黑龙江省铁力市育龄妇女宫颈癌前病变筛查的研究

Research of screening for precancerous lesions of uterine cervix in Tieli city in Heilongjiang province.

目的:检测目标人群中宫颈病变的现状及人乳头瘤病毒(human papillomavirus,HPV)流行病学特征。方法:(1)应用醋酸白试验(VIA)、碘不着色试验(VILI)对4007例妇女宫颈行肉眼观察,疑似异常病例行阴道镜检查,异常病例组织活检确诊;(2)采用导流杂交基因分型技术(HybriMax),对宫颈癌及CIN(cervical intraepithelial neopla-sia)患者进行21种HPV基因型的分型检测,分析HPV感染率以及宫颈疾病发病状况。结果:(1)两年诊断出宫颈病变发病率为5.01%,其中CINⅠ3.74%,CINⅡ0.87%,CINⅢ/原位癌0.32%,浸润癌0.07%;(2)病变宫颈HPV-DNA基因分型检测到HPV-DNA阳性127例,阳性率63.18%,其中CINⅠ53.33%,CINⅡ91.43%,CINⅢ92.30%,宫颈浸润癌100%;高危型HPV感染136例次,占77.27%,低危型40例次,占22.73%;单一亚型感染89例,占70.08%,多重HPV基因型混合感染38例,占29.92%。感染最多的基因型是HPV16,共45例次,占25.57%,其次是HPV58,占10.23%,随后基因型由高到低依次为:HPV52,占10.23%;HPV33,占7.95%;HPV6,占6.82%,不同级别CIN及浸润癌HPV感染率差异有统计学意义(P<0.05)。结论:(1)肉眼观察筛查宫颈病变虽有一定的漏诊率,但由于检查成本低廉,在经济欠发达地区,仍可作为防癌普查的基本方法;(2)HPV16型是本地区宫颈病变HPV感染的主要型别,位居第二为HPV58,HPV52、HPV33、HPV6分别位居第三、四、五位。加大对高危人群的普查力度势在必行。

Objective：Keeping tabs on the status quo of women＇s cervical cancer,cervical intraepithelial neoplasia as well as HPV genotype detection,to analyse their epidemiologic features through screening in Tieli city.Methods：Four thousand and seven women were screened for cervical cancer by using macroscopic observation with acetic-acid（VIA） and Lugol＇s iodine（VILI）,the women with positive results were further evaluated with colposcopy and made the final diagnosis by biopsy.The cervical exfolialed cells from patients with CIN and cervical cancer were checked for 21 HPV DNA types by flow-through hybridization and gene chip.Results：（1） The prevalence rate of cervical lesion was 5.01% during two years.CINⅠ 3.74%,CINⅡ0.87%,CIN Ⅲ0.33% and invasive carcinoma 0.07%,respectively.（2）HPV DNA positive cases were 127 and the positive rate was 63.18%,with CINⅠ52.00%,CINⅡ91.43%,CINⅢ93.33%and invasive carcinoma 100%.The HR-HPV positive cases were 136 and the positive rate was 79.07%,the LR-HPV positive cases were 40 and the positive rate was 20.93%.Single infection of various HPV genotypes were found in 89 cases and the rate was 70.08%.Co-infection was found in 38 cases and the rate was 29.92%.Viral genotype 16 ranked the first with 25.57%,the second was genotype 58 with 10.23%,then followed by 52 with 10.23%,33 with 7.95% and 6 with 6.82%.Conclusion：（1）Macroscopic observation still can be used as a screen method of cervical lesion in underdeveloped economic regions due to easy to make and low cost,in spite of there is a certain rate of false negative.（2）HPV16 is the most prevalent genotype in cervical cancer,followed by HPV58,52,33 and 6.