深圳人群人乳头瘤病毒感染亚型分布与宫颈上皮内瘤变现况横断面调查

Crosssectional survey of human papilloma virus subtype distribution and cervical intraepithelial neoplasia in Shenzhen

目的:研究深圳地区人群人乳头瘤病毒(human papilloma virus,HPV)感染与宫颈上皮内瘤变(cervical in-traepithelial neoplasia,CIN)的患病情况及HPV亚型与病毒载量的致病性。方法:以深圳市及周边农村地区10 000名有性生活的女性为研究对象,以液基细胞学联合多种高危型HPV检测方法进行宫颈癌筛查,对细胞学结果为意义不明的不典型鳞状上皮细胞(atypical squamous cells of undetermined sign,ASC-US)及以上者或任一种HPV检测结果阳性者行阴道镜下宫颈活检,病理诊断。结果:研究人群平均年龄38.9岁,HPV感染率16.6%,随年龄增长呈上升趋势。低度CIN(CIN1)现患率17.0%,55岁以后患病率明显下降;高度CIN(CIN2/3)现患率2.6%,45～59岁组患病率显著较高。高危型HPV感染与CIN患病明显相关,CIN1和CIN2/3的患病风险均随HPV病毒载量的升高而升高,但其相关的HPV高危亚型不同,CIN2/3主要为HPV-16、-58、-31、-33和-18型感染,CIN1主要为HPV-39、-58、-59、-52和-66型感染。结论:深圳地区的HPV感染率和CIN现患率处于较高水平;人群HPV感染有随年龄递增的趋势,45岁以上的人群为CIN2/3的重点监控对象;感染的高危型HPV亚型和载量均可提示CIN2/3患病机会的多少,并作为临床合理干预的重要依据。

Objective：To investigate the prevalence of human papilloma virus （HPV） infection and cervical intraepithelial neoplasia （CIN） and pathogenecity of the HPV subtyping and virus loads in Shenzhen district. Methods： In the study, l0 000 sexually active women from Shenzhen city and rural areas around were screened for cervical cancer, and all the cases were examined with cytology tests and several kinds of high risk HPV （HR-HPV） tests. Those with cytology≥atypical squamous cells of unde- termined sign （ASC-US） or positive HPV results underwent colposcopy with biopsy for a pathological diagnosis. Results： The average age of this study population was 38.9 years. The total prevalence of HPV infection was 16.6%, with age-specific prevalence increasing with age. The morbidity rate of the low grade cervical intraepithelial neoplasia CIN1 was 17.0%, but that with those aged ≥55 years showed a sharp drop. The morbidity rate of the high grade cervical intraepithelial neoplasia CIN2/3 was 2.6%, and was higher in the 45 to 59 years age group than in the 25 to 44 years age group. HR-HPV infectionwas an obvious relevant factor of CIN1 and CIN2/3, and the OR values increased as the virus loads in- creased, but they had different relevant HPV subtypes. We found that HPV-16, -58, -31, -33, -18 were the first five ones for CIN2/3 while HPV-39, -58, -59, -52, -66 for CIN1. Conclusion： There is a high level of HPV infection and CIN in Shenzhen district. The prevalence of HPV infeetion has a trend to increase with age, and the people aged 45 years and more are key objects for CIN2/3 screening, with the virus load and subtyping of HR-HPV infection as indicative factors.