2009年海阳市部分乡镇医院妇科门诊农村妇女高危型人乳头状瘤病毒DNA检测与细胞学联合检查情况调查

Study of High-Risk Human Papillomavirus Infection and Cytological Test Conditions Among Women With Gynecological-Surgery in Haiyang City

目的 探讨2009年山东省海阳市部分妇科门诊农村妇女高危型人乳头状瘤病毒（human papilloma virus,HPV）感染现状及细胞学联合检查的临床意义.方法 选择2009年1月至12月,在山东省海阳市8家乡镇医院妇科门诊接受第二代杂交捕获试验（hybrid captureⅡ,HC-Ⅱ）检测高危型HPVDNA和新柏液基薄层细胞学检查（Thin-prep cytology test,TCT）的4267例农村妇女（受检者）为研究对象.宫颈细胞病理学诊断标准,采用2001年国际癌症协会推m的TBS（the 2001 Bethesda system）分级标准进行细胞学诊断.检查数据经审核后进行统计学分析（本研究遵循的程序符合实施检查医院人体试验委员会所制定的伦理学标准.得到该委员会批准,征得受试对象本人的知情同意,并与之签署临床研究知情同意书）.结果 ①总高危型HPV DNA阳性感染率为21.47%（916/4267）.患者年龄为19～74岁.其中,20～29岁和30～39岁组的高危型HPV DNA阳性感染率最高,为26.68%和27.22%,分别与本组总高危型HPV DNA阳性率比较.差异有显著意义（x2=27.85,P＜0.01 x2=16.69,P＜0.01）.其中,单一高危型HPV DNA亚型感染率为62.82 0A（575/916）,高危型HPV DNA多重亚型感染率为37.18%（341/916）,两者比较.差异有显著意义（x2=56.53,P＜0.01）.高危型HPV DNA多重亚型感染中,一般以2及3种亚型感染多见,分别为29.42%（100/341）和25.22%（86/341）.其余为4,5及6种亚型混合感染.本组感染率最高的HPV亚型分别为HPV-16,-58,-33和-18,分别为33.78%（309/916）,17.15%（157/916）,11.29%（103/916）和10.75%（98/916）.②细胞学检测结果：无宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）为2613例（61.24%,2613/4267） 未明确诊断意义的不典型鳞状上皮细胞（atypicalsquamous cells of undetermined signIficance/glandular cells,ASCUS）为906例（21.23%,906/4267）,低度鳞状上皮细胞内病变（low-grade intraepithelial lesion,LSIL）为494例（11.57%,494/4267）,高度鳞状上皮内病变（high-grade intraepithelial lesion,HSIL,HSIL）为237例（5.55%,237/4267）,宫颈鳞状细胞癌（squamous cell carcinoma,SCC）为17例（0.41%,17/4267）.结论 海阳市8家乡镇医院妇科门诊农村妇女高危型HPV DNA感染率高,未明确诊断意义的不典型鳞状上皮细胞、低度鳞状上皮细胞内病变、高度鳞状上皮内病变等细胞学榆查结果明显高于国内筛查数据.应对高危型人乳头瘤病毒感染者及宫颈细胞学异常者定期随访以了解其动态变化.

Objective To investigate high risk human papillomavirus（HPV） infection and cytological test conditions among women with gynecological-surgery in Haiyang city, Shandong Province. Methods From January 2009 to December 2009, a total of 4267 women with gynecological-surgery were screened by combining high risk HPV DNA test （hybrid capture Ⅱ , HC-Ⅱ ） and Thin-prep cytological test （TCT）. Diagnostic criteria for cervical cytopathology was used the 2001 Bethesda system. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Haiyang People＇s Hospital, Qingdao University Medical College. Informed consent was obtained from all participants. Results （1）The total positive infection rate of high risk HPV DNA was 21.47% （916/4267） at the age of 19 74. Among them, the highest positive infection rate distributed in 20-29 year group （26.68%） and 30-39 year group （27.22%）. Single high risk HPV DNA subtype infection rate was 62.82% （575/916）, multiple high risk HPVDNA subtypes infection rate was 37. 18% （341/916） （Z2=56. 53,P（0. 01）. Two （29.42%, 100/341） and 3 （25.22 %, 86/341） subtypes are generally more common subtype infection in multiple high- risk HPV DNA subtypes, the others are 4, 5 and 6 high risk mixed infection. The highest infection rate of HPV subtypes are HPV-16 （33.78%, 309/916）, -58（17.15%, 157/916）, -33（11.29%, 103/916） 和-18 （10.75%, 98/916）. （2）Cytology test results showed, a totalof 2613 cases （61.24%, 2613/4267） without cervical intraepithelial neoplasia （CIN）, 906 cases （21. 23%, 906/4267） were atypical-squamous cells of undetermined significance/ glandular ceils （ASCUS）, 494 （ 11. 570%o, 494/4267 ） were low-grade intraepithelial lesion （I.SIL）, 237 （5. 55%, 237/4267） were high-grade intraepithelial lesion （HSIL）, 17 （0.41%, 17/4267） were squamous cell carcinoma （SCC）. Conclusion The infection rate of high risk HPV DNA in this study was high. The women with high-risk human papilloma virus infection and abnormal cytological test result should be followed-up regularly.