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摘要:
目的 分析高危型人乳头瘤病毒(high-risk human papillomavirus，HR-HPV)感染的相关危险因素。 方法 选取2020年10月—2021年1月就诊于首都医科大学附属北京妇产医院妇科门诊的HR-HPV感染者作为感染组，同期于妇科门诊行子宫颈癌筛查且结果为HR-HPV阴性的患者作为对照组。两组均填写自行设计的《HR-HPV感染相关危险因素调查表》，统计分析HR-HPV感染相关危险因素。 结果 共纳入感染组患者125例，对照组患者53例。对两组进行单因素组间比较显示，感染组无业或职业社会经济地位较低、用洗剂清洁外阴、冲洗阴道频率高、性取向为同性、生育次数多、既往阴道炎病史、阴道分泌物量多、阴道分泌物性状异常和沙眼衣原体感染率均高于对照组(P均＜0.05)。多因素Logistic回归分析显示，生育史(OR=5.106，95% CI：1.521~17.145, P=0.008)、既往阴道炎病史(OR=3.910，95% CI：1.167~13.099, P=0.027)、阴道分泌物异常(OR=758.313，95% CI：58.151~9888.714, P＜0.001)是HR-HPV感染的危险因素。此外，用洗剂清洗外阴或冲洗阴道的清洁习惯(OR=2.004)、性取向为同性(OR=13.972)、沙眼衣原体阳性(OR=15.058)均显示出与HR-HPV感染具有较强的关联性，但由于对照组样本量较少，并未得出有统计学意义的结果。 结论 HR-HPV感染与多种因素相关，生育次数多、既往阴道炎病史、阴道分泌物性状异常是HR-HPV感染的危险因素，建议重视阴道分泌物变化，如有异常，及时就诊。在有条件的情况下，行宫颈HR-HPV筛查时加入阴道微生态的相关检查，如患有生殖道炎性疾病，应及时治疗，从多方面预防HR-HPV感染及降低HR-HPV持续感染的风险。 Abstract:Objective To investigate the relevant risk factors of high-risk human papillomavirus(HR-HPV) infection. Methods From October 2020 to January 2021, the cases of positive HR-HPV test were selected as the infection group, and the cases of negative HR-HPV test were selected as the control group. Both groups of patients filled in self-designed "survey of HR-HPV infection-related factors" in order to explore the relevant risk factors. Results A total of 125 patients in the infection group and 53 patients in the control group were included. Univariate analysis showed that there were statistically significant differences between the two groups in the following factors: unemployed or low socioeconomic status, vulva cleaning with lotion, high frequency of vaginal irrigation, homosexual orientation, production number, history of vaginitis, large amount of vaginal secretions, abnormal characteristics of vaginal secretion and chlamydia trachomatis infection(all P < 0.05). Logistic regression analysis showed that production number(OR=5.106, 95% CI: 1.521-17.145, P=0.008), previous history of vaginitis (OR=3.910, 95% CI: 1.167~13.099, P=0.027) and abnormal vaginal secretion (OR=758.313, 95% CI: 58.151~9888.714, P < 0.001) were risk factors for HR-HPV infection. In addition, the habit of using lotion to clean the vulva or vagina(OR=2.004), homosexual orientation (OR=13.972), and chlamydia trachomatis infection (OR=15.058) all showed a strong association with HR-HPV, but due to the small number of samples in the control group, no conclusions with statistical significance were drawn. Conclusions HR-HPV papillomavirus infection is associated with a variety of factors. Production number, history of vaginitis and abnormal characteristics of vaginal secretion are risk factors for HR-HPV infection. It is therefore recommended to pay attention to the characteristics of vaginal secretions, and timely seek medical treatment if there is any abnormality. If possible, cervical HR-HPV screening should be added to the vaginal microecological examination. If there are reproductive tract inflammatory diseases, it should be treated in time, so as to prevent HR-HPV infection from many aspects and reduce the risk of continuing infection of HR-HPV. -
Key words:
- human papillomavirus /
- vaginitis /
- chlamydia trachomatis /
- mycoplasma genitalium /
- risk factors
