Resumen de Vaginal micro‑environment disorder promotes malignant prognosis of low‑grade cervical intraepithelial neoplasia: a prospective community cohort study in Shanxi Province, China

Jianmin Liu, Nan Hu, Xiao Zheng, Huimin Li, Kailu Zhao, Jiahao Wang, Mingxuan Zhang, Le Zhang, Li Song, Yuanjing Lyv, Meng Cui, Ling Ding, Jintao Wang

• Purpose Emerging evidence suggests that vaginal micro-environment disorder is closely related to the development of cervical lesions. Low-grade cervical intraepithelial neoplasia (CIN1), as an early stage of cervical lesions, exhibits a high risk of progressing to high-grade lesions or even cervical cancer. However, the effect of vaginal micro-environment on the malignant prognosis of CIN1 remains uncertain.

  Methods A total of 504 patients diagnosed with CIN1 by pathology, who were from the population-based cohorts established in Shanxi Province, China, were enrolled and followed up for 2 years. Micro-environmental factors such as vaginal pH, cleanliness, hydrogen peroxide (H 2 O 2 ), β-glucuronidase (GUSB), leucocyte esterase (LE), and sialidase (SNA) were detected to evaluate their effect on the malignant prognosis of CIN1.

  Results Abnormal vaginal pH (HR = 1.472, 95%CI 1.071–2.022), cleanliness (HR = 1.446, 95%CI 1.067–1.960), H 2 O 2 (HR = 1.525, 95%CI 1.155–2.013), GUSB (HR = 1.739, 95%CI 1.235–2.448), LE (HR = 1.434, 95%CI 1.038–1.981), and SNA (HR = 1.411, 95%CI 1.065–1.870) could promote a higher incidence of CIN1 malignant prognosis, and the combined effects of these micro-environmental factors resulted in a nearly twofold increased risk (HR = 2.492, 95%CI 1.773–3.504) compared to any single factor alone, especially under the high-risk human papillomavirus (HR-HPV) infection. Notably, the cumulative incidence of malignant prognosis for CIN1 gradually increased during the early follow-up period, reaching its peak at approximately 8 months, and then stabilizing.

  Conclusion Vaginal micro-environment disorder could promote CIN1 malignant prognosis, particularly in HR-HPV-infected women. Taking micro-environmental factors as the breakthrough, our study provides a feasible vision for preventing early stage cervical lesions.