Associations of cervicovaginal lactobacilli with high-risk HPV infection, cervical intraepithelial neoplasia, and cancer: a systematic review and meta-analysis
A partir d'une revue systématique de la littérature publiée jusqu'en février 2019 (11 études ; 1 230 cas), cette méta-analyse évalue l'association entre la dysbiose vaginale (déséquilibre du microbiote caractérisé par la diminution des lactobacilles) et la carcinogenèse cervicale
Vaginal dysbiosis characterized by depleted lactobacilli is usually correlated with HPV infection and cervical carcinogenesis, but the effect of the Lactobacillus genus and represented species on this process remains unclear.PubMed, EMBASE, and CENTRAL databases were searched up to February 15, 2019. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a fixed-effect model and Review Manager (version 5.3) for Mac.Eleven studies comprising 1230 cases were included. Lactobacillus spp. was associated with the decreased detection of high-risk subtype (hr)HPV infection (OR = 0.64, 95% CI = 0.48–0.87, I2 = 6%), cervical intraepithelial neoplasia (CIN) (OR = 0.53, 95% CI = 0.34–0.83, I2 = 0%), and cancer (CC) (OR = 0.12, 95% CI = 0.04–0.36, I2 = 0%). At the level of Lactobacillus species, L. crispatus, but not L. iners, was correlated with the decreased detection of hrHPV infection (OR = 0.49, 95% CI = 0.31–0.79, I2 = 10%) and CIN (OR = 0.50, 95% CI = 0.29–0.88, I2 = 0%).Cervicovaginal Lactobacillus spp. is associated with the decreased detection of hrHPV infection, CIN, and CC; L. crispatus may be the critical protective factor.