人乳头状瘤病毒感染致宫颈癌及癌前病变风险研究

Risk of cervical cancer and precancerous lesions in patients infected with human papilloma virus

目的 探讨感染人乳头状瘤病毒（human papilloma virus,HPV）后患宫颈癌及癌前病变风险.方法 采用HPV-DNA核酸扩增及导流杂交技术,对7 234例来我院就诊的宫颈异常患者,进行HPV21种亚型的基因检测和宫颈液基薄层细胞学（TCT）检测,对细胞学检测结果为非典型鳞状细胞（ASCUS）以上和/或HPV-DNA检测阳性的患者,行活组织病理检查,对HPV感染后患宫颈癌及癌前病变风险进行分析.结果 HPV总感染率为27.37%,检出率前四位依次是HPV 16型6.97%（504/7 234）、52型5.68%（411/7 234）、58型5.27%（381/7 234）和33型3.33%（241/7 234）,其中高危型病毒（HR-HPV）感染占78.16%（2147/2747）.宫颈癌患者HPV的检出率为73.33%（33/45）.单型HPV感染后患轻度鳞状上皮内瘤变（LSIL）及高度鳞状上皮内瘤变（HSIL）和宫颈癌的风险分别是HPV阴性者的4.055倍（95% CI 2.528～6.505）和5.103倍（95% CI 3.838～6.786）,多型混合HPV感染后患宫颈LSIL及HSIL和宫颈癌的风险分别是HPV阴性者的7.313倍（95% CI 4.314～12.397）和7.550倍（95%CI 5.395～10.564）.结论 单型HPV感染致宫颈HSIL或宫颈癌的风险是HPV阴性者的5.1倍,多型混合HPV感染致宫颈HSIL或宫颈癌的风险是HPV阴性者的7.6倍.

Objective TO evaluate the risk of cervical cancer and precancerous lesions in patients infected with human papilloma virus （HPV）. Methods HPV21 subtypes were detected using HPV-DNA nucleic acid amplification and hybridization diversion in 7234 patients with cervical abnormalities who underwent thin-prep cytology test （TCT）. Tissue biopsies were performed in patients with positive HPV-DNA or with atypical squamous cells of undetermined significance （ASCUS）; and the correlation of HPV infection with precancerous lesions or cervical cancer was analyzed. Results The total HPV infection rate was 27.37% （1780/7234）, with HPV16 ranked the first （6.97%, 504/7234）, followed by HPV52 （5.68%, 411/7234）, HPV58 （5.27%, 381/7234）and HPV33 （3.33%, 241/7234）. The HR-HPV infection accounted for 78.16% of total infection. The rate of HPV infection in patients with cervical cancer was 73.77% （33/45）. The risks of low-grade squamous intraepithelial lesion （LSIL）, high-grade squamous intraepithelial lesion （HSIL） and cervical cancer in single-type HPV infected patients were 4.055 （95% CI 2.528 -6.505） and 5.103 （95% CI 3.838 -6.786） times higher than that in HPV-negative patients; and the risks in mixed-type HPV infected patients were 7.313 （95% CI 4.314-12.397） and 7.550 （95% CI 5.395-10.564） times higher than that in HPV-negative patients, Conclusion Both single-type and mixed-type HPV infections increase the risk of cervical HSlL or cervical cancer, and the latter is more prominent.