云南省丽江地区纳西族妇女宫颈感染高危型人乳头瘤病毒调查

Study on High-Risk Human Papillomavirus Infection in Naxi Women of Lijiang,Yunnan Province

目的探讨云南省丽江地区纳西族妇女宫颈感染高危型人乳头瘤病毒(HR-HPV)的现状及高危因素。分析HR-HPV与宫颈浸润癌(SCC)及宫颈上皮内瘤变(CIN)发生发展的关系,为本地区宫颈癌的防治提供依据。方法选择2009年4月至2012年2月于本院妇科门诊就诊并接受妇科普查的6528例长期居住在丽江纳西族聚居地有性生活史的女性为研究对象。对其采用第二代杂交捕获(HC2)方法定量检测宫颈HR-HPVDNA载量。HR-HPVDNA载量判断标准:样本的相对光单位(RLU)与阳性对照临界值(CO)之比。根据RLU/CO值,将本组受试对象分为HR-HPV阴性组(RLU/CO<1.00)、低度载量组(RLU/CO为1.00～9.99)、中度载量组(RLU/CO为10.00～99.99)、高度载量组(RLU/CO≥100.00)。采用非条件多因素logistic回归法分析HR-HPVDNA载量与宫颈病变类型的关系(本研究遵循的程序符合本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,并与受试对象签署临床研究知情同意书)。结果本组6528例受试者的HR-HPV感染阳性率为12.55%(819/6528)。根据本组1680例宫颈疾病患者(纳西族妇女为1173例,非纳西族为507例)的组织病理学检查结果:慢性炎症组为500例,宫颈上皮内瘤变(cervicalintra-epithelialneoplasia,CIN)Ⅰ组为607例,CINⅡ组为435例,CINⅢ组为112例,宫颈浸润癌(squamouscervicalcancer,SCC)组为26例。其中,纳西族妇女分别占61.80%(309/500),79.08%(480/607),65.29%(284/435),74.11%(83/112)与65.38%(17/26)。纳西族妇女与其他民族妇女的HR-HPV阳性率比较,差异无统计学意义(P>0.05)。不同年龄受试者的HR-HPV感染率比较,差异有统计学意义(χ2=109.21,P<0.05)。首次性生活年龄越小,HR-HPV感染率越高(χ2=14.79,P<0.05);孕、产次增多及2个以上性伴侣者,HR-HPV感染率亦随之增加,且差异有统计学意义(χ2=54.65,316.97;P<0.05)。文化程度与HR-HPV感染率无相关性(P>0.05)。随着宫颈病变程度增加,HR-HPVDNA高度载量所占比例增加,二者呈正相关关系(r=0.425,P<0.05),慢性炎症组、CINⅠ组～CINⅢ组及SCC组分别为1.00%(5/500),3.62%(22/607),9.89%(43/435),49.11%(55/112)及65.38%(17/26)。结论受试者年轻、首次性生活年龄<18岁,孕、产次多及多个性伴侣是HR-HPV感染的高危因素。宫颈HR-HPV感染及其载量,是影响宫颈病变及发展的重要因素。

Objective To investigate the status and risk of high-risk human papillomavirus （HR- HPV） infection in Naxi women of Lijiang, Yunnan Province. To determine association between HR-HPV and the stage of squamous cervical cancer （SCC） and cervical intraepithelial neoplasia （CIN） lesion. To provide the basis for local cervical cancer control. Methods From April 2009 to February 2012,a total of 6528 women who were resident in Lijiang City and had sexual experience, Outpatient gynecological census were recruited. Their HR-HPV DNA load was detected by hybrid capture 2 （HC2）. HR-HVP infections of different cervical lesion stages were compared. HR-HPV DNA load was measured by the ratios of relative light units compared to cut off （RLU/CO）. According to RLU/CO values, they were categorized into： Negative group （〈1.00）, low viral load group （1.00-9.99）, medium viral load group （10.00-99.99）, and high viral load group （〉100.00）. Association between HR-HPV and CINs were evaluated by unconditional multinomial logistic regression. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Lijiang City People＇ Hospital. Informed consent was obtained from all participants. Results Positive for HR-HPV was 12.55%（819/6528） among 6528 tested women. There had no significance difference between infection rates of HR-HPV and ages among 6528 women（X2= 109.21, P〈0.05）. The earlier of younger woman who had first sexual behaviors were, the higher her infection rates of HR-HPV were （X2 = 14. 79, P=0. 05 ）. Cervical lesions diagnosis which was confirmed by histopathological findings indicated that cervical lesions were diagnosed by biopsies as chronic inflammation ofthecervix（n=500）,CINⅠ（n=607）,CINⅡ（n=435）,CINⅢ（n=112）与SCC（n=26）. Infection rates of HR-HPV were higher in women who had many times of gravidities and parities than those who had only one time. Infection rates of HR-HPV in women of sexual partners more than two were higher than those who had only one （X2 = 54. 65, 316. 97; P〈0. 05）. HR-HPV infection rates were disconnected with the educational levels of the tested women（P〉0.05）. HR-HPV infection rates had no significance difference between the other nationalities and local Naxi women（P〉0.05）. The percentage of high HR-HPV DNA load increased with the severity of cervical lesions[1. 00% （5/500）in chronic inflammation of the cervix group, 3.62% （22/607） in CINⅠ group, 9. 89%（43/435） in CIN Ⅲ group, 49. 11% （55/112） in CIN Ⅲ group, 65.38% （17/26）in SCC group], that is, cervical lesions had a positive correlation with the percentage of high HR-HPV DNA Ioad（r=0. 425,P〈0.05）. Conclusions Young age, first sexual behavior before 18 years old, many times of gravidities, parities and sexual partners more than two were high-risk factors of HR-HPV infection. Cervical lesions were highly influenced by HR-HPV infection and HR-HPV DNA load.