Analysis of Vaginal Microecological in Women with Cervical Intraepithelial Neoplasia and Cervical Cancer
-
摘要:
目的 研究宫颈上皮内瘤变和宫颈癌患者阴道微生态特点，为宫颈疾病预防和治疗提供参考。 方法 选取昆明医科大学第三附属医院（云南省肿瘤医院）2018年7月至2018年10月病理诊断为宫颈上皮内瘤变患者（n = 65）、宫颈癌患者（n = 51）和同期体检健康女性（n = 88）为研究对象，收集阴道拭子，通过显微镜镜检进行微生态评价。 结果 与健康组相比，宫颈上皮内瘤变组在菌群密集度构成上，差异有统计学意义（P < 0.05），在菌群多样性、优势菌、pH、Nugent评分构成上，差异无统计学意义（P > 0.05）。宫颈癌组与健康组在菌群密集度、优势菌、pH、Nugent评分构成上，差异均有统计学意义（P < 0.05），在菌群多样性构成上，差异无统计学意义（P > 0.05）。 结论 宫颈上皮内瘤变和宫颈癌患者阴道微生态失调，以宫颈癌失调最为显著。尽早发现阴道微生态失调，恢复阴道微生态平衡，有利于防治宫颈癌。 Abstract:Objective To investigate the characteristics of vaginal microecology in patients with cervical intraepithelial neoplasia and cervical cancer, and provide information for the prevention and treatment of cervical diseases. Methods From July 2018 to October 2018, patients with cervical intraepithelial neoplasia （n = 65）, patients with cervical cancer （n = 51） and healthy control （n = 88） in Yunnan Cancer Hospital were selected. Vaginal swabs were collected and microecological assessment were performed by microscopic examination. Results Compared with healthy group, there was a significant difference in the composition of bacterial density in the cervical intraepithelial neoplasia group （P < 0.05）, despite there was no significant difference in flora diversity, dominant bacteria, pH and Nugent score （P > 0.05）. There were significant differences in flora density, dominant bacteria, pH and Nugent score composition between the cervical cancer group and the healthy group （P < 0.05） and there was no significance in the composition of bacterial diversity （P > 0.05）. Conclusion Patients with cervical intraepithelial neoplasia and cervical cancer have microecological imbalance, especially in cervical cancer patients. Early detection and restoration of female vaginal microecological imbalance are beneficial for the prevention and treatment of cervical cancer. -
表 1 健康组、宫颈上皮内瘤变组阴道微生态比较[n（%）]
Table 1. Comparison of vaginal microecology between healthy control and cervical intraepithelial neoplasia group [n（%）]
项目 健康组（n = 88） 宫颈上皮内瘤变组（n = 65） χ2/Z P 菌群密集度 未见/Ⅰ级 40（45.45） 44（67.69） −2.641 0.009* Ⅱ/Ⅲ级 48（54.55） 20（30.77） Ⅳ级 0（0.00） 1（1.54） 菌群多样性 −0.867 0.386 未见/Ⅰ级 74（84.09） 58（89.23） Ⅱ/Ⅲ级 14（15.91） 6（9.23） Ⅳ级 0（0.00） 1（1.54） 优势菌 革兰阳性大杆菌 62（70.45） 52（80.00） 5.174 0.159 革兰阳性球菌 4（4.55） 2（3.08） 革兰阴性短杆菌 1（1.14） 3（4.62） 无 21（23.86） 8（12.30） pH 3.8～4.5 51（57.95） 47（73.31） 3.345 0.067 > 4.6 37（42.05） 18（27.69） Nugent评分（分） 0～3 54（56.81） 46（70.77） −1.366 0.172 4～6 30（34.09） 19（29.23） > 7 4（9.09） 0（0.00） 与健康组比较，*P < 0.05。 
下载: 导出CSV
表 2 健康组、宫颈癌组阴道微生态比较[n（%）]
Table 2. Comparison of vaginal microecology between healthy control and cervical cancer group [n（%）]
项目 健康组（n = 88） 宫颈癌组（n = 51） χ2/Z P 菌群密集度 未见/Ⅰ级 40（45.45） 36（70.59） −2.859 0.004* Ⅱ/Ⅲ级 48（54.55） 15（29.41） Ⅳ级 0（0.00） 0（0.00） 菌群多样性 未见/Ⅰ级 74（84.09） 45（88.24） −0.816 0.537 Ⅱ/Ⅲ级 14（15.91） 5（9.80） Ⅳ级 0（0.00） 1（1.96） 优势菌 革兰阳性大杆菌 62（70.45） 23（45.10） 10.543 0.014* 革兰阳性球菌 4（4.55） 8（15.69） 革兰阴性短杆菌 1（1.14） 2（3.92） 无 21（23.86） 18（35.29） pH 3.8～4.5 51（57.95） 10（19.61） 19.28 < 0.001* > 4.6 37（42.05） 41（80.39） Nugent评分（分） 0～3 54（61.36） 17（33.33） −2.948 0.003* 4～6 30（34.09） 32（62.75） > 7 4（0.05） 2（3.92） 与健康组比较，*P < 0.05。
下载: 导出CSV
-
[1] Bray F,J Ferlay,I Soerjomataram,et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin,2018,68(6):394-424. doi: 10.3322/caac.21492 [2] Kovachev S M. Cervical cancer and vaginal microbiota changes[J]. Arch Microbiol,2020,202(2):323-327. doi: 10.1007/s00203-019-01747-4 [3] Wang H,Y Ma,R Li,et al. Associations of cervicovaginal lactobacilli with high risk human papillomavirus infection,cervical intraepithelial neoplasia,and cancer:A systematic review and meta-analysis[J]. J Infect Dis,2019,220(8):1243-1254. doi: 10.1093/infdis/jiz325 [4] Norenhag J,J Du,M Olovsson,et al. The vaginal microbiota,human papillomavirus and cervical dysplasia:A systematic review and network meta-analysis[J]. BJOG,2020,127(2):171-180. doi: 10.1111/1471-0528.15854 [5] Chao X P,Sun T T,Wang S,et al. Correlation between the diversity of vaginal microbiota and the risk of high-risk human papillomavirus infection[J]. Int J Gynecol Cancer,2019,29(1):28-34. doi: 10.1136/ijgc-2018-000032 [6] Nugent R P,Krohn M A,Hillier S L. