人乳头瘤病毒-DNA分型检测在年轻妇女宫颈病变诊断中的价值

Human papillomavirus DNA typing testing in diagnosis of cervical lesions in young women

目的探讨人乳头瘤病毒(HPV)-DNA分型检测在30岁以下妇女宫颈病变诊断中的价值。方法674例30岁以下年轻妇女采用核酸分子快速杂交基因分型技术进行HPV-DNA分型检测阳性;同时进行宫颈细胞学检查、阴道镜下活检,病理检查结果为诊断标准。结果10种最常见HPV感染频率由高至低为HPV-16、52、58、6、11、33、18、53、39、31;HPV-16型与宫颈病变严重程度有明显关联,在正常或炎症组、低度鳞状上皮内瘤变(LSIL)组、高度鳞状上皮内瘤变(HSIL)组HPV的感染率分别为12.1%(33/273)、19.0%(61/321)、51.3%(40/78),HSIL组的感染率明显高于其他2组,差异有统计学意义(P<0.01);2例宫颈癌均检出HPV-16型感染;在HSIL组中HPV-16、58、33、18型感染率分别为53.8%(42/78)、16.7%(13/78)、12.8%(10/78)、7.7%(6/78),均高于正常或炎症组的感染率;在外阴宫颈湿疣病变中,HPV-6、11型的感染率明显高于其他型别HPV的感染,差异有统计学意义(P<0.01);在正常或炎症组、LSIL组、HSIL组中多重感染率分别为16.5%(45/273)、39.6%(127/321)、32.1%(25/78),LSIL组与HSIL组明显高于正常或炎症组,差异有统计学意义(P<0.01)。结论年轻妇女人群的高危型HPV感染及多重HPV感染与宫颈病变的严重程度密切相关,对年轻高危人群妇女应行HPV-DNA分型检测,及早诊断及早治疗。

Objective To assess human papillomavirus DNA （HPV-DNA） typing testing in diagnosis of cervical lesions in women under thirty years＇ old. Methods 674 young women were determined as HPV positive by DNA flow-through hybridization genotyping technique. Simultaneously, biopsy under gynecatoptron and cervical cytological examination were performed. Diagnostic criteria was according to the histopathologic examination results which was classified into four groups ： normal or inflammatory group, low- grade squamous intraepithelial lesions （LSIL） group, high-grade squamous intraepithelial lesions （HSIL） group, and cervical cancer group. Results The top ten prevalence of HPV types from highest to lowest order were as follows： HPV-16, 52, 58, 6, 11, 33, 18, 53, 39, 31. HPV-16 was highly associated with the severity of cervical lesions. The infection rate of HPV-16 in normal or inflammatory group, LSIL group and HSIL group was 12. 1%, 19. 0 % and 51.3 % respectively, with HSIL group obviously higher than the other two groups （P 〈0. 01 ）. In HSIL group, HPV-16, 58, 33 and 18 infection occured at 53. 8 %, 16. 7 %, 12. 8 % and 7.7 % of women, respectively, which were all higher than in normal or inflammatory group. The infection rates of HPV-6, 11 were significantly higher than other types of HPV infection with progenital or cervical syphilomyces disease （P 〈0.01 ） . Multiple infection rates in normal or inflammatory group, LSIL group and HSIL group were 16.5 %, 39. 6 % and 32. 1% respectively, with LSIL group and HSILgroup significantly higher than normal or inflammatory group （ P 〈 0. 01 ）. Conclusions High-risk type and multiple HPV infection are closely associated with the severity of cervical lesions in young women. With regard to high-risk young group, HPVDNA typing testing is essential for early diagnosis and treatment.