潮州地区少见型人乳头瘤病毒型别分布及与宫颈病变的关系

The prevalence of rare human papillomavirus subtypes and its correlations with cervical lesions in Chaozhou

目的研究潮州地区少见型人乳头瘤病毒(HPV)型别分布及其与宫颈病变关系。方法采用实时荧光定量PCR对49458例农村女性健康人群进行高危型人乳头瘤病毒(HR-HPV)检测,HR-HPV阳性者先进行21型核酸分子快速导流杂交分型技术(HybriMax)和液基薄层细胞学阳性检查(LCT),未分出基因型别者再进行37型HybriMax基因分型;对低级别鳞状上皮内病变(LSIL)及以上病变者行阴道镜下组织病理学活检。结果 49458例经实时荧光定量PCR检测,4080例HR-HPV DNA阳性,所有阳性标本进行21型HybirdMax基因分型,对其中未能分出基因型别的共285例应用37型HybriMax再次进行基因分型,成功分型251例,单一亚型感染48例,多重亚型感染203例,16种少见型HPV主要亚型分别为HPV55(21.67%,57/251)、HPV61(14.83%,39/251)、HPV70(13.69%,36/251)和HPV84(12.93%,34/251)。285例都进行LCT检查,无上皮内病变及恶性病变(NILM)为阴性,共164例,阴性率65.34%;非典型鳞状上皮细胞意义不明确(ASC-US)及以上病变共87例,阳性率34.66%,其中ASC-US61例,占24.30%;非典型鳞状上皮细胞不除外高级别鳞状上皮内病变(ASC-H)1例,占0.40%;低级别鳞状上皮内病变(LSIL)20例,占7.97%;高级别鳞状上皮内病变(HSIL)4例,占1.59%;鳞状细胞癌(SCC)1例,占0.40%。结论潮州地区少见型HPV优势基因型是HPV55,复合少见型的多重感染能引起宫颈HSIL及以上病变,对宫颈病变的防治及其HPV基因疫苗的研制有重要意义。

Objective To investigate the prevalence of rare human papillomavirus（HPV） subtypes and its correlations with cervical lesions in Chaozhou. Methods High-risk human papillomavirus（HR-HPV） DNA was firstly detected by real-time fluorescent quantitative PCR in 49458 healthy women in rural area of Chaozhou. Then, the HR-HPV DNA positive cases received LCT and HybriMax test which were used to detect 21 HPV subtypes and cases who could not be detected by 21 subtypes of HybriMax test, further received the second round HybriMax test which could detect 37 HPV subtypes. Histopathology biopsy was performed in patients with LSIL and even worse. Results 4080 of 49458 cases were identified as HR-HPV DNA positive by FQ-RT-PCR. All HR-HPV DNA positive samples went through 21 HPV subtypes HybriMax test, 285 cases, whose genotypes could not be identified by it, went through 37 HPV subtypes Hybrillax test, and 251 cases＇ genotypes were successfully identified. 48 cases were infected with a single HPV subtype and 203 cases were infected with multiple HPV subtypes. The most common HPV subtypes of 16 rare HPV subtypes by the descending order of infection rate were type 55 （21.67%, 57/263）, 61（14.83%, 39/263）, 70 （13.69%, 36/263） and 84（12.93%, 34/263）. For LCT, these 164 cases were diagnosed as NILM and the rest 87 cases were diagnosed as ASC-US or even worse. Among them, ASC-US, ASC-H, LSIL, HSIL and SCC were found in 62 cases （ 24.30% ） , 1 case （0.40%）, 20 cases （7.97%）, 4 cases （1.59%） and 1 case （0.40%）, respectively. Conclusion HPV55 is the predominant rare HPV subtypes in Chaozhou, and the rare multiple HPV subtypes infection is related to the HSIL and worse cervical lesions. It is significant in cervical lesions prevention and therapy, as well as the development of gene vaccine for HPV in this area.