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain inte rpretation[J]. J Clin Microbiol,1991,29(2):297-301. doi: 10.1128/jcm.29.2.297-301.1991 [7] 刘萍. 中国大陆13年宫颈癌临床流行病学大数据评价[J]. 中国实用妇科和产科杂志,2018,34(1):41-45. [8] Wheeler C M. The natural history of cervical human papillomavirus infections and cervical cancer:Gaps in knowledge and future horizons[J]. Obstet Gynecol Clin North Am,2013,40(2):165-176. doi: 10.1016/j.ogc.2013.02.004 [9] 刘洋,卿清,孙春意,等. Beclin-1、LC3-Ⅱ在宫颈病变组织中的表达及意义[J]. 昆明医科大学学报,2019,40(3):24-28. doi: 10.3969/j.issn.1003-4706.2019.03.005 [10] Liang Y,Chen M,Qin L,et al. A meta-analysis of the relationship between vaginal microecology,human papillomavirus infection and cervical intraepithelial neoplasia[J]. Infect Agent Cancer,2019,14(1):1-8. doi: 10.1186/s13027-018-0209-2 [11] Kwasniewski W,Wolun-Cholewa M,Kotarski J,et al. Microbiota dysbiosis is associated with HPV-induced cervical carcinogenesis[J]. Oncol Lett,2018,16(6):7035-7047. [12] Zheng J J,J H Song,C X Yu,et al. Difference in vaginal microecology,local immunity and HPV infection among childbearing-age women with different degrees of cervical lesions in inner mongolia[J]. BMC Womens Health,2019,19(1):109. doi: 10.1186/s12905-019-0806-2 [13] 陈剑,赵恩锋,鲍嫘,等. 宫颈癌癌前病变及宫颈癌患者阴道微生态失调相关因素[J]. 中国微生态学杂志,2020,32(8):942-945. [14] Jones S E,Versalovic J. Probiotic Lactobacillus reuteri biofilms produce antimicrobial and anti-inflammatory factors[J]. BMC Microbiol,2009,9(1):35. doi: 10.1186/1471-2180-9-35 [15] Wang K D,Xu DJ,Wang B Y,et al. Inhibitory effect of vaginal lactobacillus supernatants on cervical cancer cells[J]. Probiotics Antimicrob Proteins,2018,10(2):236-242. doi: 10.1007/s12602-017-9339-x [16] Chuah L O,Foo H L,Loh T C,et al. Postbiotic metabolites produced by Lactobacillus plantarum strains exert selective cytotoxicity effects on cancer cells[J]. BMC Complement Altern Med,2019,19(1):114. doi: 10.1186/s12906-019-2528-2 [17] Laniewski P,Barnes D,Goulder A,et al. Linking cervicovaginal immune signatures,HPV and microbiota composition in cervical carcinogenesis in non-hispanic and hispanic women[J]. Sci Rep,2018,8(1):7593. doi: 10.1038/s41598-018-25879-7 [18] Ritu W,Enqi W,Zheng S,et al. Evaluation of the associations between cervical microbiota and HPV infection,clearance,and persistence in cytologically normal women[J]. Cancer Prev Res(Phila),2019,12(1):43-56. doi: 10.1158/1940-6207.CAPR-18-0233 [19] Usyk M,Zolnik C P,Castle P E,et al. Cervicovaginal microbiome and natural history of HPV in a longitudinal study[J]. PLoS Pathog,2020,16(3):e1008376. doi: 10.1371/journal.ppat.1008376 [20] Mitra A,MacIntyre D A,Ntritsos G,et al. The vaginal microbiota associates with the regression of untreated cervical intraepithelial neoplasia 2 lesions[J]. Nature communications,2020,11(1):1999. doi: 10.1038/s41467-020-15856-y [21] 逯彩虹,李保红,李小斌,等. 宫颈癌患者阴道微生物的分布特点[J]. 中国医科大学学报,2011,40(3):267-271. [22] 刘晓霞,何茵芳. 宫颈癌对阴道内环境及常见菌群的影响[J]. 实用癌症杂志,2015,30(8):1135-1138. doi: 10.3969/j.issn.1001-5930.2015.08.009 [23] Laniewski P,Cui H,Roe D J,et al. Features of the cervicovaginal microenvironment drive cancer biomarker signatures in patients across cervical carcinogenesis[J]. Sci Rep,2019,9(1):7333. doi: 10.1038/s41598-019-43849-5 [24] Silva C,Almeida E C,Côbo Ede C,et al. A retrospective study on cervical intraepithelial lesions of low-grade and undetermined significance:Evolution,associated factors and cytohistological correlation[J]. Sao Paulo Med J,2014,132(2):92-96. doi: 10.1590/1516-3180.2014.1322579 -
