不同HPV基因亚型单纯性感染与宫颈病变的关系

HPV genotype distribution in cervical intraepithelial neoplasia and cervical cancer

目的 探讨感染不同HPV基因亚型单纯性感染与宫颈上皮内瘤变（CIN）、宫颈癌的关系. 方法 分析2013年1月-2013年12月在本院门诊就诊的31 040例女性患者的宫颈HPV检测结果,对于HPV阳性的患者行宫颈薄层液基细胞学检查（TCT）,TCT异常和高度怀疑有宫颈病变者进一步行阴道镜下宫颈多点活检.探讨不同HPV基因亚型单纯性感染与活检病理学检查结果的关系. 结果 （1）HPV52型是女性宫颈最常见的感染型（5.4％）,其他高危型HPV感染率由高到低排序依次为16、58、68、18、39、33、31、56、59、51、45、35型;（2）单一亚型HPV感染中,HPV52型是导致CIN I最常见的亚型（21.7％）,HPV16型是导致高级别CIN病变及宫颈鳞癌的主要亚型（40.5％、71.2％）,HPV18型是导致宫颈腺癌的主要亚型（80.0％）;（3）21种HPV亚型均是CIN Ⅰ发病的危险因素,其中HPV42型（OR=6.98,95％ CI为1.17 ～41.8）的危险度最大;除了HPV59、6、42型以外的HPV亚型均是高级别CIN的危险因素,其中HPV16型（0R=7.09,95％ CI为5.65 ～8.90）的危险度最大,其次是HPV33、58、31型;同时HPV16型（OR=22.69,95％ CI为15.92～32.34）是导致宫颈癌危险度最高的基因亚型,其次是HPV18、58、31型. 结论 在现有的13种高危型HPV中,HPV52型是宫颈最常见但并非最危险的亚型,HPV16、18、58和33型是同高级别宫颈癌前病变及宫颈癌关系最密切的基因亚型。

Objective To characterize HPV genotype profile of cervical intraepithelial neoplasia and cervical cancer. Methods From a population of 31 040 outpatients in Maternal and child care hospital of Guangdong Province, patients with high-risk HPV type positive underwent cytology examination. HPV positive and/or cytology ≥ ASCUS cases were recalled for colposcopic examination and multi-point biopsy if necessary. The diagnosis was defined with histopathology. Results Histology revealed CIN Ⅰ with single type of HPV in 484 women, CIN Ⅱ and CIN Ⅲ in 252, cervical squamous cell carcinoma in 66, and cervical adenocarcinoma in 5 women. HPV52 was the most common type, with a detection rate of 5.4% （ 1 685/31 040） of all cases, followed by HPV 16, 58, 68, 18, 39, 33, 31,56, 59, 51,45, and 35. HPV52 as the single infection was the most common genotype in CIN Ⅰ , with a detection rate of 21.7% （ 105/ 484）. HPV16 was the main pathogenic genotype in CIN Ⅱ-Ⅲ and cervical squamous cell carcinoma, being detected in 40. 5% （102/252） and 71.2% （47/66）, respectively. HPV18 was detected in 80% of cervical adenocm＇cinoma. All 21 types of HPV were risk factors for CIN Ⅰ with HPV42 （ OR = 6.98, 95 % CI： 1.17-41.8） having the highest risk. HPV16 （0R=7.09, 95%CI： 5.65-8.90） had the highest risk for CIN Ⅱ-Ⅲ, followed by HPV 33, 58, 31, 18, 45, and 52. However, HPV59, 6, and 42 were not risk factors for CIN Ⅱ- Ⅲ. HPV16 （OR = 22. 69, 95 % CI： 15. 92-32. 34） had the highest risk for cervical cancer, followed by HPV 18, 58, 31, 59, 33, and 46. Conclusion HPV52 is the most common genotype, but not the type with the highest risk. HPV16, 58, 18, and 33 appeare to have higher oncogenic potential than other genotypes.