人乳头瘤病毒检测对宫颈病变的诊断价值

Clinical significance of the detection of the Human Papilloma Virus（HPV） DNA typing in therapy of cervical diseases

目的评价人乳头瘤病毒（HPV-DNA）分型检测对宫颈病变的诊断价值。方法对780例HPV-DNA阳性且病理活检为宫颈癌及宫颈上皮内瘤样病变（CINⅠ-Ⅲ）患者进行手术或物理治疗，治疗后6个月、12个月行HPV-DNA检测及液基薄层细胞学检查。结果780例患者中常见HPV-DNA分型分别为16、52、58、18、33、31型；在CINⅠ患者中，HPV-52、58型检出率最高，在CINⅡ、CINⅢ、原位癌及浸润癌患者中，HPV-16型感染率明显高于其他基因型，差异有统计学意义（P〈0．01）。520例治疗后随访1年，其中432例（83．08％）HPV—DNA感染患者3个月至1年内消退，88例（16．92％）HPV感染未消退，其中细胞学检查为正常或炎症48例（54．55％），ASC．US14例（15．90％），LSIL22例（25％），HSIL4例（4．55％）；HPV持续阳性患者中细胞学检查异常均高于HPV阴性患者。结论宫颈病变患者最常见HPV基因型为16、52、58、18、33、31型，尤其是HPV-16型与高级别上皮内瘤变及宫颈癌密切相关。

Objective To evaluate the clinical significance of the detection of the Human Papilloma Virus （HPV） DNA typing in therapy of cervical diseases. Methods 780 cases have been studied. These cases which showed HPV-DNA positive and were diagnosed by biopsy as cervical cancer or cervical intraepithelial neoplasia（ CIN Ⅰ-Ⅲ） were treated by operation or physical therapy. And 6 months and 12 months after the treatment,TCT and HPV DNA test were carried out. Results The prevalence of HPV-DNA types among the 780 cases descended from HPV 16 to 52,58,18,33 and 31. Detection rates of HPV-52 and 58 were highest among the patients with CIN Ⅰ. In patients with CIN Ⅱ,CIN Ⅲ,carcinoma in situ and invasive carcinoma,the positive rate of HPV-16 was obviously higher than other genotypes, and the difference was significant （ P 〈 0.01 ）. 520 cases were followed-up after treatment, we found that HPV-DNA subsided within 3 months to 1 year in 432 cases. 88 cases still showed the HPV-DNA positive, among this group 48 cases were cytology diagnosed as normal or inflammation, but 14 cases were ASC-US,22 cases were LSIL and 4 cases were HSIL. Cytology abnormal cases were more often detected in patients with persistent HPV-positire than in patients with HPV-negative. Conclusion Referring patients with cervical diseases the common HPV genotypes are 16,52,58,18,33 and 31. Especially HPV-16 are closely related with cervical cancer and high-level cervical intraepithelial neoplasis. HPV-DNA turn negative in most patients in 12 months after treatment. Persistent infection of HPV-DNA is related with the pathological changes persist.