人乳头瘤病毒亚型与宫颈癌及癌前病变发生及预后的相关性分析

Analysis on the correlation between HPV subtypes and occurrence and prognosis of cervical cancer and cervical precancerous lesion

目的：分析宫颈癌及癌前病变发生及预后与人乳头瘤病毒（HPV）亚型之间的关联性,以期为预测肿瘤提供依据。方法：选择在新疆医科大学附属医院诊断为宫颈病变的患者150例,依据其不同的疾病进展情况予以治疗方法,治疗后每3个月进行HR-HPV及细胞学检查,包括液基细胞学（TCT）、HPV亚型、阴道镜下定位活检及病理诊断检查,观察不同宫颈病变的HPV亚型检出及转阴率情况,不同治疗方法下HPV亚型转阴率以及不同年龄段转阴率比较。结果：所有患者中共检测出HPV高危亚型15种,前5位依次HPV16、58、52、53、18,就不同的宫颈病变而言,慢性宫颈炎＋CINⅠ、CINⅡ～Ⅲ中以及宫颈癌中检测前3位高危亚型均依次为HPV16、58、52,且随着宫颈病变恶性程度的增加,HPV16占有率也从18.56%增加为33.33%,最后至50.00%,而逐渐成为优势亚型,HPV53亦呈现这一趋势。与宫颈癌的转阴率比较,慢性宫颈炎＋CINⅠ、CINⅡ～Ⅲ转阴率均降低明显,差异有统计学意义（P〈0.05）;与HPV16在宫颈癌的转阴率比较,慢性宫颈炎＋CINⅠ、CINⅡ～Ⅲ转阴率均降低明显,差异有统计学意义（P〈0.05）;与HPV53宫颈癌的转阴率比较,慢性宫颈炎＋CINⅠ、CINⅡ～Ⅲ转阴率均增加明显,差异有统计学意义（P〈0.05）;与药物治疗比较,宫颈部分切除术、全子宫切除术以及宫颈癌根治术的转阴率均升高明显,差异有统计学意义（P〈0.05）。在4种治疗方式都有的亚型中,HPV16在全子宫切除术的转阴率最高,其次为宫颈癌根治术。与老年段比较,青年段与中年段的转阴率均升高明显,差异具统计学意义（P〈0.05）。结论：HPV16、53的转阴率与宫颈病变、年龄、治疗方式具有相关性,HPV分型检测,尤其是针对HPV 16的重复、再次感染的检测不仅可为宫颈病变的筛查,进而预测肿瘤进展提供依据,而且还可用于患者的预后评估。

Objective： To analyze the correlation between occurrence and prognosis of cervical cancer and cervical precancerous le- sion and human papillomavirus （HPV） subtypes, provide a basis for predicting tumor. Methods ： A total of 150 patients diagnosed as cervi- cal lesions in the hospital were selected and treated with different therapies according to the progression of the disease, after treatment, high- risk HPV （HR-HPV） genotyping, Thinprep cytology test, colposeope-gnided biopsy, and pathological examination were conducted every three months to observe the detection rates of HPV subtypes and the negative conversion rates in patients with different cervical lesions, the negative conversion rates treated by different therapies and in different age groups were compared. Results： Among all the patients, 15 kinds of HR-HPV subtypes were detected, the top five HPV subtypes were HPV16, 58, 52, 53, 18. The top three HPV subtypes in chronic eer- vicitis and cervical intraepithelial neoplasia （CIN） I , CIN Ⅱ - Ⅲ, and cervical cancer were HPV16, 58, 52, the proportion of HPV16 in- creased from 18.56% to 33.33% and in the end grew to 50. 00% with the aggravation of cervical lesions, then HPV16 became to be the dominant subtype, as well as HPV53. Compared with cervical cancer, the negative conversion rates in chronic cervieitis and CIN I , CIN Ⅱ - Ⅲ decreased significantly （ P〈0.05 ） ; compared with cervical cancer, the negative conversion rates of HPVI6 in chronic cervicitis and CIN I , CIN Ⅱ - Ⅲ decreased significantly （P〈0.05） ; compared with cervical cancer, the negative conversion rates of HPV53 in chronic cervicitis and CIN I , CIN Ⅱ - Ⅲ increased significantly （ P〈0. 05 ） ; compared with drug therapy, the negative conversion rates treated by in- complete hysterectomy, complete hysterectomy, and radical hysterectomy increased significantly （ P〈0. 05 ） . Among the subtypes treated by four therapies, the negative conversion rate of HPV16 treated by complete hysterectomy was the highest, followed by radical hysterectomy. Compared with old patients, the negative conversion rates in adolescents and middle-aged patients increased significantly （ P〈0. 05 ） . Con- clusion： The negative conversion rates of HPV16 and HPV53 are correlated with cervical lesions, age and therapy. HPV genotyping, espe- cially for repeated and secondary infection of HPV16, not only can provide a basis for cervical lesions screening and tumor prediction, but al- so can be used for prognosis evaluation.