HR-HPV载量与宫颈病变的相关性分析

Correlation analysis of high-risk human papillomavirus viral load and cervical lesions

目的探讨高危型人乳头瘤病毒(HR-HPV)载量与宫颈上皮内瘤变(CIN)及宫颈癌病变程度的相关性。方法收集解放军总医院2006年1月-2011年8月5年中因宫颈病变行阴道镜活检或手术治疗的1248例患者,根据宫颈病变及临床分期分为5组:宫颈炎组、CINⅠ组、CIN Ⅱ-Ⅲ组、宫颈癌Ⅰ期组、宫颈癌Ⅱ期组,依据第二代杂交捕获实验(HC-Ⅱ)方法检测所有患者HR-HPV病毒载量(RLU/CO),将其分为0～0.99、1.00～9.99、10.00～99.99、100.00～999.99、1000.00～5个HR-HPV病毒载量组。对宫颈炎、CINⅠ、CIN Ⅱ-Ⅲ、宫颈癌Ⅰ期、宫颈癌Ⅱ期各组中不同的HR-HPV病毒载量进行比较,并分析HR-HPV病毒载量与宫颈病变发生的相关性。结果 CINⅠ组、CIN Ⅱ-Ⅲ组、宫颈癌Ⅰ期、宫颈癌Ⅱ期患者HR-HPV病毒载量(分别为842.1±98 3.9、690.1±795.0、893.1±974.2、699.5±908.3RLU/CO)显著高于宫颈炎患者(274.2±613.6,P<0.05);CINⅠ组和宫颈癌Ⅰ期的病毒载量高于CIN Ⅱ-Ⅲ组(P<0.05)。当HR-HPV病毒载量≥100RLU/CO时,CIN及宫颈癌的发生危险度随病毒载量的增加而增加,但HPV病毒载量分级与宫颈病变病理分级无相关性。对于宫颈鳞癌ⅠB-Ⅱ期患者,当HR-HPV病毒载量≥100RLU/CO时,宫颈癌淋巴结转移的危险性增加(P<0.05),且宫颈肿瘤最大直径≥4cm的危险性增加(P<0.05),而HR-HPV病毒载量与患者年龄、组织学类型、宫颈肌层癌浸润深度及淋巴管浸润无关。结论 HR-HPV病毒载量与CIN及宫颈癌的发生密切相关。病毒载量越高,发生CIN及宫颈癌的危险性越大,且与宫颈鳞癌的临床特征有关。

Objective To explore the association between high-risk human papillomavirus （HR-HPV） viral load and pathological grades of cervical intraepithelial neoplasia（CIN） and cervical cancer.Methods A total of 1248 patients from General Hospital of PLA,who underwent colposcopy and surgery due to cervical lesions between Jan.2006 and Aug.2011 were enrolled in this study,and they were divided five groups： cervicitis,CIN Ⅰ,CIN Ⅱ-Ⅲ,stage Ⅰ cervical cancer and stage Ⅱ cervical cancer. HR-HPV viral load （RLU/CO） was determined by the Hybrid Capture Ⅱ （HCⅡ） system, and they were categorized into five groups： 0-0.99,1.00-9.99,10.00-99.99,100.00-999.99,≥1000.00.The mean value and standard deviation of different HR-HPV viral load in the patients with cervicitis or with CIN Ⅰ,CINⅡ-Ⅲ,stage Ⅰ cervical cancer or stage Ⅱ cervical cancer were compared, and the correlation of HR-HPV viral load and pathogenesis of cervical lesions was analyzed. Results HPV viral loads were significantly higher in CINⅠ（842.1±983.9）,CINⅡ-Ⅲ（690.1±795.0）,stage Ⅰ cervical cancer（893.1±974.2） and stage Ⅱ cervical cancer（699.5±908.3） patients than in cervicitis patients（274.2±613.6,P0.05）,and the HPV viral loads in CINⅠ（842.1±983.9） and stage Ⅰ cervical cancer patients were higher than those in CINⅡ-Ⅲ patients（P0.05）.When HR-HPV viral load was ≥100RLU/ CO,the risk of CIN and cervical cancer increased with the increase in viral load,but there was no correlation between the viral load and pathological grades of cervical lesions.In the patients with stage ⅠB-Ⅱ cervical squamous cell carcinoma,when the HR-HPV viral load was ≥100RLU/CO,the risk of lymph node metastasis increased（P0.05）,and the number of patients with maximum diameter of the cervical tumor ≥4cm also increased（P0.05）.However,the HR-HPV viral load was not correlated with patient age,pathological type of the lesion,depth of cancer cell invasion into cervical muscle layer and lymphatic invasion.Conclusions HR-HPV viral load is closely correlated with genesis of CIN and cervical carcinoma.The higher the viral load,the greater the risk of CIN and cervical cancer is,and it is correlated with the clinical features of cervical squamous cell carcinoma.