Analysisof VaginalMicroecological Changes，SubtypeDistributionof HPVInfection inPatients with Cervical HSIL，and Influencing Factors of HPVOutcome/YUAN Aiqin，XUMeihua，YUJiamei.//Medical Innovation of China，2025，22（18）：157-162

[Abstract]Objective：To explore the vaginal microecology changes and the subtype distribution of human papillma virus （HPV） infection in patients with cervical high-grade squamous intraepithelial lesion （HSIL），and toanalyzethe influencing factorsofHPVoutcome.Method：A totalof15Opatients withcervical HSIL diagnosed bypathological examination inYichun Maternal and Child Health Center from January 2O21 to December 2022 were selected as the disease group，and another1OO healthy women who underwent physical examinations at the Outpatient Department durig the same period were selected as the control group.The disease group was divided into the HPV persistent infection group and the HPV negative conversion group based on whether HPV turned negative after one year of treatment.The vaginal microecology of the disease group and the control group was compared，thedistributionof high-risk HPV（HR-HPV）infectionsubtypes wasanalyzed，andtheinfluencing factors of HPVoutcome were analyzed.Result：The proportions of patients with densityof normalflora，the diversityof normal floraand normal flora in thedisease group were allower thanthose in the control group，the proportions of patients with hydrogen peroxide （ H₂0₂ ） deficiency，sialidase （SNa） positive，leukocyte esterase （LE） positive， N-acetylaminohexosidase （NAG） positive and pH value gt;4.5 in the disease group were all higher than those in the control group，the differenceswere all statistically significant（ P lt;0.05）.Among the 150 patientswith cervical HSIL， the infection rate of HPV16 was the highest，folowed by HPV18.Compared with the HPV negative conversion group， age，infection subtype 16/18，pathological diagnosis of cervical intraepithelial neoplasia （CIN） at grade || ，and the proportions of patients with abnormal flora density，abnormal flora diversity，flora imbalance， H₂O₂ deficiency， SNa （+），ndpHgt;4.5intheHPVpersistentinfectiongroupwereallhigher，thediferences werestatisticallysignificant （ P lt;0.05）.Multivariate logistic regresson analysis showed that age，infection subtype 16/18，pathological diagnosis of CIN grade II，abnormal flora density，abnormal flora diversity，flora dysbiosis， H₂₂ deficiency， SNa （+） ，and pH gt;4.5 were independent risk factors for persistent HPV infection （ P lt;0.05）. Conclusion： Patients with cervical HSIL may present vaginal microecological changes.Age，infection subtype，pathological grade，microbiota density， microbiota diversity，dominant bacteria，and changes in H₂O₂ ，SNa and pH are independent risk factors for persistent HPV infection.

[Key words] Cervical high-grade squamous intraepithelial lesion Vaginal microecology Human papilloma virus

First-author'saddress：Department of Obstetricsand Gynecology，Yichun Maternaland Child Health Center，Yichun33600o，China doi：10.3969/j.issn.1674-4985.2025.18.036

子宫颈癌是危害女性健康的恶性肿瘤之一，据世界卫生组织（WHO）统计，2022年我国新发子宫颈癌约有15万例，死亡人数约为5.6万，我国子宫颈癌防控形势严峻，发病人数占全球的 18.6%^[1] 子宫颈癌的主要病因是人乳头状瘤病毒（HPV）的持续感染，尤其是高危型HPV（HR-HPV），其主要发病特点为经过10年以上的癌前病变期，即子宫颈鳞状上皮内病变（SIL），包括低级别鳞状上皮内病变（LSIL）和高级别鳞状上皮内病变（HSIL）。SIL与女性感染年龄、HPV感染亚型及病毒载体数量等密切相关，大部分LSIL可自然消退，而HSIL存在癌变的可能。SIL若不及时接受有效治疗，进展为浸润性癌和原位癌的可能性极大[2]。HPV感染患者中有 10%～30% 继续进行性发展，既往研究证实，阴道微生态在HSIL进展的过程中具有重要影响[。健康女性阴道内环境以乳酸、过氧化氢0 H₂O₂ ）、乳酸菌素等革兰氏阳性乳杆菌为优势菌，主要发挥预防感染、维持阴道微生态平衡的作用[4。据文献报道，阴道菌群长期失调可影响病毒清除，增加子宫颈HPV感染的风险，促进子宫颈病变的进一步发展5。基于此，本研究旨在探讨子宫颈HSIL患者阴道微生态变化及与HPV感染的相关性，报道如下。

1资料与方法

1.1一般资料

选取2021年1月—2022年12月宜春市妇幼保健院经病理检查确诊的150例子宫颈HSIL患者，设为疾病组。另择同期门诊体检的健康女性100例纳入对照组。纳入标准：（1）疾病组参照文献[6]《妇产科学》诊断，均经阴道镜活检、病理学检查确诊子宫颈HSIL且HPV感染；（2）对照组体检健康；（3）非妊娠期、非月经期；（4）育龄期且有性生活史。……