Correlation of vaginal lactic acid bacteria changes with high-risk human papillomavirus-infected cervical...

To investigate the correlation between vaginal lactobacilli and intraepithelial neoplasia (CIN) and high-risk infection of human papillomavirus (HR-HPV).

A total of 358 HR-HPV-infected women who underwent gynecological examinations were selected as the study subjects. The HR-HPV-infected women were randomly divided into a training set (n = 251) and a validation set (n = 107) at a ratio of 7:3. In the training set, influencing factors associated with the occurrence of CIN were screened by multivariate Logistic regression analysis, and a Nomogram prediction model was constructed. The predictive performance of the model was evaluated by plotting the receiver operating characteristic (ROC) curve and calibration curve, and then validated in the validation set. Meanwhile, decision curve analysis (DCA) was used to evaluate the clinical application value of the Nomogram model.

The incidence of CIN was 54.98% (138/251) in the training set and 53.27% (57/107) in the validation set, with no significant differences in the incidence of CIN and clinical characteristics between the two groups (P > 0.05). In the training set, a decrease in the number of vaginal lactobacilli, an increase in vaginal pH, a higher HR-HPV load, an older age, a longer duration of persistent HPV infection, and a decrease in serum vitamin D level were independent risk factors for the occurrence of CIN in HR-HPV-infected women (all P < 0.05), and a Nomogram prediction model was further constructed. The Nomogram model showed good calibration and goodness-of-fit in both the training set and the validation set (C-index values were 0.845 and 0.761, and the P-values of the Hosmer-Lemeshow test were 0.368 and 0.412, respectively). The ROC curves showed that the areas under the curve (AUCs) of the Nomogram model for predicting the occurrence of CIN in HR-HPV-infected women in the training set and the validation set were 0.845 (95% CI: 0.767-0.923) and 0.761 (95% CI: 0.611-0.910), respectively, with sensitivities and specificities of 0.660, 0.845, and 0.619, 0.725, respectively.

The Nomogram is helpful for early prediction of CIN in HR-HPV-infected women and guiding the formulation of appropriate clinical intervention measures.