山西省襄垣县妇女人乳头状瘤病毒感染与宫颈癌关系的研究

Study of the association between human papillomavirus infection and cervical cancer in Xiangyuan county, Shanxi province

目的 了解我国宫颈癌高发区妇女生殖道人乳头状瘤病毒 (humanpapillomavirus ,HPV)感染状况 ,研究高危型HPV感染与宫颈癌的关系。方法 应用第二代杂交捕获试验对山西省襄垣县 1997名 35～ 45岁已婚妇女自己采集的阴道细胞和医生采集的宫颈细胞 ,检测 13种高危型HPV脱氧核糖核酸 (DNA)。采用多因素的非条件logistic回归模型分析HPV感染与宫颈癌及宫颈上皮内瘤变 (CIN)的关系。用卡帕 (kappa)系数衡量两种标本HPV检测的符合度。 结果 该人群的高危型HPVDNA总检出率为 2 0 .8%。HPVDNA检出率随病变程度加重呈趋势性增高 (χ2 =44 4.0 4,P =0 .0 0 0 )。两年龄组 (35～ 39岁和 40～ 45岁 )妇女的宫颈HPVDNA检出率几乎一样(2 0 .9%∶2 0 .6 %,χ2 =0 .0 3,P =0 .86 )。非条件logistic回归分析显示 ,HPV感染与宫颈上皮内高度病变及癌症 (≥CINⅡ )和低度病变 (CINⅠ )的发生高度相关 (OR =2 5 4.2和OR =2 6 .4) ,归因危险百分比 (ARP)分别为 98.1%和 83.6 %。自我取样HPV检测的灵敏度低于医生取样HPV检测 (84%∶98%,χ2 =5 .92 ,P =0 .0 15 ) ,特异度差异无显著性 (86 %∶85 %,χ2 =0 .0 0 ,P =0 .997) ,但两种标本HPV检测的符合度较好 (kappa =0 .74)。结论 女性生殖道高危型HPV感染是当地宫颈癌及CIN流?

Objective To investigate human papillomavirus (HPV) prevalence in the high incidence areas of cervical cancer in Shanxi and to study the association between HPV infection and cervical cancer. Methods Cells exfoliated from cervix (collected by clinician) and from vagina (collected by subject herself) of 1997 women aged 35 45 from Xiangyuan county, Shanxi province were analyzed blindly by Hybrid Capture Assay (HC Ⅱ), which could detect 13 HPV types of high risk. Unconditional logistic regression model was used to analyze the relation between HPV and cervical cancer/cervical intraepithelial neoplasia (CIN). Kappa coefficient was used to compare the agreement of the two tests. Results HPV DNA detection rate in the population was 20.8 % while HPV infection rates increased with the seriousness of cervical lesions (χ 2= 444.04 , P = 0.000 ). Rates of the two groups (35 39 and 40 45) had no significant difference ( 20.9 %∶ 20.6 %,χ 2= 0.03 , P = 0.86 ). Unconditional logistic regression analysis showed, when comparing with the normal subjects, the risk odds ratio of HPV infection with cervical cancer/high grade CIN and low grade CIN were 254.2 and 26.4 respectively, with attributable risk proportions ( ARP ) 98.1 % and 83.6 % respectively. The sensitivity of self collected vaginal swabs assayed for HPV DNA was lower than that of clinician collected cervical samples assayed for HPV DNA (84%∶98%,χ 2= 5.92 , P = 0.015 ). No significant difference in specificity was seen between them (86%∶85%,χ 2= 0.00 , P = 0.997 ) and there was fair agreement between the two tests (kappa= 0.74 ). Conclusion High risk HPV infection in female genital tract was the major risk factor of cervical cancer and CIN in the areas. Prevention and control of cervical cancer should be focused on avoiding HPV infection, screening women for HPV infection and monitoring population infected by high risk HPV. Self collected vaginal swabs assayed for HPV DNA seemed a more practical method in primary screening for cervical cancer.