The Cervical Hr Hpv Infection And The Relationship Of Tcm Constitution And Vaginal Immune Microenvironment

Cervical cancer is the second leading cause of cancer death in women, exceeded only by breast cancer. And persistent infection with high-risk human papillomavirus (HR-HPV) has been widely recognized to be the main cause of cervical intraepithelial neoplasia (CIN) and cervical cancer. About20%women with intercourse experience can be infected with HPV. But most of patients infected with HR-HPV could eliminate the viruses naturally, only about15%of them will be persistent infected and finally develop into CIN and cervical cancer. The virus itself and environmental factors can not completely explain this fact; maybe the constitution type of the host is one of important factors which affect the outcome of HR-HPV infection. The relation between TCM-based constitution and disease is one of the hotspots in clinical research of TCM at present. But few similar reports on HR-HPV persistent infection have been published. On the other hand, persistent infection with HR-HPV is relevant to the dynamic changes of local immune microenvironment. It has been confirmed by clinical and experimental data that imbalance of Thl/Th2has a certain relation to the natural course of HPV related diseases.Objective:To explore the trend of Thl/Th2bias in cervical-vaginal lavage fluid and its effect on the development of HR-HPV persistent infection by comparing the level of Thl type cytokines (IFN-γ) and Th2type cytokines (IL-10) between CIN patients and healthy subjects. And to evaluate the value of TCM-based constitution for diagnosing and predicting the cervical disease.Methods:Retrospective analyze clinical information of146patients received fluid based thin-layer cytological test (TCT) at Gynecologic Department of Dong Fang hospital and86patients who received HC-II Test and colposcopy with multiple punch biopsies because of abnormal cervical cytological specimen or high-grade clinical suspicion. According to cytological and pathological diagnosis, the patients were divided into three groups:(①inflammatory group(as normal control group);②CIN I;③IN II-III. The concentrations of IFN-y and IL-10in cervical-vaginal lavage fluid were determined with ELISA. And according to TCM Constitution classification and criterion, by means of questionnaire method, they arc categorized into nine constitution types namely that gentleness type, qi-deficiency type, yang-deficiency type, yin-deficiency type, phlegm-wet type, wetness-heat type, blood-stasis type, qi-depression type, special inherited type. Adopt Microsoft Excel to establish a database, and use SPSS16.0statistical software to analyze the data.Results:1. Risk factors of HR-HPV persistence:Univariate analysis showed that risk factors with statistical significance included smoking,delivery mode,pregnancy,educational background, diet habit.2. Distribution of physical types of the CIN I group,there were13patjents in wetness-heat type(28.26%),9in gentleness type(19.57%),7in qi-deficiency type(15.22%), and other types were17patients(36.96％).And in the CIN II-III group,the wetness-heat type was the most(27.50%)and qi-deficiency type(17.50%)and phlegm-wet type(15.00%)were in the next place.Contrasting to control group,there were18cases in gentleness type (30.00%),12in yang-deficiency type(20.00%)and9in qi-depression type(15.00%).As compared with the normal control group,distribution frequency of wetness-heat type and qi-deficiency type in the CIN group was significant higher(P<0.01).3.The level of IFN-γ produced by Thl cells was lowet in patients of CIN than that of normal controls,there were significant difference between them(P<0.01).The level of IL-10produced by Th2cells was different in three groups too,but it had no obvious correlation with lesion degree.Conclusion:1.The physical types of CIN concentrate upon wetness-heat type and qi-defjciency type, which may be the susceptible physical types of HR-HPV persistence. And it suggests association of HR-HPV persistent infection with constitution type in TCM of women.2.Persistent infection with HR-HPV is relevant to the dynamic changes of local immune microenvironment.Th1/Th2is imbalance in cervical intraepithelial neoplasia.Th1type cytokines are inhibited,and Th2type cytokines are relatively enhanced,so Th1/Th2shifts to Th2.It may play an important role in the immunity inhibition and lead to HR-HPV persistent infection.