作者贡献：王晓丹负责实验组标本收集、查阅文献、撰写初稿；张展负责对照组标本收集、设计并指导研究对象填写问卷；刘朝晖负责修订论文。利益冲突：所有作者均声明不存在利益冲突 -
表 1 HR-HPV感染相关因素的单因素分析[n(%)]
因素 类别 感染组(n=125) 对照组(n=53) P值 因素 类别 感染组(n=125) 对照组(n=53) P值 年龄 20~24岁 2(1.6) 4(7.6) 0.762 性生活方式 单纯经阴道 110(88.0) 46(86.8) 0.823 25~29岁 19(15.2) 7(13.2) 方式多样 15(12.0) 7(13.2) 30~34岁 32(25.6) 10(18.9) 避孕方式 规范用避孕套 66(52.8) 29(54.7) 0.473 35~39岁 37(29.6) 16(30.2) 口服避孕药 3(2.4) 0(0) 40~44岁 16(12.8) 13(24.5) 宫内节育器 11(8.8) 3(5.7) 45~49岁 19(15.2) 3(5.7) 多种方式 17(13.6) 12(22.6) 受教育程度 专科或以下 40(32.0) 13(24.5) 0.302 未避孕 28(22.4) 9(17.0) 本科 62(49.6) 28(52.8) 生育次数 0次 37(29.6) 24(45.3) 0.034 研究生或以上 23(18.4) 12(22.6) 1次 60(48.0) 22(41.5) 职业 无 11(8.8) 2(3.8) ＜0.001 2次 28(22.4) 7(13.2) 工人/农民 11(8.8) 2(3.8) 3次 0(0) 0(0) 医疗卫生业 7(5.6) 15(28.3) 流产次数 0次 50(40.0) 18(34.0) 0.626 文艺工作者 3(2.4) 4(7.6) 1次 36(28.8) 15(28.3) 金融/经济 8(6.4) 6(11.3) 2次 23(18.4) 18(34.0) 信息技术业 7(5.6) 1(1.9) 3次 16(12.8) 2(3.8) 公务员 6(4.8) 0(0) 既往阴道炎病史 无 31(24.8) 24(45.3) ＜0.001 其他 72(57.6) 23(43.4) 有 73(58.4) 28(52.8) 月收入 ＜5000元 29(23.2) 8(15.1) 0.653 反复发作 21(16.8) 1(1.9) 5000~10 000元 43(34.4) 23(43.4) 阴道分泌物量 少 59(47.2) 6(11.3) ＜0.001 ＞10 000元 53(42.4) 22(41.5) 中等 53(42.4) 45(84.9) 吸烟 否 114(91.2) 52(98.1) 0.112 多 13(10.4) 2(3.8) 是 11(8.8) 1(1.9) 阴道分泌物性状 白色稀薄 98(78.4) 7(13.2) ＜0.001 酗酒 否 119(95.2) 53(100) 0.181 黄色均质 21(16.8) 5(9.4) 是 6(4.8) 0(0) 泡沫样 2(1.6) 0(0) 清洁外阴方式 清水 105(84.0) 51(96.2) 0.023 豆腐渣样 1(0.8) 0(0) 洗剂 20(16.0) 2(3.8) 血性 2(1.6) 1(1.9) 冲洗阴道 否 82(65.6) 46(86.8) 0.005 正常 1(0.8) 40(75.5) 偶尔 39(31.2) 6(11.3) 分泌物清洁度 Ⅰ度 95(76.0) 44(83.0) 0.281 经常 4(3.2) 1(1.9) Ⅱ度 24(19.2) 8(15.1) 是否经常使用护垫 否 53(42.4) 17(32.1) 0.319 Ⅲ度 6(4.8) 1(1.9) 偶尔 68(54.4) 36(67.9) 外阴红肿 无 125(100.0) 53(100.0) 1.000 经常 4(3.2) 0(0) 轻度 0(0) 0(0) 月经是否规律 否 29(23.2) 6(11.3) 0.068 严重 0(0) 0(0) 是 96(76.8) 47(88.7) 宫颈口脓性分泌物 无 122(97.6) 53(100.0) 0.556 是否已婚 否 24(19.2) 12(22.6) 0.601 有 3(2.4) 0(0) 是 101(80.8) 41(77.4) 外阴或阴道烧灼痛 无 120(96.0) 51(96.2) 0.966 初次性生活年龄 ＜15岁 4(3.2) 3(5.7) 0.980 轻度 5(4.0) 1(1.9) 15~20岁 35(28.0) 13(24.5) 严重 0(0) 1(1.9) > 20岁 86(68.8) 37(69.8) CT 阴性 109(87.2) 2(98.1) 0.024 性伴侣数 1人 99(79.2) 40(75.5) 0.582 阳性 16(12.8) 1(1.9) 2人 26(20.8) 13(24.5) MG 阴性 123(98.4) 2(98.1) 0.892 性取向 同性 19(15.2) 2(3.8) 0.031 阳性 2(1.6) 1(1.9) 异性 106(84.8) 51(96.2) HR-HPV: 高危型人乳头瘤病毒；CT: 沙眼衣原体；MG: 生殖支原体 
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表 2 HR-HPV感染相关因素的Logistic回归分析
变量 偏回归系数 标准误 Wald χ2值 P值 OR值 95% CI 下限 上限 职业(白领/蓝领或无业) 0.114 0.497 0.053 0.819 0.818 0.113 5.930 职业(其他/蓝领或无业) -0.428 0.423 1.027 0.311 0.476 0.081 2.796 清洁习惯(有/无) 0.348 0.308 1.274 0.259 2.004 0.599 6.704 性取向(同性/异性) 1.319 1.026 1.653 0.199 13.972 0.251 778.222 生育史(有/无) 0.815 0.309 6.961 0.008 5.106 1.521 17.145 既往阴道炎病史(有/无) 0.682 0.309 4.884 0.027 3.910 1.167 13.099 阴道分泌物异常(是/否) 3.316 0.655 25.613 ＜0.001 758.313 58.151 9888.714 CT(阳性/阴性) 1.356 0.733 3.419 0.064 15.058 0.850 266.756 HR-HPV、CT: 同表 1
