高危型人乳头瘤病毒负荷量与宫颈癌及癌前病变的相关性研究

The study of correlation between viral load of high risk human papillomavirus and cervical cancer and precancer

目的探讨高危型人乳头瘤病毒(HPV)的病毒负荷量与宫颈癌及其癌前病变(CIN)的关系。方法选择2003年1月至2004年7月间在广东省人民医院宫颈疾病专科门诊就诊的妇女5584例,采用第2代杂交捕获试验(HC-Ⅱ)进行高危型HPVDNA的半定量检测,阴道镜下定位活检,病理学结果为确诊标准。结果高危型HPV检测阳性1590例,阳性率28.47%,各种病理类型的宫颈病变中高危型HPV感染率分别为:宫颈鳞癌88.89%,宫颈腺癌66.67%,CINⅢ92.77%,CINⅡ86.30%,CINⅠ44.58%,宫颈扁平型湿疣86.69%,慢性宫颈炎9.59%。随着宫颈病变严重程度的增加,高危型HPV的病毒负荷量也增高,它们之间的相关性有显著意义(H=1984.714,P<0.01),其中慢性宫颈炎与宫颈癌及CIN的差异有显著性意义(P<0.01);CINⅠ与宫颈腺癌之间的差异无显著性意义(P>0.05),但与宫颈扁平型湿疣、CINⅡ、CINⅢ及宫颈鳞癌的差异有显著性意义(P<0.01);而宫颈扁平型湿疣、CINⅡ、CINⅢ与宫颈鳞癌之间的差异无显著性意义(P>0.05)。用ROC曲线分析HC-Ⅱ检测宫颈高度病变,最能平衡敏感度和特异度的阳性分界点是3.7pg/mL,Youden指数为0.72,敏感度为92%,特异度为80%。结论高危型HPV的病毒负荷量增高与宫颈病变严重程度的增加密切相关;合理设置阳性分界点,可提高HC-Ⅱ检测宫颈高度病变的特异度。

Objective To explore the relation between human papillomavirus （HPV） DNA load and cervical cancer, cervical intraepithelial neoplasia（CIN）. Methods The restmspective study was carried out in which 5584 women who received treatments from January, 2003 to July, 2004 in Guangdong Provinical People＇s Hospital were recruited. HPV DNA was semi-quantitatively determined by hybrid capture Ⅱ （ HC- Ⅱ ） , then cervical biopsy was obtained under colposcopy and results of histopathologic tests were the final diagnoses. Results High risk HPV DNA was detected in 1590 women（24. 47% ）. Among them, infection rates of high risk HPV according to different cervical diseases were the as follows： 88. 89% of cervical squamous cell carcinoma, 66. 67% of cervical adenocarcinoma, 92. 77% of CINm, 86. 30% of CIN Ⅱ , 86. 69% of cervical HPV infection and 9. 59% of chronic cervicitis. It was found that high risk HPV DNA load increased with aggrevation of cervical diseases and there was significant correlation（ H = 1984. 714, P 〈0.01 ）. Significant differences of high risk HPV infection rate existed between chronic cervicitis and cervical cancer, CIN （P 〈 0.01 ）, and between CIN Ⅰ and cervical HPV infection, CIN Ⅱ , CINm ,cervical squamous cell carcinoma（P 〈0.01 ）. But no significance was found between CIN Ⅰ and cervical adenocarcinoma （ P 〉 0. 05 ）, and between cervical squamous cell carcinoma and cervical HPV infection, CIN Ⅱ , CIN Ⅲ （ P 〉 0. 05 ）. Positive cutoff of sensitivity and specificity of HPV load was 3.7pg/mL by ROC curve analysis with Youden index of 0. 72, sensitivity of 92% and specificity of 80%. Conclusion There is significant correlation between elevated high risk HPV DNA load and severity of cervical lesion . Appropriate parameter of positive cutoff may increase specificity of HC- Ⅱ for detecting cervical lesion.