标题：中晚期妊娠合并CIN患者HPV感染状况、外周血T细胞亚群细胞水平变化及临床意义

      作者：雷盼盼，刘妮    渭南市妇幼保健院妇科，陕西 渭南 714000

      卷次： 2023年34卷22期

      【摘要】 目的 探讨中晚期妊娠合并宫颈上皮内瘤变(CIN)患者人乳头瘤病毒(HPV)感染状况、外周血T细胞亚群细胞水平变化及临床意义。方法 回顾性分析2020年7月至2021年12月在渭南市妇幼保健院诊治的60例中晚期妊娠合并CIN孕妇的临床资料，将其设为观察组，另选择同期产检的60例健康中晚期孕妇作为对照组。比较两组孕妇产前人乳头瘤病毒(HPV)阳性状况、产前及产后 6个月免疫功能指标(包括CD4、CD8)水平及观察组CIN分级不同孕妇产前与产后6个月HPV感染、HPV DNA载量和免疫功能指标水平。结果 观察组孕妇的单一感染、多重感染、HPV阳性率分别为56.67%、23.33%、80.00%，明显高于对照组的13.33%、0、13.33%，差异均有统计学意义(P<0.05)；产前，CINⅢ级孕妇的HPV感染率为100.00%，明显高于Ⅰ级、Ⅱ级的71.43%、85.00%，差异有统计学意义(P<0.05)，三级孕妇的HPV DNA载量比较差异无统计学意义(P>0.05)；产后6个月，CINⅢ级孕妇HPV转阴率为 8.33%，明显低于Ⅰ级、Ⅱ级的 64.29%、50.00%，HPV DNA载量为(1.73±0.27) ng/L，明显高于Ⅰ级、Ⅱ级的(0.46±0.11) ng/L、(0.71±0.14) ng/L，差异均有统计学意义(P<0.05)；产前及产后6个月，观察组孕妇的CD4水平分别为(36.37±8.05)%、(37.26±4.99)%，明显低于对照组的(41.56±6.23)%、(43.42±5.89)%，CD8水平分别为(28.93±8.49)%、(24.55±3.81)%，明显高于对照组的(24.13±3.90)%、(22.79±3.17)%，差异均有统计学意义(P<0.05)；产前及产后 6个月，不同CIN分级孕妇的CD8水平比较差异无统计学意义(P>0.05)；产前及产后 6个月，CINⅢ级孕妇的CD4水平分别为(35.21±7.21)%、(36.20±4.99)%，均明显低于Ⅰ级、Ⅱ级的(40.46±6.47)%、(37.26±7.03)%和(42.92±5.37)%、(39.42±4.89)%，差异均有统计学意义(P<0.05)。结论 中晚期妊娠合并CIN患者HPV阳性率明显高于健康同期妊娠孕妇，免疫功能明显较差，且HPV感染、免疫功能同CIN发展存在一定相关性。
      【关键词】 子宫颈上皮内瘤变；妊娠期；人乳头瘤病毒；免疫功能；人乳头瘤病毒感染
      【中图分类号】 R714.2 【文献标识码】 A 【文章编号】 1003—6350（2023）22—3248—04

HPV infection status and peripheral blood T cell subsets in patients with CIN during second and third trimestersof pregnancy and their clinical significance.
LEI Pan-pan, LIU Ni. Department of Gynaecology, Weinan Maternal andChild Health Hospital, Weinan 714000, Shaanxi, CHINA
【Abstract】 Objective To investigate the infection status of human papillomavirus (HPV), the changes of pe-ripheral blood T cell subsets in patients with cervical intraepithelial neoplasia (CIN) during second and third trimestersof pregnancy and their clinical significance. Methods The clinical data of 60 women with CIN during second and thirdtrimesters of pregnancy diagnosed and treated in Weinan Maternal and Child Health Hospital from July 2020 to Decem-ber 2021 (observation group) were retrospectively analyzed. Sixty healthy women of second and third trimesters ofpregnancy during the same period were selected as the control group. The prenatal human papillomavirus (HPV) posi-tive status, levels of immune function indicators (including CD4 and CD8) in prenatal and postpartum 6 months, andlevels of HPV infection, HPV DNA load, and immune function indexes at the prenatal stages and 6 months postpartumin pregnant women of different CIN stages were compared between the two groups. Results The single infection,multiple infection, and HPV positive rates of pregnant women in the observation group were 56.67%, 23.33%, and80.00%, which were significantly higher than 13.33%, 0, and 13.33% in the control group (P<0.05). At the prenatalstages, the HPV infection rate of pregnant women with CIN Ⅲ was 100.00% , which was significantly higher than71.43% of pregnant women with CINⅠ and 85.00% of pregnant women with CINⅡ (P<0.05); HPV DNA loadshowed no statistically significant difference among pregnant women with CIN Ⅰ,Ⅱ, Ⅲ. Six months after delivery,the HPV negative conversion rate of pregnant women with CIN Ⅲ was 8.33%, which were significantly lower than64.29% of pregnant women with CIN Ⅰand 50.00% of pregnant women with CIN Ⅱ; the HPV DNA load was (1.73±0.27) ng/L, which were significantly higher than (0.46±0.11) ng/L of CIN Ⅰ and (0.71±0.14) ng/L of CINⅡ; the differ-ences were statistically significant (P<0.05). At the prenatal stages and 6 months postpartum, the CD4 levels in the ob-servation group were (36.37±8.05)% and (37.26±4.99)% , which were significantly lower than (41.56±6.23)% and(43.42±5.89)% in the control group (P<0.05); CD8 level were (28.93±8.49)% and (24.55±3.81)%, which were signifi-cantly higher than (24.13±3.90)% and (22.79±3.17)% in the control group (P<0.05); there was no statistically signifi-cant difference in CD8 level among patients with CIN Ⅰ,Ⅱ, Ⅲ (P>0.05). At the prenatal stages and 6 months postpar-tum, the CD4 levels of pregnant women with CIN Ⅲ were (35.21±7.21)% and (36.20±4.99)%, which were significant-ly lower than (40.46±6.47)% and (37.26±7.03)% of pregnant women with CIN Ⅰ and (42.92±5.37)% and (39.42±4.89)% of pregnant women with CIN Ⅱ (P<0.05). Conclusion The positive rate of HPV in patients with CIN duringthe second and third trimesters of pregnancy is significantly higher than that of healthy pregnant women during thesame period, and the immune function is significantly poor. HPV infection and immune function were related to the de-velopment of CIN.
      【Key words】 Cervical intraepithelial neoplasia; Pregnancy; Human papillomavirus; Immune function; Humanpapillomavirus infection