西藏高海拔地区阴道微生态与HPV感染的 相关性研究

Correlation between Vaginal Microecology and HPV Infection in High-Altitude Region of Xizang Region

摘要: 目的：探讨西藏高海拔地区妇产科门诊患者阴道微生态状况与人乳头瘤病毒(HPV)感染的相关性，为高原地区预防HPV感染及相关宫颈病变提供理论依据。方法：纳入2025年8月至2026年2月于拉萨市人民医院妇产科同时行HPV检测及阴道微生态检测的299例女性。收集临床资料、阴道微生态指标(菌群密集度、多样性、优势菌、Nugent评分、AV评分等)、HPV分型及TCT结果。采用卡方检验或Fisher精确检验分析阴道微生态异常与HPV感染及TCT异常的关联，计算比值比(OR)及95%置信区间(CI)；采用Cochran-Armitage趋势检验评估微生态感染数量与HPV阳性率的剂量–反应关系。结果：299例患者中，微生态异常率为49.8%，其中细菌性阴道炎(31.4%)和需氧性阴道炎(23.4%)最为常见；HPV总体阳性率为28.1%，高危型HPV阳性率为20.7%，主要型别为16型(4.3%)、58型(4.0%)和52型(3.7%)。微生态异常者HPV感染风险显著高于正常者(37.6% vs 18.7%, OR = 2.62, 95%CI: 1.55~4.44, P < 0.001)。需氧性阴道炎(OR = 2.64, 95%CI: 1.50~4.63, P = 0.001)和细菌性阴道炎(OR = 2.18, 95%CI: 1.29~3.70, P = 0.003)与HPV感染显著相关。AV评分 ≥ 3分者HPV阳性率显著升高(49.1% vs 23.5%, P < 0.001)；革兰阴性短杆菌为优势菌者HPV感染率最高(40.8%)；乳酸杆菌减少/缺失者HPV阳性率高于正常者(42.9% vs 30.2%, P = 0.013)。随着微生态感染数量增加，HPV阳性率呈上升趋势(无感染组17.5%、单一感染组45.7%、双重及以上感染组34.6%)，趋势检验具有统计学意义(P trend = 0.002)。双重及以上感染者HPV感染风险是无感染者的2.50倍(95%CI: 1.29~4.84)。微生态异常者TCT异常风险是正常者的4.35倍(95%CI: 1.41~13.51, P = 0.006)，双重及以上感染者TCT异常风险升高2.88倍(95%CI: 1.07~7.73, P = 0.030)。结论：西藏高海拔地区女性阴道微生态失衡普遍存在，需氧性阴道炎和细菌性阴道炎与HPV感染密切相关。微生态失衡程度越重，HPV感染及TCT异常风险越高，呈剂量–反应关系。建议在高原地区推广阴道微生态检测，将微生态评估纳入宫颈癌筛查管理体系。

Abstract: Objective: To investigate the association between vaginal microecological status and human papillomavirus (HPV) infection among women attending the obstetrics and gynecology outpatient clinic in the high-altitude region of Xizang region, and to provide a theoretical basis for preventing HPV infection and related cervical lesions in plateau areas. Methods: A total of 299 women who underwent both HPV testing and vaginal microecological testing at the Department of Obstetrics and Gynecology of Lhasa People’s Hospital from August 2025 to February 2026 were enrolled. Clinical data, vaginal microecological indicators (including flora density, diversity, dominant bacteria, Nugent score, AV score, etc.), HPV genotyping results, and TCT findings were collected. The chi-square test or Fisher’s exact test was used to analyze the associations between vaginal microecological abnormalities and HPV infection as well as TCT abnormalities, and odds ratios (OR) with 95% confidence intervals (CI) were calculated. The Cochran-Armitage trend test was used to evaluate the dose-response relationship between the number of microecological infections and HPV positivity rate. Results: Among the 299 patients, the prevalence of vaginal microecological abnormalities was 49.8%, with bacterial vaginosis (31.4%) and aerobic vaginitis (23.4%) being the most common types. The overall HPV positivity rate was 28.1%, and the high-risk HPV positivity rate was 20.7%. The predominant HPV genotypes were HPV-16 (4.3%), HPV-58 (4.0%), and HPV-52 (3.7%). Women with microecological abnormalities had a significantly higher risk of HPV infection compared to those with normal microecology (37.6% vs 18.7%, OR = 2.62, 95%CI: 1.55~4.44, P < 0.001). Aerobic vaginitis (OR = 2.64, 95%CI: 1.50~4.63, P = 0.001) and bacterial vaginosis (OR = 2.18, 95%CI: 1.29~3.70, P = 0.003) were significantly associated with HPV infection. Patients with an AV score ≥3 had a significantly higher HPV positivity rate than those with an AV score <3 (49.1% vs 23.5%, P < 0.001). The HPV infection rate was highest (40.8%) among those with gram-negative short bacilli as the dominant bacteria. Women with reduced/absent Lactobacillus had a higher HPV positivity rate than those with normal Lactobacillus (42.9% vs 30.2%, P = 0.013). As the number of microecological infections increased, the HPV positivity rate showed an upward trend (17.5% in the no-infection group, 45.7% in the single-infection group, and 34.6% in the dual or more infections group), and the trend test was statistically significant (P trend = 0.002). Women with dual or more infections had a 2.50-fold higher risk of HPV infection compared to those without infection (95%CI: 1.29~4.84). Regarding TCT findings, women with microecological abnormalities had a significantly higher risk of abnormal TCT results than those with normal microecology (OR = 4.35, 95%CI: 1.41~13.51, P = 0.006), and women with dual or more infections also had a significantly higher risk (OR = 2.88, 95%CI: 1.07~7.73, P = 0.030). Conclusion: Vaginal microecological imbalance is highly prevalent among women in the high-altitude region of Xizang region. Aerobic vaginitis and bacterial vaginosis are closely associated with HPV infection. The severity of microecological imbalance is positively correlated with the risks of HPV infection and TCT abnormalities in a dose-response manner. It is recommended to promote vaginal microecological testing in plateau regions and integrate microecological assessment into cervical cancer screening protocols.