阴道炎流行病学特征及危险因素分析

Epidemiological Characteristics and Risk Factors of Vaginitis

摘要: 目的：本研究旨在分析女性阴道炎的流行病学特征，并探讨不同类型阴道炎与高危型人乳头瘤病毒(HR-HPV)感染之间的关联及其危险因素，为从人群层面制定个体化预防策略、降低阴道炎发病率及预防相关并发症提供依据。方法：对2014年1月至2023年12月在安徽医科大学第二附属医院接受阴道炎五项联合检测的76,122例女性样本，以及接受高危型HPV感染检测的8767例女性样本进行回顾性分析。采用单因素和多因素逻辑回归分析探讨不同类型阴道炎的危险因素。结果：在76,122例患者中，滴虫性阴道炎(TV)、外阴阴道假丝酵母菌病(VVC)和细菌性阴道病(BV)的总感染率为23.10% (17,584/76,122)。BV感染最为常见，阳性率为14.10% (10,736/76,122)，且多因素分析显示BV感染是HR-HPV感染的独立危险因素(OR = 1.697, 95%CI: 1.240~2.305, P < 0.001)。VVC的发生与季节相关，夏秋季(6.6%)的阳性率显著高于春冬季(5.5%) (P < 0.01)，且在<20岁和20~29岁年龄段检出率较高。TV的发生则与年龄(<20岁和40~49岁处于较高水平)相关，<20岁高峰与性活动因素相关，40~49岁高峰可能与围绝经期前后激素变化有关。结论：不同类型阴道炎的流行病学特征及其危险因素存在差异。BV与HR-HPV感染密切相关，VVC的发生受季节和年龄影响，TV则更多与性行为相关。建议针对不同年龄、季节及HR-HPV感染状态，开展个体化的阴道炎预防和筛查策略，特别应加强对年轻女性的性健康教育和老年女性BV的临床监测。

Abstract: Objective: This study aimed to analyze the epidemiological characteristics of vaginitis in women and to explore the associations between different types of vaginitis and high-risk human papillomavirus (HR-HPV) infection and their risk factors, so as to provide evidence for developing individualized prevention strategies at the population level, reducing the incidence of vaginitis and preventing related complications. Methods: A retrospective analysis was conducted on 76,122 female samples who underwent the five-item combined vaginitis test and 8767 female samples who underwent HR-HPV testing at the Second Affiliated Hospital of Anhui Medical University from January 2014 to December 2023. Univariate and multivariate logistic regression analyses were used to explore the risk factors for different types of vaginitis. Results: Among the 76,122 patients, the overall infection rate of Trichomonas vaginitis (TV), vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) was 23.10% (17,584/76,122). BV infection was the most common, with a positive rate of 14.10% (10,736/76,122). Multivariate analysis showed that BV infection was an independent risk factor for HR-HPV infection (OR = 1.697, 95% CI: 1.240~2.305, P < 0.001). The occurrence of VVC was associated with season, with a significantly higher positive rate in summer and autumn (6.6%) than in spring and winter (5.5%) (P < 0.01), and the detection rate was higher in the <20 and 20~29 years age groups. The occurrence of TV was associated with age (with higher levels in the <20 and 40~49 years groups), with the <20 years peak related to sexual activity and the 40~49 years peak possibly related to perimenopausal hormonal changes. Conclusion: The epidemiological characteristics and risk factors of different types of vaginitis vary. BV is closely associated with HR-HPV infection, the occurrence of VVC is influenced by season and age, and TV is more related to sexual behavior. It is recommended to implement individualized vaginitis prevention and screening strategies based on age, season and HR-HPV infection status, with special emphasis on sexual health education for young women and clinical surveillance of BV in elderly women.