不同宫颈病变中人乳头状瘤病毒的型别分布研究

Distribution of types of human papillomavirus causing cervical lesions

目的探讨人乳头状瘤病毒(HPV)在不同宫颈病变中的型别分布特点。方法选取2008年11月-2010年5月,在医院妇科门诊就诊并经组织病理学证实的宫颈病变患者353例,采用HPV基因芯片检测及分型所有患者子宫颈分泌物中的HPV亚型。结果 353例宫颈病变患者中,184例HPV阳性,阳性率为52.1%,随着宫颈病变级别增高,HPV感染率逐渐上升(2χ趋势=89.18,P<0.001);353例宫颈病变中HPV亚型感染频度由高到低前5位依次为16、33、11、18、6;不同宫颈病变中HPV亚型分布虽有一定的差异,但HPV16感染率在宫颈各级病变中均具首位;随着宫颈病变级别增高,高危型HPV感染所占比例逐渐上升(χ2趋势=13.79,P<0.001);184例HPV基因分型检测阳性的宫颈病变中HPV多重感染率为37.5%,最常见类型为HPV16、18二重感染;除CINⅢ及宫颈癌组外,多重感染随宫颈病变级别增高而逐渐上升(χ2趋势=5.38,P<0.05);CINⅢ及宫颈癌组中74.1%为HPV16合并的单一或多重感染。结论不同宫颈病变感染HPV的优势亚型不同,其中HPV16亚型感染,是高危型HPV中影响宫颈病变的发生、发展的重要因素,具有最强的致癌性;多重感染与宫颈病变的进展相关。

OBJECTIVE To investigate the distribution of types of human papillomavirus（HPV） in cervical lesions.METHODS From Nov 2008 to May 2010,at the 1st People′s Hospital of Xiaoshan district,Hangzhou,353 cases with cervical lesions confirmed by biopsy were chosen.HPV subtypes in each collected sample was detected by HPV gene chip technique.RESULTS HPV infection rate of the 353 cases with cervical lesions was 52.1%.The infection rates were increased gradually with higher grade of cervical lesions（χ2 trend=89.18,P0.001）;The prevalence of the first five HPV subtypes from highest to lowest order was as follows：HPV16,HPV33,HPV11,HPV18,HPV6.The distribution of HPV subtype varied in different cervical lesions,but HPV-16 was the most common subtype.High-risk HPV types increased significantly with higher grade of cervical lesions（χ2 trend=13.78,P0.001）.The multiple infection rate of the 184 HPV genotyping testing positive cases was 37.5%.The double infection of HPV16/18 was the most common type.Except for CIN Ⅲ and cervical cancer groups,multiple infection rates were increased gradually with higher grade of cervical lesions（χ2 trend=5.38,P0.05）.In CIN Ⅲ and cervical cancer groups,single or multiple HPV16 infection rate was 74.1%.CONCLUSION The main HPV subtypes are different in differrent kind of cervical lesions.The infection of HPV16 is an important factor in the occurrence and development of cervical lesions and it has strongest carcinogenicity.Multiple infection is associated with progression of cervical lesions.