人乳头瘤病毒基因型在宫颈癌、癌前病变及正常宫颈妇女中的分布

Human Papillomavirus Type Distribution in Women with and without Cervical Lesion

【目的】了解本地的宫颈癌、癌前病变及正常宫颈的妇女宫颈部位人乳头瘤病毒(HPV)感染及基因型的分布情况。【方法】利用导流杂交方法检测宫颈细胞的HPV DNA并进行基因型分型。以中山大学附属孙逸仙纪念医院参加宫颈癌普查人群中的液基细胞学(LCT)正常的妇女为宫颈细胞学正常组,经病理诊断确定为宫颈上皮内瘤变I级(CIN 1)为宫颈低度病变(LSIL)组,宫颈上皮内瘤变II级(CIN 2)和宫颈上皮内瘤变III级(CIN 3)为高度病变(HSIL)组;手术病理证实为浸润性宫颈癌为宫颈癌(ICC)组。比较各组的HPV感染率及其21种基因型的检出率。【结果】971例宫颈细胞学正常、86例LSIL、286例HSIL和97例浸润性宫颈癌(ICC)妇女符合研究条件,各组总HPV检出率分别为9.6%、62.1%、82.3%和90.2%,13种高危型HPV(HR-HPV)(包括HPV-16、18、31、33、35、39、45、51、52、56、58、59及68型)检出率分别为7.2%、50.2%、80.6%和87.4%,5种低危型HPV(LR-HPV)(包括HPV-6、11、42、43和44型)分别为2.1%、6.0%、9.2%和5.4%,其他类型HPV(包括HPV-53、66和cp8304型)分别为1.4%、4.7%、8.0%和8.5%。前5位检出率的HPV基因型,在宫颈细胞学正常组妇女分别为52(2.7%)、16(1.3%)、31(1.2%)、58(1.1%)、cp8304(0.9%);在LSIL组妇女分别为52(23.3%)、16(11.6%)、68(9.3%)、33(7.0%)、53(7.0%);在HSIL组的分别为16(39.9%)、58(7.7%)、33(6.3%)、18(5.6%)、52(4.9%);在ICC组分别为16(52.6%)、18(21.6%)、58(9.3%)、52(6.2%)、cp8304(4.1%)。【结论】本研究的细胞学正常宫颈、癌前病变和宫颈癌的总HPV检出率与国内文献报道相似。随着宫颈病变加重,HPV检出率增加。细胞学正常和LSIL者,HPV-52型是最常见的HPV亚型;随着宫颈病变加重,HPV-16/18型成为优势亚型。HPV-16/18型与宫颈病变进展关系密切。

[Objective]To survey the prevalence of human papillomavirus （HPV） and the type distribution in the women with and without cervical lesion from Guangzhou city. [ Methods]The women who anticipated cervical cancer screening with normal cytology were grouped as normal LCT group, histologically confirmed cervical intraepithelial neoplasm grade I （CIN 1 ） as low-grade intraepithelial lesion （LSIL）, CIN2-3 as high-grade intraepithelial lesion （HSIL） and invasive cervical cancer as ICC. Samples were detected by flow-through rapid hybridization. The set had a capacity of detecting 21 genotypes including high-risk HPVs （ 13 subtypes including HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68）, low-risk HPVs （5 subtypes including HPV-6, 11, 42, 43, and 44） , and other types （3 subtypes including HPV-53, 66, and cp8304）. [Results]A total of 971, 86, 286, and 97 women with normal cytology, with CIN 1, with CIN 2-3, and with ICC were enrolled, respectively. Overall HPV prevalences were 9.6%, 62.1%, 82.3%, and 90.2%, respectively, in women with normal cytology, with LSIL, with HSIL, and with ICC. High-risk HPV prevalences were 7.2%, 50.2%, 80.6%, and 87.4%; Low-risk HPV prevalences were 2.1%, 6.0%, 9.2%, and 5.4%; other HPVprevalences were 1.4%, 4.7%, 8.0%, and 8.5%. Stratified by cervical lesion grade, the five most common prevalent HPVs and type-specific prevalence were HPV-52（2.7%）, 16（1.3%） ; 31 （1.2%）, 58（1.1%）, cp8304 （0.9%） in the women with normal cytology; 52（23.3%）, 16（11.6%）, 68（9.3%）, 33（7.0%）, and 53（7.0%） in the women with LSIL; 16（39.9%）, 58（7.7%）, 33（6.3%）, 18（5.6%）, and 52（4.9%） with HSIL; 16（52.6%）, 18 （21.6% ）, 58 （9.3%）, 52 （6.2%）, cp8304 （4.1% ） with ICE. [ Conclusion ] Overall HPV prevalence in the women from Guangzhou with normal cytology, LSIL, HSIL, and ICC were similar to that reported in China and increased with severity of cervical lesion. But HPV-52 was the most predominant prevalence in the women with normal cytology and LSIL instead of HPV-16/18. HPV-16/18 turned to be predominant prevalence in the women with HSIL and ICC and may played important roll in progressing to ICC.