绝经后女性阴道微生态与阴道上皮内瘤变的相关性

目的:探讨绝经后女性阴道微生态与阴道上皮内瘤变(vaginal intraepithelial neoplasia, VaIN)的相关性,为绝经后女性VaIN的科学防治提供临床依据。方法:选择2020年5月至2020年8月复旦大学附属妇产科医院宫颈疾病诊疗中心经阴道镜检查、活组织检查和组织病理学诊断为VaIN的160例绝经后女性为病变组,另选同期常规体检的人乳头瘤病毒阴性且液基薄层细胞检测正常的健康绝经后女性志愿者50例为对照组,比较2组间阴道微生态的差异。结果:绝经后女性的阴道微生态普遍呈现失衡状态,多样性升高、密集度降低,过氧化氢阳性率明显升高,优势菌以革兰阳性短杆菌为主。病变组较对照组乳杆菌减少、多样性升高;两组白细胞酯酶阳性率、乙酰氨基葡萄糖苷酶阳性率、Nugent评分异常率差异均有统计学意义(P0.05)。Logistic回归分析结果表明,VaIN与白细胞酯酶阳性率、优势菌异常和多样性升高有关。白细胞酯酶阳性率的OR值为1.251(95%CI 1.101 4～1.421 1),优势菌异常的OR值1.242(95%CI 1.031 3～1.496 7),多样性降低的OR值为0.791(95%CI 0.672 5～0.931 1)。结论:绝经后女性阴道微生态的改变,尤其是白细胞酯酶阳性率、优势菌异常和多样性升高,与VaIN的发生发展密切相关。

Relationship between vaginal intraepithelial neoplasia and vaginal microecology in postmenopausal women

Objective: To explore the relationship between vaginal intraepithelial neoplasia (VaIN) and vaginal microecology in postmenopausal women. Methods: Postmenopausal women admitted to the Medical Center for Diagnosis and Treatment of Cervical Disease of Obstetrics and Gynecology Hospital, Fudan University from May 2020 to August 2020 were included. For patient who carried human papillomavirus (HPV) or with abnormal liquid-based cytologic test (LCT) result, further colposcopy was performed (biopsy when necessary). Totally, 160 patients with VaIN were assigned to the lesion group, 50 healthy postmenopausal women were assigned to the normal group. The results of vaginal microecology examination were compared between the two groups. Results: The vaginal microecology of postmenopausal women was generally out of balance:diversity increased, density reduced, positive rate of hydrogen peroxide increased significantly, and G⁺ brevibacterium increased (P<0.05). Compared with normal group, the mall amounts of lactobacillus reduced and diversity increased, positive leucocyte esterase increased, positive acetylglucosaminidase decreased, and abnormal Nugent scores increased in the lesion group (P<0.05). The results of multiple-factor analysis showed that VaIN was related to the increased positive leucocyte esterase, small amounts of lactobacillus, and reduced diversity. For positive leucocyte esterase and small amounts of lactobacillus, the odds ratio (OR) value was 1.251 (95%CI 1.101 4-1.421 1) and 1.242 (95%CI 1.031 3-1.496 7), respectively, while reduced diversity had the OR value of 0.791 (95%CI 0.672 5-0.931 1).Conclusions: The changes in vaginal microecological environment, especially the positive leucocyte esterase increases, lactobacillus decreases, and diversity increases, are associated with the incidence of VaIN.