中国大陆地区不同宫颈病变人群中人乳头瘤病毒感染率及型别分布的系统研究

Prevalence and genotypes distribution of human papillomavirus in patients with different grades of cervical lesions in China's Mainland

目的探讨中国大陆地区不同级别宫颈病变女性人群中人乳头瘤病毒(HPV)感染和型别分布规律,为制定适宜特定地区人群的宫颈癌防控措施提供依据。方法检索1990年1月至2018年10月间Pub Med、CNKI和维普数据库发表的所有关于中国女性人群HPV感染及型别分布的研究,采用Stata 12.0软件进行数据分析。结果共有63篇文献纳入最终分析,HPV总感染率随病变级别严重程度逐渐升高,在宫颈上皮内瘤变Ⅰ级(CIN1)、宫颈上皮内瘤变Ⅱ级(CIN2)、宫颈上皮内瘤变Ⅲ级(CIN3)和宫颈癌人群中分别为67.2%[95%CI(59.4,75.0)%]、79.1%[95%CI(73.6,84.7)]、85.9%[95%CI(83.0,88.8)%]和85.3%[95%CI(83.0,87.6)%]。不同级别宫颈病变中HPV型别分布有差异,最常见的前三位,宫颈癌中为HPV16/18/58,CIN3和CIN2中均为HPV16/58/52,CIN1中为HPV16/52/58。HPV52是CIN1中第二常见的型别,但其所占比例在CIN2、CIN3和宫颈癌中开始下降。不同地区的HPV感染率及型别分布存在差异,高危型HPV感染是各地区最常见的型别感染。结论我国大陆地区宫颈病变女性人群中HPV感染率及型别分布具有地区分布和病变级别分布差异,以高危型HPV16/18/58/52感染为主。

Objective We aimed to conduct a systematic review and meta-analysis to evaluate the HPV infection rate and specific genotypes distribution among female population with different stage grades of cervical lesions in China's Mainland,so as to provide epidemiological evidence for the prevention and control of cervical cancer among specific geographical regions and populations.Methods Published research on HPV infection rate and genotypes distribution in Chinese women were searched from Pub Med,China National Knowledge Infrastructure(CNKI)and VIP database for Chinese technical periodicals from January 1990 to October 2018.Stata 12.0 software was used for meta-analysis.Results Sixty-three studies were eligible for the final meta-analysis.The overall HPV infection rate increased with the degree of cervical disease severity.The pooled infection rate of overall HPV was 67.2%[95%CI(59.4,75.0)],79.1%[95%CI(73.6,84.7)],85.9%[95%CI(83.0,88.8)]and 85.3%[95%CI(83.0,87.6)],respectively among women with CIN1,CIN2,CIN3 and ICC.The distribution of HPV genotype varies in different cervical lesion grades.The three most common HPV genotypes were HPV16/18/58 in patients with ICC,HPV16/58/52 both in patients with CIN3 and patients with CIN2 and HPV16/52/58 in patient with CIN1.HPV52 is the second most common type in patients with CIN1,but the proportion decreased in patients with CIN2,CIN3 and ICC.The HPV prevalence and genotypes distribution varied among women in different regions.High-risk HPV remained the most common genotypes in all regions.Conclusion There are differences in the HPV infection rate and genotypes distribution among women with different grades of cervical lesions in different regions.High-risk HPV16/18/58/52 remains the common genotypes.