宫颈上皮内病变与HPV相关

WOMEN'S CERVICAL INTRAEPITHELIAL LESIONS ASSOCIATE WITH HPV

目的了解辽宁省妇女生殖道人乳头瘤病毒(Human Papillomavirus,HPV)感染情况,研究辽宁省妇女宫颈上皮内病变与HPV感染的相关性。方法回顾性分析600例行核酸分子快速导流杂交基因芯片技术(Hybri Max)检测的患者,该600例患者均行薄层液基细胞学技术(Liguid-based cytologic teset,LCT)检查,有127例患者行病理活检,结合3种方法研究HPV感染与宫颈病变的相关性。结果导流杂交HPV-DNA检测结果与LCT结果相结合,600例患者中,感染HPV的阳性率分别为正常32%(92/288),Asc-us42%(87/208),LSIL53%(40/75),HSIL86%(19/22),癌100%(7/7)。导流杂交HPV-DNA检测结果与病理活检结果相结合,感染HPV的阳性率分别为:正常或慢性炎症36.17%(17/47),CINⅠ66.67%(36/54),CINⅡ-Ⅲ84.21%(16/19),癌100%(7/7),HPV感染阳性率随宫颈病变程度加重而明显升高。细胞学与组织学病理诊断符合率分别为LSIL72%(54/75),HSIL86.36%(19/22),SCC100%(7/7)。不同年龄阶段妇女感染HPV的阳性率依次为20-29岁46.76%(65/139),30-39岁43.41%(79/182),40-9岁40.48%(71/174),50-59岁38.16%(29/76),60-69岁37.50%(6/16),70岁76.92%(10/13)。600例患者HPV感染总阳性率为40.83%(245/600),在HPV21种亚型中,有19种亚型均被检测出,感染率最高的是HPV16 35.51%(87/245),其它常见型别依次为HPV58,HPV6,HPV53,HPV18,HPV31,HPV52和cp8304。此外还发现高危型HPV16的感染率:正常或慢性炎症35.29%(6/17)CINⅠ33.33%(12/36),CINⅡ-Ⅲ56.25%(9/16),癌85.71%(6/7),其感染率阳性率在各种程度的宫颈病变中占很大比重,也随宫颈病变的严重程度而增高,进一步论证了HPV16的高危性。结论辽宁省妇女HPV感染的主要亚型是HPV16,HPV58及HPV6.无论是与细胞学检测结果相结合还是与病理活检结果相结合,HPV感染阳性率均随宫颈病变程度的加重而增高。提示宫颈病变的防治重点应放在预防及治疗HPV感染。

Objective To understand information about human papillomavirus（HPV） infection of women in Liaoning Province,and to research the correlation between HPV infection and local women＇s cervical intraepithelial lesions.Methods Retrospective analysis of 600 patients with routine diversion hybridization HPV-DNA sub-type detection.All the patients had LCT inspection and 127 cases had biopsy.All the methods above were used to study the correlation.ResultsThe positive rate of HPV infection in 600 cases were the normal 32%（92/288）,Asc-us 42%（87/208）,LSIL 53%（40/75）,HSIL 86%（19/22）,cancer 100%（7/7）,by combining the results of HPV-DNA hybridization diversion test with LCT.When HPV-DNA hybridization diversion test results were combinded with biopsy results,the positive rates of HPV infection in normal or chronic inflammation,CIN Ⅰ,CIN Ⅱ-Ⅲ and cancer were 36.17%（17/47）,66.67%（36/54）,84.21%（16/19）and 100%（7/7） respectively.HPV infection positive rate significantly increased with the degree of cervical lesion.The coincidence rates of cytological and patholo-gical diagnosis were LSIL 72%（54/75）,HSIL 86.36%（19/22）,SCC 100%（7 / 7） respectively.The positive rates of HPV infection detected in different age groups were 46.76%（65/139）in 20-29 years,43.41%（79/182）in 30-39,40.48%（71/174）in 40-49,38.16%（29/76）in 50-59,37.50%（6/16）in 60-69,and 76.92%（10/13）in 70-above.The overall HPV infection positive rate was 40.83%（245/600）in 600 patients.19 subtypes were detected in 21 HPV subtypes,while the highest infection rate was HPV16 35.51%（87/245）,followed by other common types： HPV58,HPV6,HPV53,HPV18,HPV31,HPV52 and cp8304.In addition,high-risk HPV16 infection rates were as follows： normal or chronic inflammation 35.29%（6 / 17）,CIN Ⅰ 33.33%（12/36）,CIN Ⅱ-Ⅲ 56.25%（9 / 16） and cancer 85.71%（6 / 7）.Its prevalence in various degrees of cervical lesions further demonstrates the high risk of HPV16.ConclusionThe major subtypes of female HPV infection in Liaoning Province are HPV16,HPV58 and HPV6.Both cytological test and biopsy show that HPV infection increases with the degree of cerrical lesions.The results suggest that the emphasis of cervical lesion treatment should be placed on prevention and treatment of HPV infection.