宫颈病变与人乳头瘤病毒感染临床病例分析

Human papillomavirus testing in cervical cancer and precancerous lesions screening

目的评价人乳头瘤病毒(Human Papillomavirus,HPV)感染在宫颈病变早期筛查中的作用,为进一步诊断和判断预后提供依据。方法来我院进行宫颈癌筛查,因宫颈液基薄层细胞学检查存在异常细胞妇女413例,均进行阴道镜下组织活检和HPV-DNA分型。结果上皮内瘤样病变(CIN)I患者中以ASCUS检出符合率最高,CIN II患者中以LSIL检出符合率最高,CIN III患者中以HSIL检出符合率最高。慢性宫颈炎患者一种或多种高危型HPV(HR-HPV)感染率要低于CIN患者(χ2=32.105,P=0.000),宫颈癌HR-HPV感染率为100%;慢性宫颈炎患者与CIN患者低危型HPV(LR-HPV)感染率比较,差异无统计学意义(χ2=0.205,P=0.650)。宫颈病变患者以单一HR-HPV亚型感染更常见。结论宫颈癌及癌前病变与HPV感染密切相关,HR-HPV基因检测及分型在宫颈病变的预后判断、疗效监测等方面具有重要价值。

Objective To evaluate the role of HPV testing in early screening for cervical cancer and precancerous lesions so as to obtain scientific knowledge for diagnosis and prognosis of the disease.Method 413 women admitted to Dongyang People＇s Hospital for cervical cancer or precancerous lesions screening were subjected to cervical tissue biopsy under colposcopy and HPV DNA gene typing.Findings Atypical squamous cells （ ASCUS） with the highest rate were found in patients with cervical intraepithelial neoplasia （ CIN） I.Low squamous intraepithelial lesion （ LSIL） with the highest rate were found in patients with CIN II, and high squamous intraepithelial lesion （ HSIL） with the highest rate were found in patients with CIN III.One or more high risk HPV （ HR-HPV） types were detected in 32.6% of the chronic cervicitis patients compared to 63.0% of the CIN patients.HR-HPV infection rate was 100% in cervical cancer patients.The difference was statistically significant.Single HR-HPV infection is the more common subtypes in cervical lesions patients. The prevalence of low risk HPV （ LR-HPV） types was similar between chronic cervicitis and CIN groups.Conclusion Cervical cancer and precancerous lesions are closely associated with HPV infection. Our findings also suggest that genotyping of HR-HPV testing can provide scientifically sound prognosis.