摘要
目的探讨雌激素补充治疗对绝经后高危型人乳头瘤病毒(human papillomavirus,HPV)感染女性阴道菌群及局部免疫的影响。方法2018年6月至2023年6月期间在上海市瑞金康复医院妇科招募体检或因妇科疾病就诊的74例绝经后女性为研究对象。根据HPV检测结果分为高危型HPV阴性女性(正常组,n=14)和高危型HPV阳性女性(n=60)。采用随机对照试验,将高危型HPV阳性女性利用随机数字表法分为试验组(高危型HPV阳性且口服低剂量雌激素治疗,n=30)和对照组(高危型HPV阳性且未口服低剂量雌激素,n=30)。在入组时(即第0周)、入组后第4周和第8周采用荧光定量PCR仪和酶联免疫吸附实验检测3组的阴道微生物群落结构以及阴道灌洗液中的炎症细胞因子表达情况。结果入组时3组患者年龄、绝经时间、体质量指数、收缩压、舒张压、心率、pH值和阴道细胞成熟指数(vaginal cell maturation index,VMI)差异均无统计学意义(均P>0.05),基线可比。经雌激素治疗后,试验组第4周(5.27±0.13)和第8周(4.84±0.15)的pH值均显著低于第0周(6.59±0.17,均P<0.001),而试验组第4周(41.62±2.62)和第8周的VMI(58.28±2.16)均显著高于第0周(25.97±2.60,均P<0.001)。定量结果表明正常组、试验组、对照组3组间及各自组内(即每组不同检测时间点)的大肠杆菌(Escherichia coli)丰度差异均无统计学意义(均P>0.05)。试验组第0周加德纳菌(Gardnerella)和奇异菌属(Atopobium)丰度显著高于第4周和第8周(均P<0.001)。但经雌激素治疗后第4周的试验组阴道Gardnerella和Atopobium丰度显著低于对照组(均P<0.001),和正常组相比差异均无统计学意义(均P>0.05)。第0、第4、第8周的正常组、试验组和对照组组间的普雷沃氏菌属(Prevotella)、加氏乳酸杆菌(L.Gasseri)和惰性乳酸杆菌(L.Iners)丰度差异均无统计学意义(均P>0.05)。第0周试验组和对照组卷曲乳酸杆菌(L.Crispatus)和詹氏乳酸杆菌(L.Jense
Objective To investigate the effect of estrogen supplementation therapy on vaginal microbiota and local immunity of postmenopausal high-risk human papillomavirus(HPV)infected women.MethodsA total of 74 postmenopausal women who underwent gynecological examinations or visits at Department of Gynecology,Shanghai Ruijin Rehabilitation Hospital from June 2018 to June 2023 were included in this study.According to HPV test,they were divided into the high-risk HPV-negative women(normal group,n=14)and the high-risk HPV-positive women(n=60).A randomized controlled clinical trial was designed.Within the high-risk HPV-positive women,they were further randomly assigned by using the random number table method to the experimental group(high-risk HPV-positive women receiving low-dose estrogen therapy orally,n=30)and control group(high-risk HPV-positive women not receiving low-dose estrogen therapy,n=30).Vaginal microbiota composition and expression of inflammatory cytokines in vaginal lavage fluid were measured using fluorescence quantitative PCR and enzyme-linked immunosorbent assay at baseline(week 0),4th week,and 8th week after enrollment.ResultsThere were no significant differences in age,menopausal time,body mass index,systolic pressure,diastolic pressure,heart rate,pH value and vaginal cell maturation index(VMI)among the normal group,the experimental group and control group(all P>0.05)which indicated the baseline was comparable.After estrogen treatment,the pH value of the experimental group at 4th and 8th weeks(5.27±0.13,4.84±0.15)was significantly lower than that at week 0(6.59±0.17,all P<0.001),while the vaginal cell maturation index(VMI)at 4th and 8th weeks(41.62±2.62,58.28±2.16)was significantly higher than that at week 0(25.97±2.60,all P<0.001).The quantitative results showed no significant differences in the abundance of Escherichia coli among the normal group,the experimental group,and control group,and within each group at different time points(all P>0.05).The abundance of Gardnerella and Atopobium in the exp
作者
许啸声
赵荣
冯炜炜
沈健
Xu Xiaosheng;Zhao Rong;Feng Weiwei;Shen Jian(Department of Obstetrics and Gynecology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Gynecology,Shanghai Ruijin Rehabilitation Hospital,Shanghai 200023,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2024年第2期116-122,共7页
Chinese Journal of Reproduction and Contraception
基金
上海市自然科学基金(18ZR1423900)。
