高危型HPV—DNA负荷量与宫颈病变的相关性探讨

The investigation of the relationship between high-risk human papillomavirus DNA load and cervical lesion

目的探讨高危型人乳头瘤病毒DNA（high risk humanpa pillomavirus DNA，hr—HPV—DNA）负荷量与子宫颈病变的相关性。方法回顾性分析2009年1月至2010年10月就诊于我院妇科门诊并采用第二代杂交捕获法检测hr—HPV的患者6018例，从中筛选出181例hr—HPV检测结果为阳性的患者，并同时行薄层液基细胞学检查、阴道镜下宫颈多点活检及病理学检查。结果181例hr-HPV—DNA阳性患者中，细胞学结果：未见上皮内病变38例（20．99％），非典型鳞状上皮细胞87例（48．07％），低度鳞状上皮内病变29例（16．02％），高度鳞状上皮内病变27例（14．92％），在不同级别细胞病理学改变组中hr-HPV—DNA负荷量差异有统计学意义（X^2=25．833，P=0．000）；组织学结果：慢性宫颈炎89例（49．17％），宫颈上皮内瘤样病变（cervical intraepithelial neoplasia，CIN）141例（22．65％），CIN II 23例（12．71％），CIN III 23例（12．71％），鳞癌5例（2．76％），不同程度宫颈组织病理学改变组中hr-HPV—DNA负荷量差异有统计学意义（X^219．014，P=0．001）；宫颈细胞学病变程度和组织学病变程度与hr-HPV—DNA负荷量相关系数r分别为0．282与0．213（P均〈0．01）。结论hr-HPV—DNA负荷量增高可能促进宫颈病变的发生发展，但hr—HPV—DNA负荷量并不能作为预测宫颈病变严重程度的指标。

Objective To explore the relationship between high-risk human papillomavirus DNA（hr- HPV-DNA） load and different stage of cervical lesion. Methods The hybrid capture Ⅱ method was used to detect the load of hr-HPV-DNA in 6018 women from January 2009 to October 2010 outpatients of gynelology. 181 women with hr-HPV positive were received examinations of liquid-based cytology, multi-focal directed punch biopsies under colposcopy and pathology analysis at the same time. Results Among 181 patients with hr-HPV positive, according to the cytologic diagnosis, 38（20.99%） cases were negative for intraepithelial lesion, 87（48.07%） cases were atypical squamous cells, 29（16.02%） cases were low-grade squamous intraepithelial lesion, 27（14.92%） cases were high-grade squamous intraepithelial lesion. The load of hr-HPV-DNA were different in different grade of cellular pathology change groups and the difference had statistical significance （X^2= 25.833, P= 0.000）. According to the pathological diagnosis, 89 （49.17%） cases were chronic eervieitis, 41 （22.65%） cases were cervical intraepithelial neoplasia I （CIN I）, 23 （12.71%） cases were CIN Ⅱ, 23 （12.71%） cases were CIN III and 5 （2.76%） cases were squamous cell carcinoma. The load of hr-HPV-DNA were differ- ent in different grade of histopathology change groups and the difference had statistical significance（X^2= 19.014, P= 0.001）. The correlativity between the load of hr-HPV-DNA and the degree of cervical celluar pathological lesions, histologic lesions were 0.282 and 0.213 respectively（P all〈 0.01）. Conclusion High load of hr-HPV- DNA may promote the happening and development of cervical leision, but can not be used as the predictor of the severity.