Микробиота влагалища и ВПЧ-ассоциированные заболевания шейки матки: установленная взаимосвязь

Основная цель данного обзора – проанализировать научные данные о микробиоте нижних отделов половых путей и факторах, влияющих на ее состав, а также взаимосвязь с ВПЧ-ассоциированными заболеваниями шейки матки. Современные исследования подтверждают, что определенные виды лактобацилл могут играть защитную роль, снижая вероятность инфицирования вирусом папилломы человека (ВПЧ) и способствуя его элиминации. В то же время дисбиотические изменения, включая снижение уровня лактобацилл и увеличение численности условно-патогенных микроорганизмов, ассоциируются с развитием бактериального вагиноза и других нарушений биоценоза влагалища. Эти состояния могут способствовать персистенции ВПЧ, увеличивая риск формирования цервикальной интраэпителиальной неоплазии и рака шейки матки. Большинство исследований свидетельствуют о значительных различиях в составе вагинального микробиома у женщин с цервикальной интраэпителиальной неоплазией и злокачественными новообразованиями шейки матки по сравнению со здоровыми пациентками. Важную роль в этом процессе играют анаэробные бактерии, такие как Gardnerella vaginalis, Mobiluncus spp., Peptoniphilus spp., Parvimonas micra, Prevotella spp., которые могут подавлять рост лактобацилл и нарушать нормальный баланс микрофлоры. Кроме того, снижение уровня Lactobacillus crispatus связано с более высокой вероятностью персистенции ВПЧ и прогрессирования дисплазии. Изучение механизмов взаимодействия вагинальной микробиоты и ВПЧ важно для понимания патогенеза предраковых и злокачественных процессов шейки матки. Дальнейшее изучение этих аспектов позволит разработать новые стратегии профилактики и лечения, направленные на модуляцию вагинальной микрофлоры и снижение риска прогрессирования заболеваний.

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