Study On The Relationship Between Cervical Microvascular Changes And Prognosis Of HPV Infection Based On US-SR Technique

Objective:Cervical precancerous lesion can cause cancer,and its pathological basis is that High-risk human papillomavirus(HR-HPV)infected cervical lesions invade the cervical squamous epithelium.At present,there is a lack of accurate localization diagnosis measures.Timely and effective diagnosis and intervention measures are very important for the prevention and treatment of cervical lesions caused by HR-HPV infection.The local microvascular changes of the cervix may be the pathogenic basis of the progression of cervical lesions,and the observation of them can guide the diagnosis and prognosis of cervical lesions.Ultrasonic super-resolution microangiograp Hy(US-SR)can observe the vascular structure and blood flow in the deep part of the tissue,but it has not been used in the cervix.The purpose of this study is to explore the feasibility and effectiveness of US-SR in observing cervical microvessels,the changes of cervical microvessels,HPV infection status and vaginal microecology in women with HR-HPV infection after focused ultrasound(FU)treatment,and prove that FU intervention can improve the progression of cervical lesions in patients with HR-HPV infection.Materials and Methods:1.A total of 48 women with normal cervical cancer screening in Liuzhou Maternal and Child Health Hospital from December 2021 to January2022 were enrolled.The subjects were examined by colposcopy and US-SR sequentially.Using the primary US-SR equipment(ultrasonic probe transverse diameter 37.9mm,longitudinal diameter 27.3mm),three different cervical sites of each patient were randomly observed,and the data were collected and statistically analyzed to verify the feasibility of using US-SR to observe cervical microvessels and to explore the calculation method of correlation values of different characteristics of cervical microvessels under US-SR.The average vascular curvature and mean vascular velocity of normal cervical microvessels were calculated respectively.2.According to the results of the first part of the experiment,after technical improvement,175 women’s cervical data were collected from September 2022 to March 2023 in Liuzhou Maternal and Child Health Hospital and sequentially examined by colposcopy and US-SR.The improved US-SR equipment(ultrasonic probe transverse diameter 17.5mm,longitudinal diameter 6mm)was used to detect the average microvessel diameter,microvessel density,mean vascular curvature and mean vascular velocity at different levels of cervical lesions.The data were compared with those of normal people,and the data were collected and statistically analyzed.To find the numerical characteristics related to the different characteristics of cervical microvessels in different grades of cervical lesions.The above indexes detected by US-SR were compared with the pathological results by ROC curve to verify the specificity and sensitivity of US-SR in detecting cervical microvascular changes.3.A total of 169 women who received FU treatment for cervical HR-HPV infection from July 2020 to September 2022 were enrolled.Vaginal secretions were collected at admission and 3 months after FU treatment.Vaginal secretions were also collected from 101 patients with acute vaginitis after one week of drug treatment,and these samples were detected by HPV-DNA and vaginal microecology,and the data were compared and analyzed.Among them,34 women were willing to undergo US-SR examination before and 3 months after FU treatment,and their cervical microvascular data,HPV infection status and vaginal microecology data before and after operation were collected and compared.Results:1.The data of mean vascular curvature and mean vascular velocity at 3different cervical sites were randomly collected from 48 women with normal cervical cancer screening.There was no significant difference in the average blood flow velocity of cervical sites collected three times(P> 0.05).There was a significant statistical difference in the average vascular curvature of the cervical sites collected three times(P< 0.05).2.Among the 175 different cervical loci,there were 141 cases of normal cervical loci,6 cases of LSIL loci,10 cases of HSIL loci and 18 cases of cervical cancer loci.The average diameter,density,curvature and flow velocity of microvessels at the representative site 3.6.9.12 of the four quadrants of the normal cervix were not significantly different from those of141 different sites of the normal cervix(P> 0.05).There was no significant difference in the average diameter of microvessels among different cervical lesion sites(P> 0.05).The microvessel density in patients with cervical cancer was significantly lower than that in normal cervix(P< 0.05).The mean