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目的 探讨不同年龄段宫颈人乳头瘤病毒（human papillomavirus, HPV）感染患者的阴道微生态特征及其与外周血T辅助细胞（T helper, Th）1/Th2免疫失衡的相关性，为制定年龄分层精准干预策略提供理论依据。方法 回顾性收集2022年1月至2024年12月在汉中市人民医院就诊的123例HPV感染患者临床资料，按年龄分为青年组（18～30岁，n=42）、中年组（31～45岁，n=51）及围绝经期组（46～55岁，n=30）。检测阴道微生态指标（pH值、菌群构成、酶活性）及外周血Th1/Th2细胞因子[干扰素-γ(interferon-gamma, IFN-γ)、白细胞介素（interleukin, IL）-4等]，分析组间差异及相关性。结果 随年龄增长，患者阴道pH值、加德纳菌检出率、Th2型细胞因子IL-4水平呈显著递增趋势：青年组、中年组、围绝经期组pH值分别为4.22±0.31、4.83±0.54、5.35±0.64；加德纳菌检出率分别为11.9%、37.25%、56.7%;IL-4水平分别为（6.32±1.89）pg/mL、（13.11±3.13）pg/mL、（17.68±4.53）pg/mL，组间差异均有统计学意义（均P<0.001）。随年龄升高，阴道乳酸杆菌占比、Th1/Th2比值呈显著递减趋势：3组乳酸杆菌占比分别为78.52%、53.62%、36.41%;Th1/Th2比值分别为5.86±1.53、1.96±0.55、1.08±0.33，组间两两比较差异均具有统计学意义（均P<0.001）。Spearman相关性分析显示，阴道乳酸杆菌占比与Th1/Th2比值呈显著正相关（r=0.71,P<0.001），阴道致病菌富集、微生态酶活性异常与Th2型免疫偏移呈显著负相关（P<0.001）。多变量线性回归分析校正年龄、孕次、HPV型别等混杂因素后，乳酸杆菌占比与Th1/Th2比值呈独立正相关（b=0.32,95%CI:0.18～0.46,P<0.001）；加德纳菌检出率、阴道pH值均与Th1/Th2比值呈独立负相关（b=-0.25,95%CI:-0.39～-0.11,P=0.001;b=-0.21,95%CI:-0.35～-0.07,P=0.003）。结论 年龄增长可能通过雌激素水平下降及免疫衰老，协同加剧阴道菌群紊乱与Th1/Th2失衡，促进HPV持续感染；针对不同年龄段患者制定菌群-免疫联合干预策略具有潜在临床价值。
Abstract：Objective To explore the vaginal microbiota characteristics of patients with cervical HPV infection in different age groups and their correlation with Th1/Th2 immune imbalance, providing a theoretical basis for age-stratified intervention. Methods A retrospective analysis was conducted on 123 HPV-infected patients from January 2022 to December 2024, divided into three groups: young group(18-30 years, n=42), middle-aged group(31-45 years, n=51), and perimenopausal group(46-55 years, n=30). Vaginal microecological indicators(pH, microbial composition, enzyme activity) and peripheral blood Th1/Th2 cytokines(IFN-γ, IL-4, etc.) were measured, with intergroup differences and correlations analyzed. Results Vaginal pH values showed a stepwise increase with age [(4.22±0.31),(4.83±0.54), and(5.35±0.64) in the young, middle-aged, and perimenopausal groups, respectively; P<0.001]; the detection rates of Gardnerella were 11.9%, 37.25%, and 56.7%, respectively(P<0.001); Th2-type cytokine IL-4 levels were(6.32±1.89) pg/mL,(13.11±3.13) pg/mL, and(17.68±4.53) pg/mL, respectively(P<0.001); the proportion of Lactobacillus was 78.52%, 53.62%, and 36.41%, respectively(P<0.001); and the Th1/Th2 ratios were 5.86±1.53, 1.96±0.55, and 1.08±0.33, respectively(P<0.001), with statistically significant differences between each pair of groups. Spearman analysis showed that the proportion of Lactobacillus was positively correlated with the Th1/Th2 ratio(r=0.71, P<0.001), while enrichment of pathogenic bacteria and abnormal microecological enzyme activity were significantly negatively correlated with the Th1/Th2 ratio(P<0.001). Multivariable linear regression analysis indicated that, after controlling for age, parity, and HPV type, the proportion of Lactobacillus remained independently positively correlated with the Th1/Th2 ratio(b=0.32, 95%CI: 0.18 – 0.46, P<0.001); Gardnerella detection rate was independently negatively correlated with the Th1/Th2 ratio(b=-0.25, 95%CI:-0.39 –-0.11, P=0.001); and pH value was independently negatively correlated with the Th1/Th2 ratio(b=-0.21, 95%CI:-0.35 –-0.07, P=0.003). Conclusion Increasing age may exacerbate vaginal dysbiosis and Th1/Th2 imbalance through a decrease in estrogen levels and immunosenescence, thereby promoting persistent HPV infection. Formulating a combined microbiota-immunity intervention strategy for different age groups has potential clinical value.
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基本信息:
中图分类号:R737.33
引用信息:
[1]赵向阳,魏亚楠,田轶.不同年龄宫颈HPV感染患者的阴道微生态差异性及其与免疫功能Th1/Th2失衡的相关性分析[J].传染病信息,2026,39(04):353-359.
2026-08-30
2026-08-30