高危型人乳头瘤状病毒负荷量与宫颈病变严重程度的关系

Correlation between high-risk human papillomavirus viral load and severity of cervical lesion

目的研究妇女生殖道感染高危型人乳头瘤状病毒（hr-HPV）负荷量与宫颈病变严重程度的关系。方法接受第二代杂交捕获试验（HCⅡ）进行HPV DNA检测、且进一步行阴道镜下宫颈组织活检并行病理检查的女性1 806例,分析病毒负荷量与宫颈病变严重程度的相关性。结果1 806名女性总hr-HPV感染率为35.5%（641/1806）;正常女性感染率仅为23.2%（301/1299）,明显低于宫颈病变病例（P=0.000）。在高病毒负荷量中,只有宫颈癌与宫颈上皮内瘤样病变（C IN）1之间的差异显著（P=0.049）,危险比值比为8.5,95%可信区间为1.0-71.4。在中、低度病毒负荷量中,C IN2、C IN3和宫颈癌对比C IN1均无显著性差异。C IN1、C IN2、C IN3和宫颈癌各组的相对光单位比值（RLU/PC）行对数值转换,中位数差异不显著（P=0.712）。结论检测高危型HPV能很好地区分病变宫颈和正常宫颈,而高危型HPV病毒负荷量与宫颈病变严重程度关系不密切,能否作为宫颈病变严重程度预测指标有待进一步研究。

Objective To explore the correlation between high-risk human papillomavirus （hr-HPV） viral load and severity of cervical lesion. Methods One thousand eight hundred and six women undergoing both hr-HPV DNA test by hybrid capture Ⅱ （ HC Ⅱ ） and colposcopic biopsy for histologic results were enrolled in this study. Correlation between hr-HPV viral load and pathological findings was investigated. Results Of 1 806 cases,641 （35.5%） patients were positive for HPV DNA. 23.2% （301/1299） of women with normal diagnosis had HPV infection, significantly lower than cervical lesion including cervical intraepithelial neoplasia （CIN） and cervical cancer（P = 0. 000）. Associations （ odds ratio） among severity of cervical lesion and viral load were calculated. The significantly increased risk only existed between cervical cancer and CIN1 on high viral load （odds ratio, 8.5; 95% confidence interval, 1.0 -71.4; P = 0. 049）. Furthermore, viral load values in CIN1, 2, 3 and cervical cancer were calculated and median analysis revealed non-significant difference （P = 0. 712）. Conclusion The hr-HPV viral load can distinguish cervical lesion as CIN and cervical cancer from normal one, while the prediction of the severity of cervical lesion may be inadequate and need further investigations.