Study On The Relationship Between Vaginal Microenvironment And Human Papillomavirus Infection In Reproductive Tract

Objective: To explore the effect of vaginal microenvironment changes on human papillomavirus infection in genital tract.Methods: We collected the data of HPV typing and vaginal secretion examination in 921 gynecologic outpatients of Chenzhou No.1 People’s Hospital from June 2018 to November 2018.Among them,153 were in the 16.18 subtype infection group,360 were in the non-16.18 high-risk HPV infection group(Hereinafter referred to as high-risk infection group),182 were in the low-risk HPV infection group and 226 were in the HPV negative group.The differences of vaginal microenvironment(PH value,lactic acid bacteria,bacterial vaginosis,vulvovaginal candidiasis)among the four groups were analyzed.(2)The cervical exfoliated cells,vaginal secretions and vaginal lavage fluid were collected from 125 patients in gynecological clinic of Chenzhou No.1 People’s Hospital from October 2018 to December 2018.The cervical exfoliated cells were detected by HPV typing,vaginal secretions were routinely detected,and the levels of interleukin-17 were measured by Enzyme Linked Immunosorbent Assay(ELISA)in vaginal lavage fluid.According to the results of HPV typing,the patients were divided into four groups,including 32 cases of 16.18 subtype infection group,33 cases of non-16.18 high-risk HPV infection group,30 cases of low-risk HPV infection group and 30 cases of HPV negative group.Results:(1)(1)16.18 subtype infection group 153 cases,age 23-68 years old,mean 45.29 ±9.16 years old,High-risk HPV infection group,aged 17-72 years old,mean 45.43 ±8.87 years old,Low-risk HPV infection group aged 22-68 years old,mean 44.8±9.32 years old,HPV negative group aged 23-71 years old,mean 45.08±9.31 years old.The difference is not statistically significant(P=0.888).(2)Different groups of PH(with PH > 4.4 as outliers): The abnormal value of PH was found in 56 cases(36.6%)with subtype 16.18 infection,101 cases(28.06%)with high-risk HPV infection,48 cases(26.37%)with low-risk HPV infection and 36 cases(15.93%)with HPV negative group.There is statistically significant(χ2=29.005,P<0.001).(3)Lactobacillus negative was found in 49 cases(32.03%)with subtype 16.18 infection,92 cases(25.56%)with high-risk HPV infection,44 cases(24.18%)of low-risk HPV infection group,and 15 cases(19.91%)with HPV negative group(χ2=13.957,P=0.003).There is significant difference.(4)The positive rate of BV was found in 16.18 subtype infection group [49 cases(32.03%)],the high risk group [105 cases(29.17%)],the low risk group [52 cases(28.57%)],and the negative group [45 cases(19.91%)].There is significant difference(χ2=8.727,P=0.033).(5)The positive rate of VVC was found in 16.18 subtype group [108 cases(70.59%)],in the high risk group [237 cases(65.83%)],in the low risk group [110 cases(60.44%)] and in the negative group [137 cases(60.62%)].There is significant difference(χ2=5.518,P=0.138).(6)Comparison of vaginal microenvironment between HPV infection and non-infection:The infection rate of HPV in patients with abnormal ph(> 4.4)[205 cases(87.23%)] was higher than that of normal level(PH < 4.4)[490cases(71.43%)].There is significant difference(χ2=23.614,P<0.001).The infection rate of HPV in lactobacillus negative patients [185 cases(83.71%)] was higher than that in lactobacillus positive cases [510 cases(72.86%)].There is significant difference(χ2=10.685,P<0.001).The infection rate of HPV in BV positive group [206 cases(82.7%)] was higher than that in non-infected group [489 cases(72.99%)].There is significant difference(χ2=8.142,P=0.004).The infection rate of HPV in VVC positive patients [455 cases(76.86%)] was slightly higher than that in VVC negative cases [240 cases(72.95%)].There is significant difference(χ2=1.746,P=0.186).(7)Logistic regression analysis model was constructed with HPV infection as dependent variable,PH value,lactic acid bacteria and BV as independent variables.It is suggested that PH > 4.4,negative Lactobacillus and positive BV are independent risk factors for HPV infection.OR values of Lactobacillus negative and BV positive were 2.993(1.959,4.571),0.527(0.353,0.787),1.870(1.288,2.716).(2)(1)There were 32 patients with hpv16.18 subtype infection,age 23-68 years old,mean 46.38 ±7.85 years old,33 patients with high-risk HPV infection group,age 24-68 years old,mean 46.21 ±11.24 years old,30 patients with low-risk HPV infection group,age 21-63 years old,mean 45.77±10.63 years old),There was no significant difference in the age of each group.(2)The concentrations of IL-17 in different HPV infection states were compared(the 16.18 infection group [65.2774.05 pg / ml(a)],the high-risk HPV group [48.09 ±3.26 pg/ml(b)],Low risk HPV infection group [23.75 ±2.16 pg/ml(c)],HPV negative group [19.48 ±2.5 pg/ml(d)]).The results of two comparisons showed that the concentration of group a was significantly different from that of group b,group c and group d(P < 0.001).There was significant difference between group b and group c(P < 0.001).There was significant difference between group b and group d(P < 0.001).There was no significant difference between group c and group d(P = 0.060).Conclusions:(1)PH > 4.4,lactobacillus deficiency and BV are independent risk factors for HPV infection.(2)High expression of IL-17 is closely related to high-risk HPV infection.