宫颈细胞学阴性患者高危型HPV含量与CIN2及更高级别病变的相关性

Relationship Between High-risk Human Papillomavirus and CIN2 or High Grade in Patients with Negative Cervical Cytology

[目的]探讨高危型人乳头状瘤病毒（HPV）检测对宫颈液基细胞学阴性妇女宫颈上皮内瘤变（CIN）的诊断价值。[方法]收集宫颈癌筛查中细胞学阴性而高危型HPV阳性的妇女498例,行阴道镜下宫颈活检。分析高危型HPV负荷量与CIN2^＋的相关性。[结果]在498例患者中,CIN2^＋病变者共65例,占13.1%。高危型HPV〈10的257例中患CIN2^＋有13例,占5.1%。高危型HPV10-100和〉100的病例中患CIN2^＋比例分别为18.2%（26/143）和26.5%（26/98）。各组之间的CIN2^＋比例差异有统计学意义（χ^2=93.673,P=0.000）。在调整年龄因素后,高危型HPV 10-100患CIN2^＋的风险是〈10者的2.356倍（95%CI：1.449-8.828）,而〉100者患CIN2^＋的风险是〈10者的3.595倍（95%CI：2.214-13.533）。[结论]高危型HPV负荷量与CIN病变级别密切相关,高危型HPV负荷量越高,患CIN2＋的危险度越高。

[Purpose] To investigate the value of high-risk human papillomavirus（HR-HPV） in the diagnosis for cervical intraepithelial neoplasia（CIN） with negative liquid-based cytology. [ Methods ] A total of 498 women with positive HR-HPV and negative cytology were enrolled. All cases underwent colposcopic guided biopsy.The relationship of the load of HR-HPV and CIN2 or worse was analyzed. [Results] Of 498 patients,65 patients were CIN2^＋ lesions, accounting for 13.1%. The ratio of CIN2＋ was 5.1% in HR-HPV〈10 group,while it was 18.2%（26/143）in HR-HPV10~ 100 group and 6.5% （26/98）in HR-HPV〉100 group,with significant difference among the 3 groups （χ^2=93.673 ,P=0.000）. After adjustment of the age,the risk of CIN2^＋ in patients with HRHPV 10 - 100 was higher that that in patients with HR-HPV 〈10 （OR =2.356,95% CI ： 1.449 - 8.828） ,while the risk of CIN2^＋ in patients with HR-HPV 〉100 was higher than that in patients with HR-HPV〈 10（OR=3.595,95%CI ： 2.214-13.533）. [ Conclusions ] The load of HR-HPV closely relates to grade of CIN. The higher the load of HR-HPV ,the higher the risk of of CIN2^＋.