16320例妇科门诊患者HPV感染情况分析

Analysis of human papillomavirus infection in 16320 patients from gynecologic clinic

目的:研究妇科门诊患者生殖道人乳头瘤病毒(HPV)感染情况及其与宫颈病变的关系。方法:收集2009年1月至2013年12月就诊于湘雅三医院妇科门诊16 320例患者的临床资料。应用回顾性研究方法,分析HPV总体感染情况,比较不同年龄组、不同亚型HPV感染率,分析HPV持续性感染情况及宫颈细胞学结果。结果:16 320例患者中共检出4 332例HPV感染者,HPV总感染率为26.54%。HPV总感染率和高危型感染率的低峰为30~39岁(P<0.05),高峰为≥60岁(P<0.05);高危型感染率在各年龄组差异有统计学意义(P<0.05),低危型感染率在各年龄组差异无统计学意义(P=0.693)。HPV阳性间隔1年后的清除率为87.65%。非持续阳性组与持续阳性组高、低危型感染构成比差异无统计学意义(P=0.545),均以高危型为主;单一、混合感染构成比差异有统计学意义(P<0.05),持续阳性组混合感染明显高于非持续阳性组。持续阳性组中最常见的HPV亚型为16,52,58,CP8304,33。持续阳性组发生不能明确意义的非典型鳞状上皮细胞(ASC-US)、高度鳞状上皮病变(HSIL)、鳞状细胞癌(SCC)显著升高(P<0.05)。结论:HPV持续性感染以高危型、混合感染为主,本地区应重视HPV 16,52和58型持续性感染的防治。

Objective: To evaluate the genital human papillomavirus(HPV) infection in patients from gynecology clinic, and to investigate the association of persistent HPV infection with cervical lesions. Methods: From January, 2009 to December, 2013, clinical data of 16 320 patients in Th ird Xiangya Hospital were collected. A retrospective analysis was carried out to evaluate the overall prevalence of HPV infection. Th e prevalence of HPV infection in diff erent ages and subtypes were compared. Th e prevalence of persistent HPV infection and results of cervical cytology were analyzed. Results: The overall HPV prevalence was 26.54%. The lowest overall and high-risk HPV prevalence were found in women at the age of 30-39 years old(P<0.05); the highest ones were found at the age of over 60 years old, with significant difference among the aged groups(P<0.05). There was no significant difference in low-risk HPV prevalence among the aged groups(P=0.693). The clearance rate of HPV was 87.65% one year later. There was no significant difference in high-risk and low-risk HPV infection between the non-persistent positive group and the persistent positive group(P=0.545), but the difference in single and multiple subtypes infection between these 2 groups was significant(P<0.05). In the persistent positive group, the most common genotypes were HPV 16, 52, 58, CP8304, and 33. The incidence of ASC-US, HSIL or SCC was significantly increased in the persistent positive group. Conclusion: Persistent HPV infection mainly consists of multiple and high-risk HPV infection. It is necessary to focus on the prevention of HPV 16, 52 and 58 persistent infection in our region.