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[1] Zhang J, Cheng K, Wang Z. Prevalence and distribution of human papillomavirus genotypes in cervical intraepithelial neoplasia in China: a meta-analysis[J]. Arch GynecolObstet, 2020, 302: 1329-1337. [2] Cruz-Gregorio A, Aranda-Rivera AK, Pedraza-Chaverri J. Human Papillomavirus-related Cancers and Mitochondria[J]. Virus Res, 2020, 286: 198016. doi: 10.1016/j.virusres.2020.198016 [3] Norenhag J, Du J, Olovsson M, et al. The vaginal microbiota, human papillomavirus and cervical dysplasia: a systematic review and network meta-analysis[J]. BJOG, 2020, 127: 171-180. doi: 10.1111/1471-0528.15854 [4] Xie L, Li Q, Dong X, et al. Investigation of the association between ten pathogens causing sexually transmitted diseases and high-risk human papilloma virus infection in Shanghai[J]. Mol Clin Oncol, 2021, 15: 132. doi: 10.3892/mco.2021.2294 [5] 赵敬, 杨金豪, 张文帆, 等. 2009—2020年中国女性生殖道支原体、衣原体和人乳头瘤病毒感染与宫颈癌发生相关性的Meta分析[J]. 天津医科大学学报, 2021, 27: 396-400. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYK202104019.htm [6] Tamarelle J, Thiébaut ACM, de Barbeyrac B, et al. The vaginal microbiota and its association with human papillomavirus, Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections: a systematic review and meta-analysis[J]. Clin Microbiol Infect, 2019, 25: 35-47. doi: 10.1016/j.cmi.2018.04.019 [7] 秦丽欣, 封露露, 刘晓旭, 等. 石家庄地区部分女性高危型人乳头瘤病毒感染情况和相关危险因素分析[J]. 中国妇幼保健, 2021, 16: 3771-3774. doi: 10.19829/j.zgfybj.issn.1001-4411.2021.16.036 [8] 廖琪. 2368例女性健康体检者HPV感染相关因素分析[J]. 中国性科学, 2017, 26: 54-56. https://www.cnki.com.cn/Article/CJFDTOTAL-XKXZ201702018.htm [9] 魏丽惠. HPV感染现状及在宫颈癌和癌前病变筛查中的意义[J]. 实用妇产科杂志, 2017, 2: 81-83. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ201702002.htm [10] 陈春林. 中国宫颈癌临床诊疗与大数据[J]. 中国实用妇科与产科杂志, 2018, 34: 25-29. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF201801008.htm [11] 柳铮男, 谢静燕. 阴道微生物与子宫颈HPV感染及子宫颈病变的关系[J]. 实用妇产科杂志, 2022, 1: 33-36. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202201011.htm [12] 侯月敏, 安瑞芳. 阴道内环境与HPV感染[J]. 实用妇产科杂志, 2021, 12: 887-889. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202112003.htm [13] 叶雨蓝. 高危型人乳头瘤病毒阳性宫颈鳞状上皮内病变患者的高危型人乳头瘤病毒分型及阴道微生态特点[J]. 中国妇幼保健, 2022, 5: 809-812. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202205010.htm [14] 黄晓澜, 王冬冬, 杨清. 阴道炎症与宫颈癌发生的相关性研究进展[J]. 中国微生态学杂志, 2019, 31: 485-489. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWS201904027.htm [15] Mosmann JP, Zayas S, Kiguen AX, et al. Human papillomavirus and Chlamydia trachomatis in oral and genital mucosa of women with normal and abnormal cervical cytology[J]. BMC Infect Dis, 2021, 21: 422. [16] Adebamowo SN, Ma B, Zella D, et al. Mycoplasma hominis and Mycoplasma genitalium in the Vaginal Microbiota and Persistent High-Risk Human Papillomavirus Infection[J]. Front Public Health, 2017, 5: 140. [17] Naldini G, Grisci C, Chiavarini M, et al. Association between human papillomavirus and chlamydia trachomatis infection risk in women: a systematic review and meta-analysis[J]. Int J Public Health, 2019, 64: 943-955. [18] Koster S, Gurumurthy RK, Kumar N, et al. Modelling Chlamydia and HPV co-infection in patient-derived ectocervix organoids reveals distinct cellular reprogramming[J]. Nat Commun, 2022, 13: 1030. [19] 郭凤, 黄伟, 王佩红, 等. 阴道微生态与HPV感染及宫颈病变的关系探讨[J]. 临床医学研究与实践, 2022, 9: 17-20. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202209006.htm [20] 罗燕艳, 罗小婉, 符丽华, 等. 宫颈高危型HPV感染后的转归与阴道微生态的相关性分析[J]. 中国微生态学杂志, 2022, 5: 585-589. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWS202205018.htm -
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