潮州地区女性宫颈人乳头状瘤病毒基因型与宫颈病变的关系

The relationship between the HPV genotype and cervical lesions in Chaozhou area

目的了解潮州地区女性宫颈人乳头瘤病毒（HPV）感染型别分布特征及其与宫颈病变关系。方法采用核酸分子快速导流杂交分型技术（HybriMax）对2166例门诊女性患者宫颈脱落细胞进行HPV基因分型以及对部分高危型HPV阳性妇女进行液基薄层细胞学检测（LCT）。结果潮州地区2166例门诊女性患者中有490例为HPV阳性，感染率为22．62％；15种高危亚型HPV（HR-HPV）感染率为15．05％；6种低危亚型HPV（LR-HPV）感染率为4．29％；高／低危亚型HPV混合感染率为3．28％。72．45％的HPV阳性患者是单-亚型感染。阳性率最高的HPV亚型是HR-HPV52（22．24％），其次为HR．HPV16（20．20％）和LR-HPV11（14．90％）。36-45岁年龄段女性的阳性率最高，为31．84％。223例HR-HPV阳性患者接受LCT检查，144例为无上皮内病变及恶性病变（NILM），细胞学检查阴性率为64．57％（144／223）；以非典型鳞状卧瞠盹意义不明确（ASC-US）及以晰拗阻陛，阻懒35．43％（79／223）。在阳性病变中ASC．US占22．42％（50／223），非典型鳞状上皮细胞不除外高级别鳞状上皮内病变（ASC-H）占1．79％（4／223），低级别鳞状上皮内病变（LSIL）占8．07％（18／223），高级别鳞状上皮内病变（HSIL）占2．69％（6／223），鳞状细胞癌（SCC）占0．45％（1／223）。HR-HPV阳性妇女与同期HPV阴性妇女的LCT结果差别有显著性意义（X^2=37．116，P=0．001）。结论本地区女性HPV感染以HPV52为主，生育年龄女性（26-45岁）阳性率较高。HR-HPV阳性检测结合LCT检查可提高女性宫颈瘤变的检出率。

Objective To investigate the infection rate of human papillomavirus（HPV）, distribution of HPV subtypes and the relationship between the HPV genotypes and cervical lesions. Methods Cervical deciduous cells from 2166 outpatient women were detected to identify HPV genotypes by using nucleic acid hybridization technique（HybriMax）. A part of HR-HPV positive samples were detected by LCT. Results Among 2166 female patients, 490 were found with HPV infection. The infection rate of 15 high risk HPV subtypes（HR-HPV） and that of 6 low risk HPV subtypes（LR-HPV） were 15.05% and 4.29%, respectively. The infection rate of multiple HR-HPV/ LR-HPV was 3.28%. 72.45% of positive cases were infected by single subtype. The predominant HPV subtype was HR-HPV52（22.24%）, followed by HR-HPV16（20.20%） and LR- HPVll（14.90%）. The positive rate of 36-45 age group was the highest（31.84%）. 223 HR-HPV positive patients received LCT and negative for intraepithelial lesions or malignancy（NILM） was considered as cytology negative. Atypical squamous cells of undetermined signification（ASC-US） and/or worse was considered as cytology positive. The negative and positive rates were 64.57% and 35.43%, respectively. Among cytology positive cases, 50（22.42%） cases were ASC-US, 4（1.79%） cases were atypical squamous cells can not exclude high- grade squamous intraepithelial lesions（ASC-H）, 18（8.07%） cases were low-grade squamous intraepithetial lesions（LSIL）, 6（2.69%） cases were high-grade squamous intraepithelial lesions（HSIL） and 1（0.45%） case was squamous cells cancer（SCC）. Significant difference was found between the LCT results of HR-HPV positivecases and that of HPV negative cases（ X^2 2=37.116, P=0.001）. Conclusion HPV52 was the most common HPV genotype in Chaozhou. The women at the age group of 26-45 had higher HPV infection rate than that of other age groups. LCT combined with HR-HPV test was an effective method for screening cervical intraepithelial lesion.