甘肃省妇女宫颈HPV感染的流行病学特征

Epidemiological characteristics of cervical human papillomavirus infection among women in Gansu

目的：了解甘肃地区健康妇女宫颈人乳头瘤病毒（human papillomavirus,HPV）感染的流行病学特征,探讨人乳头瘤病毒HPV的型别与病理分级的关系。方法：选择2009年5~8月在甘肃省妇幼保健院妇科门诊行宫颈HPV分型检测的576例患者为研究对象,采用核酸分子快速导流杂交基因芯片技术（Hybrimax）对所有患者宫颈脱落细胞进行HPV分型,随后进行阴道镜检查、宫颈多点活检和宫颈管诊刮术,以病理学诊断为金标准。结果：576例患者中,HPV阳性率19.44%,高危型占73.21%。不同宫颈病变中常见的HPV亚型（检出率〉10.0%）从高到低依次为HPV16（26.12%）、HPV58（15.67%）、HPV52（10.45%）。不同病理分级中HPV型别不同,宫颈癌中依次为HPV16、18、31;CINⅡ及CINⅢ中依次为HPV16、58、31、33、66;CINⅠ中依次为HPV16、58、52、33、39、6、11、68、cp8304。对于病理诊断≥CINⅡ者,HPV分型检测的敏感度为79.31%,特异度为87.26%,阳性预测值为41.07%,阴性预测值为97.41%。结论：HPV基因分型检测,可1次检测多种亚型,了解HPV型别分布的地域性差异,对于研制适宜甘肃省妇女的特异性HPV疫苗有指导意义,且有利于宫颈病变的分级、分型及指导个体化治疗。

Objective：To understand the epidemiological characteristics of cervical human papillomavirus（HPV）infection among healthy women in Gansu,explore the relationship between types of HPV and pathological grades.Methods：576 cases receiving cervical HPV typing and detection in gynecology outpatient department in the hospital from May to August in 2009 were selected,HPV typing of cervical exfoliated cells was performed by nucleic acid molecular rapid diversion hybridization gene chip technology;colposcopy,cervical multi-point biopsy and cervical canal diagnostic curettage were used in the study,pathological diagnosis was gold standard.Results：The positive rate of HPV was 19.44%,the proportion of high risk HPV was 73.21%;the detection rates of common HPV subtypes in different cervical lesions were listed as follows from high to low（detection rate10.0%）：HPV16（26.12%）,HPV58（15.67%）and HPV52（10.45%）;cervical lesions of different pathological grades had different HPV types：HPV16,18,31 in cervical carcinoma,HPV16,58,31,33,66 in CIN Ⅱ and CIN Ⅲ,HPV16,58,52,33,39,6,11,68,cp8304 in CIN Ⅰ;for the cases with pathological diagnosis≥CIN Ⅱ,the sensitivity,specificity,positive predictive value and negative predictive value of HPV typing and detection were 79.31%,87.26%,41.07% and 97.41%,respectively.Conclusion：HPV gene typing and detection can detect various subtypes once,understanding geographic difference of distribution of HPV subtypes has directive significance for developing specific HPV vaccine suitable for the women in Gansu,which is helpful for grading,typing of cervical lesions and individual treatment.