生的相关性。结果观察组宫颈病变发生率(21.4%)显著高于对照组(1.3%,P0.000 1)。按照HPV感染分型,进一步将观察组分为高危组(78例)、低危组(32例)和混合感染组(30例)。高危组(25.6%)和混合感染组(26.7%)宫颈病变发生率均显著高于低危组(6.3%,P=0.009;P=0.019)。同时,观察组CT感染率(27.1%)显著高于对照组(3.3%,P0.000 1)。HPV感染患者中,高危组(33.3%)和混合感染组(36.7%)的CT感染率均显著高于低危组(3.1%,P=0.021;P=0.019)。依据是否存在C T感染将观察组患者分为H P V单纯感染组和C T混合感染组。结果显示后者宫颈病变率(57.8%)显著高于前者(25.5%,P=0.046)。且CT混合感染组,高危HPV和混合HPV感染患者宫颈病变的发生率分别为39.3%和50.0%,均明显高于HPV单纯感染组中高危HPV和混合HPV感染患者,其发生率分别为16.0%和15.4%,差异均具有统计学意义(P=0.026和P=0.017)。Logistic回归分析显示高危型HPV感染(OR=2.180,P=0.018)、HPV和CT混合感染(OR=6.690,P=0.012)是宫颈病变发生的风险因素。结论女性生殖道CT感染与HPV感染密切相关,HPV和CT混合感染是宫颈癌前病变和癌变的独立风险因素。通过早期筛查女性生殖道HPV感染和CT感染,及时有效地治疗微生物混合感染,对进一步降低宫颈癌前病变和宫颈癌的发病率,提高临床治疗效果具有重要意义。
[Abstract]:Objective to study the relationship between human papillomavirus (human papilloma virus,HPV) infection and chlamydia trachomatis (Chlamydia trachomatis,CT) infection in female genital tract. Methods 540 outpatients with gynecology and obstetrics were studied. All patients were examined by HPV,CT and cervical cytology. Further cervical biopsies were performed in patients suspected of cervical lesions. According to the results of HPV test, 140 patients with positive HPV were set up as the control group. The relationship between HPV infection and CT infection in the genital tract and the occurrence of cervical lesions were analyzed. Results the incidence of cervical lesions in the observation group (21.4%) was significantly higher than that in the control group (1.3%, P 0.000 1). According to HPV infection classification, the observation group was further divided into high risk group (78 cases), low risk group (32 cases) and mixed infection group (30 cases). The incidence of cervical lesions in high risk group (25.6%) and mixed infection group (26.7%) was significantly higher than that in low risk group (6.3P 0.009). At the same time, the CT infection rate in the observation group (27.1%) was significantly higher than that in the control group (3.30.000 1). The CT infection rate in the high-risk group (33.3%) and the mixed infection group (36.7%) was significantly higher than that in the low-risk group (3.1%). According to the presence of C T infection, the patients in the observation group were divided into H P V infection group and C T mixed infection group. The results showed that the rate of cervical lesions in the latter group (57.8%) was significantly higher than that in the former (25.5%). The incidence of cervical lesions in CT mixed infection group, high risk HPV and mixed HPV infection group was 39.3% and 50.0%, respectively, which was significantly higher than that in high risk HPV infection group and mixed HPV infection group. The incidence rate was 16.0% and 15.4%, respectively. The difference was statistically significant (P0. 026 and P0. 017). Logistic regression analysis showed that high risk HPV infection (OR=2.180,P=0.018) and mixed CT infection (OR=6.690,P=0.012) were risk factors of cervical lesions. Conclusion the co-infection of CT and CT in female genital tract is an independent risk factor for precancerous lesions and carcinogenesis. The early screening of HPV infection and CT infection in female genital tract and the timely and effective treatment of mixed microbial infection are of great significance to further reduce the incidence of cervical precancerous lesions and cervical cancer and to improve the clinical therapeutic effect.
【作者单位】：重庆市铜梁区妇幼保健院重庆市铜梁区妇幼保健计划生育服务中心妇产科;第三军医大学大坪医院妇产科;上海交通大学医学院附属瑞金医院妇产科;
【基金】：重庆市卫生适宜技术推广项目(2016jstg027)~~
【分类号】：R737.33

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