A Correlation Between Female Vaginal Microecology And High-risk Human Papillomavirus Infection: A Meta-analysis

Objective: To systematically evaluate the correlation between female vaginal microecology and high-risk Human Papilloma Virus(HPV)infection,so as to provide a basis for clinical prevention and treatment of HPV infection and cervical lesions.Methods: A search strategy was developed based on PICOS principles to systematically retrieve published literature in Chinese/English on the correlation between vaginal microecology and high-risk human papillomavirus.Website databases include China Biomedical Literature Database(CBM),CNKI,VIP,Wanfang Database,Pubmed,Embase and Cohrane library databases.A search method combining subject words and free words is used,and a secondary search is performed based on references in the original document.The retrieval date is from the establishment of the database to February 1,2020.Two researchers screened the documents according to the inclusion and exclusion criteria,and used the Newcastle-Ottawa scale to evaluate the quality of the literature.After screening out the documents and data that finally met the requirements,Stata12.0 software was used for statistical analysis.Results: A total of 39 articles were included,including 35 in Chinese and 4in English.Results of Meta analysis showed that:(1)Bacterial vaginosis(BV)is positively correlated with high-risk HPV infection,and BV infection is a risk factor for high-risk HPV infection.The difference is statistically significant(OR=2.94,95%CI: 2.47-3.50,P < 0.05).There’s no publication bias,and the results are stable and reliable.(2)Trichomonas vagvaginitis(TV)is positively correlated with high-risk HPV infection,and TV infection is a risk factor for high-risk HPV infection.The difference is statistically significant(OR=2.18,95%CI: 1.59-2.98,P < 0.05).There’s no publication bias,and the results are stable and reliable.(3)Vulvovaginal Candidiasis(VVC)has a positive correlation with high-risk HPV infection.VVC infection is a risk factor for high-risk HPV infection,and the difference is statistically significant(OR =1.53,95% CI: 1.24-1.88,P <0.05),no publication bias,and the results are stable and reliable;(4)Ureaplasma urealyticum(UU)has a positive correlation with high-risk HPV infection.The UU infection is a risk factor for high-risk HPV infection,and the difference is statistically significant(OR = 3.39,95% CI:2.23-5.14,P <0.05),due to the funnel chart and Egger’s test chart suggest that there may be a publication bias in the study of the correlation between UU and high-risk HPV infection.The evaluation results using the Trim and Fill analysis show that the OR values of the effect before and after clipping are 1.220(95%CI: 0.804-1.637)and 0.575(95% CI: 0.126-1.025),indicating that there may be a bias that has little effect on the meta-analysis combined OR value,the results are robust,and the sensitivity analysis results also show that the results are stable and reliable;(5)Chlamydia trachomatis(CT)has a positive correlation with high-risk HPV infection.And the CT infection is a risk factor for high-risk HPV infection,and the difference is statistically significant(OR = 4.01,95% CI:2.76-5.81,P < 0.05).There’s no publication bias,and the results are stable and reliable.Conclusion:(1)The abnormality of vaginal microecology has a certain positive correlation with high-risk HPV infection.(2)BV,TV,VVC,UU,and CT are all risk factors for high-risk HPV infection,and CT and UU are the most dangerous;(3)the risk of cervical high-risk HPV infection in patients with BV,TV,VVC,UU and CT is higher than that of patients without BV,TV,VVC,UU and CT.