Role of the Vaginal Microbiological Ecosystem andCytokine Profile in the Promotion of Cervical Dysplasia: A Case–Control Study

[摘要] Objective:To identify alterations in the cytokine profile and microbial ecosystem of the vagina in associationwith cervical dysplasia.Methods:Demographics, lifestyle variables and Papanicolau (Pap) smear results of subjects presenting to thesame site for gynecologic complaints, obstetric visits or colposcopy were prospectively recorded. Vaginal smearfor Gram stain, aerobic and anaerobic culture, pH, and wet mount and KOH examination forTrichomonas vaginalis,Gardnerella vaginalisand yeast organisms were performed. Vaginal lavage specimens were centrifuged, and thepellets and supernatants were assayed for human papillomavirus (HPV) by polymerase chain reaction and forcytokines interleukin (IL)-1ß IL-6, IL-10 and IL-12 by enzyme-linked immunosorbent assay (ELISA) respectively.Subjects with abnormal Pap smears underwent colposcopy and biopsy as indicated.Results: Of 51 patients, 32 were referred for colposcopy, 12 presented with gynecologic needs, and sevenpresented for obstetric visits. Median age was 24 years. Demographics did not differ significantly between thedysplasia and control groups except for a trend towards more sexual partners in the dysplasia group. Biopsies wereperformed in 81% (26/32) of patients presenting for colposcopy and 17 revealed cervical intraepithelial neoplasia.IL-1ß, IL-6, IL-10, and IL-12 levels were elevated in 63% (20/32), 38% (15/39), 4% (2/49), and 0% of samplesrespectively. Elevated vaginal lavage IL-1ß was associated with a 6.1 odds ratio (95% confidence interval 1.06–35)of cervical dysplasia. Alterations in other variables studied were not associated with cervical dysplasia.Conclusions: Elevated IL-1ß, possibly representing a complex host inflammatory response to multiple pathogens,was demonstrated in patients with cervical dysplasia.

[学科分类] 妇产科学