标题：子宫切除术后阴道微生态的变化及其与外周血TLR2、TLR4表达和细胞免疫炎症因子的关系

      作者：袁永兴，高建建，逯蕾，胡茜，王靖    西安国际医学中心医院妇科一病区，陕西 西安 710100

      卷次： 2023年34卷5期

      【摘要】 目的 探究子宫切除术后患者阴道微生态变化，并分析阴道微生态与Toll样受体2 (TLR2)、Toll样受体4(TLR4)及细胞免疫炎症因子关系。方法 选取2021年1~12月西安国际医学中心医院收治的95例行子宫切除术患者纳入研究，于术前、术后1周检测阴道微生态状况，并根据术后阴道微生态失衡情况分为失衡组70例和正常组25例；检测术前、术后1周外周血TLR2、TLR4及血清辅助性T细胞1 (Th1)类因子[白介素-2 (IL-2)、肿瘤坏死因子-α (TNF-α)]、Th2类因子[白介素-4 (IL-4)、白介素-10 (IL-10)]表达水平。采用Spearman相关分析法分析阴道微生态与TLR2、TLR4及细胞免疫炎症因子相关性；绘制受试者工作特征曲线(ROC)评估TLR2、TLR4及细胞免疫炎症因子对阴道微生态失衡的诊断价值。结果 与术前比较，术后1周患者阴道pH值升高，菌群密度、菌群多样性及乳杆菌数量均下降，差异均有统计学意义(P<0.05)；术后阴道微生态失衡率73.68%，明显高于术前的44.21%，差异有统计学意义(P<0.05)；失衡组患者的外周血TLR2、TLR4表达百分率及血清 IL-2、TNF-α水平均明显高于术前及正常组，IL-4、IL-10水平明显低于术前及正常组，差异均有统计学意义(P<0.05)；经Spearman相关分析法分析结果显示，术后患者阴道 pH值与TLR4、IL-2、TNF-α表达呈正相关(P<0.05)；菌群密度、菌群多样性与 TLR2、TLR4、IL-2、TNF-α表达均呈正相关(P<0.05)，与 IL-4、IL-10均呈负相关(P<0.05)；乳杆菌与TLR2、TLR4、IL-2、TNF-α表达呈负相关(P<0.05)；TLR2、TLR4、IL-2、TNF-α、IL-4、IL-10诊断阴道微生态失衡的 ROC曲线下面积分别为0.729、0.842、0.830、0.741、0.812、0.715。结论 子宫切除术后患者阴道微生态失衡率升高，且阴道微生态失衡与TLR2、TLR4及细胞免疫炎症因子关联密切。
      【关键词】 子宫切除术；阴道微生态；Toll样受体；细胞免疫；炎症因子；相关性
      【中图分类号】 R713.4 【文献标识码】 A 【文章编号】 1003—6350（2023）05—0688—06

Changes of vaginal microecology after hysterectomy and their relationship with expression of peripheral bloodTLR2, TLR4, and cellular immune inflammatory factors.
YUAN Yong-xing, GAO Jian-jian, LU Lei, HU Qian, WANGJing. WardⅠ, Department of Gynecology, Xi'an International Medical Center Hospital, Xi’an 710100, Shaanxi, CHINA
【Abstract】 Objective To explore the changes of vaginal microecology in patients after hysterectomy, and toanalyze the relationship between vaginal microecology and Toll-like receptor 2 (TLR2), Toll-like receptor 4 (TLR4), andcellular immune inflammatory factors. Methods Ninety-five patients undergoing hysterectomy admitted to Xi'an Inter-national Medical Center Hospital between January 2021 and December 2021 were selected and included in the study.Vaginal microecology was detected before surgery and at 1 week after surgery. According to the imbalance of vaginal mi-croecology after surgery, the patients were divided into 70 cases in imbalance group and 25 cases in normal group. Theexpression levels of peripheral blood TLR2, TLR4, T helper cell 1 (Th1) factors [interleukin-2 (IL-2), tumor necrosisfactor-α (TNF-α)], and Th2 factors [interleukin-4 (IL-4), Interleukin-10 (IL-10)] were detected before surgery and at 1week after surgery. Spearman correlation analysis was used to analyze the correlation between vaginal microecology,TLR2, TLR4 and cellular immune inflammatory factors. Receiver operating characteristic curve (ROC curve) was drawnto evaluate the diagnostic value of TLR2, TLR4, and cellular immune inflammatory factors on vaginal microecologicalimbalance. Results Compared with before surgery, the vaginal pH value of the patients was increased at 1 week aftersurgery, while the flora density, flora diversity, and Lactobacillus count were decreased (P<0.05). The vaginal microeco-logical imbalance rate of was 73.68% after surgery, significantly higher than 44.21% before surgery (P<0.05). The ex-pression percentages of peripheral blood TLR2 and TLR4 and the levels of serum IL-2 and TNF-α of patients in imbal-ance group were significantly higher than those before surgery and those in normal group, while the levels of IL-4 andIL-10 were obviously lower than those before surgery and those in normal group (P<0.05). Spearman correlation analy-sis results showed that vaginal pH of patients after surgery was positively correlated with the expressions of TLR4, IL-2,and TNF-α (P<0.05). The flora density and flora diversity were positively correlated with the expressions of TLR2,TLR4, IL-2, and TNF-α (P<0.05), but were negatively correlated with IL-4 and IL-10 (P<0.05). Lactobacillus was neg-atively correlated with the expressions of TLR2, TLR4, IL-2, and TNF-α (P<0.05). The areas under the ROC curves ofTLR2, TLR4, IL-2, TNF-α, IL-4, and IL-10 in the diagnosis of vaginal microecological imbalance were 0.729, 0.842,0.830, 0.741, 0.812, and 0.715, respectively. Conclusion The rate of vaginal microecological imbalance increases in pa-tients after hysterectomy, and vaginal microecological imbalance is closely related to TLR2, TLR4 and cellular immuneinflammatory factors.
      【Key words】 Hysterectomy; Vaginal microecology; Toll-like receptor; Cellular immunity; Inflammatory factors;Correlation