flow velocity of cervical microvessels in patients with HSIL was significantly lower than that in normal cervix(P< 0.05).The average vascular curvature of normal cervix,HSIL and cervical cancer patients was significantly higher than that of normal cervix and cervical cancer patients(all P< 0.05)Compared with the pathological results,the area under the ROC curve of mean vascular velocity,mean diameter and microvessel density of cervical microvessels under US-SR was less than 0.5.it can be considered that the mean vascular velocity,mean diameter and microvessel density of cervical microvessels under US-SR have no diagnostic value in diagnosing cervical precancerous lesions.The area under the ROC curve of average vascular curvature is 0.751,which is larger than 0.500.It can be considered that the average cervical vascular curvature has a certain diagnostic value for whether patients are diagnosed as cervical precancerous lesions.The maximum Yoden index was0.435,and the corresponding average vascular curvature was 4.0101.3.Of the 169 patients,101(59.7%)suffered from acute vaginitis when they entered the group.There was no inflammatory index after one week of targeted antibiotic treatment,but there was no significant difference in the diversity and density of vaginal flora,the proportion and function of Lactobacillus(negative rate of hydrogen peroxide and p H value)one week after treatment and before treatment.The normal flora rate was 40.3% when the patients were enrolled in the group,and increased to 93.5% 3 months after FU treatment.The differences of vaginal secretion parameters between the two groups were as follows: negative rate of hydrogen peroxide(37.3%vs.3.6%),positive rate of leukocyte esterase(54.4% vs.5.9%),positive rate of sialidase(38.5% vs.4.1%),positive rate of bacterial vaginitis(55% vs.4.7%),positive rate of fungal vaginitis(44.4% vs.5.9%),Positive rate of trichomonal vaginitis(7.1%vs.0).The difference was statistically significant(P< 0.01).The p H value and Nugent score at the beginning of treatment were significantly higher than those at 3 months after FU treatment(P< 0.01).The positive rates of HPV in patients with normal vaginal microecology and abnormal vaginal microecology 3 months after FU treatment were 5.8%,6.7% and 100%respectively after 3 months FU treatment,and there was significant difference among the three groups(P< 0.0l).The vaginal microecology was normal and abnormal 3 months after FU treatment.Among the 34 women who were willing to undergo US-SR examination before and 3 months after focused ultrasound(FU)treatment,the normal flora rate increased from 14.7% to67.6% 3 months after FU treatment.The differences of vaginal secretion parameters between the two groups were as follows: negative rate of hydrogen peroxide(64.7% vs.17.6%),positive rate of leukocyte esterase(82.3% vs.29.4%),positive rate of sialidase(64.7% vs.20.6%),positive rate of bacterial vaginitis(67.6% vs.23.5%),positive rate of fungal vaginitis(52.9%vs.26.4%),Positive rate of trichomonal vaginitis(8.8%vs.0).The differences were statistically significant(P< 0.05).The p H value and Nugent score at the beginning of treatment were significantly higher than those at 3 months after FU treatment(P< 0.01).The vaginal microecology was normal at the time of entering the group and 3 months after FU,and the vaginal microecology was abnormal when entering the group.The positive rates of HPV in the patients with abnormal vaginal microecology 3 months after FU,3 months after FU treatment and 3 months after FU treatment were 0,0 and 100%,respectively,there was significant difference among the three groups(P< 0.01).After 3months of FU treatment,there was a significant difference in the average vascular curvature between the HPV negative group and the FU group(P=0.00),but there was no significant difference between the HPV positive group and the FU group 3 months after FU treatment(P>0.05).Conclusion:1.Ultrasonic super-resolution microvascular imaging(US-SR)can be used to observe the microvascular structure and blood flow of cervical epithelium.The data of average diameter,microvessel density,mean vascular curvature and mean vascular flow velocity of cervical microvessels can be observed.2.The microvessel density,mean vascular velocity and mean vascular curvature of HSIL and cervical cancer observed by US-SR were significantly different from those of normal cervix,in which the average vascular curvature had a certain diagnostic value for the diagnosis of cervical precancerous lesions and may become a new method for the diagnosis of cervical lesions in the future.3.After FU treatment,the cervical microvascular state will be changed,the positive rate of cervical HR-HPV infection can be reduced,and the vaginal microecological environment can be improved.