HPV不同亚型感染与宫颈病变的关系

The relation of various sub-type HPV infection with precancerous lesions of uterine cervix

目的探讨不同亚型人乳头瘤病毒(HPV)感染与宫颈病变的关系。方法对细胞学筛查为异常并经病理组织学证实的524例宫颈病变(包括宫颈炎251例、CINⅠ130例、CINⅡ67例、CINⅢ61例及ICC 15例)进行HPV分型检测。结果①HPV总阳性率为55.53%(291/524),HPV感染率随着宫颈病变级别的增加逐渐上升(P<0.01),HPV感染在不同年龄组差异有高度显著性(P<0.01),21～50岁系高发年龄。②检出20种HPV亚型,其中高危型16种,低危型4种,随宫颈病变程度的增加HPV亚型分布有所变化,宫颈炎组以HPV16、58、18、11、31、33、6为常见亚型,低度病变组(CINⅠ)以HPV16、58、18、31、56、11、33为常见类型,而高度病变组(CINⅡ～Ⅲ)以高危型HPV16、58、18、31、33、59和56型为最常见,15例浸润癌检出7种高危亚型HPV,分别是16、58、18、31、33、59和68型。HPV16亚型随宫颈病变级别加重感染率呈上升趋势(P<0.01)。结论感染率最高的高危型HPV16、58、18、31、33是主要致病基因型,尤其是HPV16型与宫颈病变程度有关,高危型HPV持续感染及多重感染是导致宫颈癌变的主要原因之一。

Objective The association of various subtype human papillovirus （HPV） infection with precancerous lesions of uterine cervix are investigated. Methods HPV typing test was performed for 524 cases with precancerous lesions of uterine cervix proven by cytological examination and histopathological examination, including 251 cases of cervicitis, 130 cases of cervical intraepithelial neoplasia Ⅰ （CIN Ⅰ）, 67 cases of CIN Ⅱ, 61 cases of CIN Ⅲ and 15 eases of infiltrating cervix cancer （ICC）. Results 1. Of 524 patients, 291 of them （55.53%） were found with HPV-positive, the higher grade of lesions of uterine cervix was, the more the infection rate was （ P 〈 0.01）. The infection rate differed significantly among various age groups （ P 〈 0.01）, the highest risk age was from 21 to 50 years. 2. 20 subtypes of HPV were isolated, 16 of them was high risk type, 4 of them was low risk type. The HPV subtype varied with severity of cervix diseases increased, cervicitis group presented with HPVI6, 58, 11, 31, 33 and 6; low grade of uterine cervix lesion group （CIN Ⅰ） commonly presented with HPV 16, 58, 18, 31, 56, 11 and 33, and high grade lesion group （CIN Ⅱ～Ⅲ ） were found with high risk type HPV 16, 58, 18, 31, 33, 59 and 56. 7 types of high risk HPV were found in 15 cases with ICC, including types 16, 58, 18, 31, 33, 59 and 68. HPV16 subtype increased significantly with higher grade of the cervix lesions （ P 〈 0.01）. Conclusion The highest infected HPVof high risk types 16, 58, 18, 31 and 33 were the major pathogen, HPV16 was especially correlated with cervix disease severity, continuous high risk HPV infection and multi - infection results in cervix canceration,