文章摘要
宫颈尖锐湿疣患者HPV感染分布情况与阴道微生态及外周血Treg/Th17细胞免疫失衡的关系
The relationship between the distribution of HPV infection in patients with cervical condyloma acuminatum and the imbalance of vaginal microecology and peripheral blood Treg/Th17 cell immunity
投稿时间：2025-11-05  修订日期：2026-08-06
DOI：
中文关键词: 尖锐湿疣  乳头状瘤病毒科  阴道  微生态  T淋巴细胞  免疫失衡
英文关键词: Condyloma acuminatum  Papillomaviridae Vagina  Microecology  T lymphocytes Immune imbalance
基金项目:河北省省级科技计划资助：21377822D
作者单位邮编
赵鑫* 秦皇岛市妇幼保健院 066000
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中文摘要:
      目的:探讨宫颈尖锐湿疣(CA)患者人乳头瘤病毒(HPV)的感染分布特征,并分析其与阴道微生态及外周血调节性T细胞(Treg)/辅助性T细胞17(Th17)免疫平衡的关系。方法:前瞻性选取157例宫颈CA患者,检测其宫颈组织23种HPV亚型、阴道微生态指标及外周血Treg/Th17细胞相关因子(Treg%、Th17%、TGF-β、IL-17、Foxp3 mRNA、RORγt mRNA)水平。根据HPV分型将HPV阳性患者分为低危型(n=118)、高危型(n=6)及混合型组(n=26),并根据病毒载量将HPV阳性患者分为高载量组(n=79)、中载量组(n=31)和低载量组(n=40)。比较各组HPV亚型、阴道微生态指标及外周血Treg/Th17细胞相关因子水平。结果:本研究HPV总感染率为95.54%(150/157),以一重感染(73.33%)为主,主要型别为HPV11(46.67%)和HPV6(23.33%)。鉴于混合型感染以多种高危HPV亚型为主导,混合型组在过氧化氢阳性率、白细胞酯酶阳性率、唾液酸苷酶阳性率、清洁度III–IV度比例、pH＞4.5比例、BV阳性率以及TV阳性率方面均显著高于其他组(均P＜0.05),乳酸杆菌(中大量)比例显著降低(P＜0.001)。与单一低危或高危型感染相比,混合型患者的Treg细胞及相关因子水平(TGF-β、Foxp3)以及Treg/Th17细胞水平显著更高(P＜0.05),而Th17细胞及相关因子水平(IL-17、RORγt)显著更低(P＜0.05),且此免疫失衡趋势在高病毒载量组中更为明显。Pearson相关性分析结果显示,Treg细胞比例及其相关转录因子水平以及Treg/Th17细胞水平与HPV感染严重程度呈明显正相关(r=0.743、0.749、0.740、0.780,均P＜0.05),Th17细胞比例及其相关转录因子水平与HPV感染严重程度呈明显负相关(r=-0.424、-0.713、-0.612,均P＜0.05)。结论:宫颈CA患者以HPV11和HPV6感染最为常见,其中高危型尤其是混合型HPV感染与更严重的阴道微生态紊乱及外周血Treg/Th17细胞免疫失衡密切相关,且免疫失衡程度随病毒载量升高而加剧,提示HPV感染、微环境与细胞免疫在CA发病中存在相互作用。
英文摘要:
      Objective: To explore the infection distribution characteristics of human papillomavirus (HPV) in patients with cervical condyloma acuminatum (CA), and to analyze its relationship with vaginal microecology and the immune balance of regulatory T cells (Treg)/helper T cell 17 (Th17) in peripheral blood. Methods: A total of 157 patients with cervical CA were prospectively selected. The levels of 23 HPV subtypes in cervical tissues, vaginal microecological indicators and Treg/Th17 cell-related factors (Treg%, Th17%, TGF-β, IL-17, Foxp3 mRNA, RORγt mRNA) in peripheral blood were detected. According to HPV typing, HPV-positive patients were divided into low-risk group (n=118), high-risk group (n=6) and mixed group (n=26), and according to viral load, HPV-positive patients were divided into high-load group (n=79), medium-load group (n=31) and low-load group (n=40). Compare the HPV subtypes, vaginal microecological indicators and the levels of Treg/Th17 cell-related factors in peripheral blood of each group. Results: The total infection rate of HPV in this study was 95.54% (150/157), mainly primary infection (73.33%), and the main types were HPV11 (46.67%) and HPV6 (23.33%). Given that mixed infections are dominated by multiple high-risk HPV subtypes, the mixed group was significantly higher than the other groups in terms of the positive rate of hydrogen peroxide, the positive rate of leukocyte esterase, the positive rate of sialidase, the proportion of cleanliness grade III-IV, the proportion of pH > 4.5, the positive rate of BV and the positive rate of TV (all P < 0.05). The proportion of Lactobacillus (medium to large quantity) was significantly reduced (23.08%) (P < 0.001). Compared with single low-risk or high-risk infections, the levels of Treg cells and related factors (TGF-β, Foxp3) and Treg/Th17 cells in mixed patients were significantly higher (P < 0.05), while the levels of Th17 cells and related factors (IL-17, RORγt) were significantly lower (P < 0.05). Moreover, this trend of immune imbalance is more obvious in the group with high viral load. The results of Pearson correlation analysis showed that the proportion of Treg cells and the levels of related transcription factors, as well as the level of Treg/Th17 cells, were significantly positively correlated with the severity of HPV infection (r=0.743, 0.749, 0.740, 0.780, all P < 0.05). The proportion of Th17 cells and the levels of related transcription factors were significantly negatively correlated with the severity of HPV infection (r=-0.424, -0.713, -0.612, all P < 0.05). Conclusion: Patients with cervical CA are most commonly infected with HPV11 and HPV6. Among them, high-risk HPV infections, especially mixed HPV infections, are closely related to more severe vaginal microecological disorders and immune imbalance of Treg/Th17 cells in peripheral blood, and the degree of immune imbalance intensifies with the increase of viral load. It is suggested that HPV infection, microenvironment and cellular immunity interact in the pathogenesis of CA.
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