医院机会性筛查人群HR-HPV感染的流行病学特征及与宫颈癌前病变的关系

Epidemiologic characteristics of high risk human papillomavirus( HR-HPV) infection in population undergone hospital opportunistic health screening and the relationship between cervical cancer lesion and HR-HPV infection

目的：研究医院机会性筛查人群高危型人乳头瘤病毒（ high risk-human papillomavirus,HR-HPV）感染的流行病学特征,探讨HR-HPV感染与宫颈癌前病变的关系。方法收集2012年1月1日至2012年12月31日期间,就诊于首都医科大学附属北京朝阳医院妇科门诊,同时接受HR-HPV和宫颈薄层液基细胞学检查（ thinprep cytologic test,TCT）符合纳入标准的2305例患者资料。采用二代杂交捕获法（hybird capture II,HC-II）进行HR-HPV检测。结果1）医院机会性筛查人群HR-HPV感染率为34.84%,年轻女性（20~24岁）感染率最高（50.0%）,随着年龄的增加,感染率逐渐下降,45~49岁女性感染率最低（24.18%）,≧55岁者感染率升高（47.02%）,感染率呈双高现象。宫颈薄层液基细胞学异常率的年龄分布特点,与HR-HPV感染率的年龄分布特点一致。2） TCT结果为正常或者炎性反应、不典型鳞状上皮细胞（ atypical squamous cells undetermined significance,ASCUS）、低度鳞状上皮内瘤样病变（low squamous intraepithelial lesion,LSIL）、高度鳞状上皮内瘤样病变（high squamous intraepithelial lesion,HSIL）、宫颈鳞状细胞癌（squamous of cervical carcinoma,SCC）中, HR-HPV的感染率分别是23.98%、66.47%、87.21%、98.04%、100%。宫颈组织活检病理为正常或炎性反应、宫颈上皮内瘤样病变1级（ cervical intraepithelial lesions-Ⅰ,CIN-Ⅰ）、CIN-Ⅱ、CIN-Ⅲ、SCC患者HR-HPV的感染率分别为67.44%、86.96%、88.24%、94.57%、90.48%。3）在ASCUS患者中,宫颈高级别病变（≧CIN-Ⅱ）的发生率31.73%,HR-HPV阳性组宫颈高级别病变（≧CIN-Ⅱ）的检出率36.93%,HR-HPV阴性组宫颈高级别病变（≧CIN-Ⅱ）的检出率21.43%,两组间的差异具有统计学意义（X2=4.13,P=0.042）。4）在LSIL患者中,宫颈高级别病变的发生率34.40%,HR-HPV阳性组宫颈高级别病变的检出率37.37%,HR-HPV阴性组宫颈高级别病变的检出率14.29%,两组间的差异具有统计学意义（X2=5.76,P=0.016）。结论不同年龄,HR-HPV感染率及TCT异常率不同,〈24岁和≧55岁为HR-HPV感染及异常宫颈薄层液基细胞学高峰年龄。 HR-HPV感染率和宫颈病变严重程度呈显著正相关。 HR-HPV检测不能作为ASCUS和LSIL患者分流管理的唯一手段,HR-HPV阴性的ASCUS和LSIL不能排除≧CIN-Ⅱ级病变,仍然需要做阴道镜检查。

Objective To study epidemiological characteristics of population who underwent opportunistic screening for high risk-human papillomavirus（ HR-HPV） infection, and to explore the relationship between HR-HPV infection and cervical precancerous lesions.Methods Data from 2 305 patients, according the inclusion criteria, who underwent HR-HPV DNAs and cervical cytology tests at the outpatient department of OB ＆ GYN, Beijing Chaoyang Hospital from January 1, 2012 to December 31, 2012, were collected. HR-HPV DNAs were detected by hybrid capture-Ⅱ（ HC-Ⅱ） method, cervical exfoliated cells were collected and inspected. SPSS 18. 0 software was used for statistical analysis. Results 1） The infection rate of HR-HPV of the screening crowd was 34. 84%, of which the young women（20-24 years old） is the highest（50. 0%）. With aging, the rate decreased gradually, the lowest rate of women aged 45-49 years （24. 18%）. It increased again after the age of 55 years（47. 02%）, showing second peak of infection. The age distribution of positive rate of cervical cytology tests also had two peaks, consistent with characteristics of age distribution of HR-HPV infection rate. 2） HR-HPV infection rates were respectively 23. 98%, 66. 47%, 87. 21%, 98. 04% and 100% in normal or inflammation, atypical squamous cells undetermined significance（ ASCUS） , low squamous intraepithelial lesion（ LSIL） , high squamous intraepithelial lesion（ HSIL） , squamous of cervical carcinoma（ SCC） , thin preparation test（ TCT） results, respectively. HR-HPV infection rates of subjects with normal cervical biopsy or inflammation, cervical intraepithelial lesions（CIN）-Ⅰ, CIN-Ⅱ, CIN-Ⅲ, ASCUS, LSIL, HSIL and SCC were 67. 44%, 86. 96%, 88. 24%, 94. 57%, 90. 48%, respectively. With the increasing level of cervical cytology lesions and cervical histological lesions, the rate of HR-HPV infection significantly increased. 3） In ASCUS patients, the incidence of high-grade cervical lesions was 31. 73%, which in HR-HPV positive group was 36. 93% and in negative group was 21. 43%. The difference was statistically significant between the two groups（X2=4. 13, P=0. 042）. 4） In LSIL patients, the incidence of high-grade cervical lesions was 34. 40%, which in HR-HPV positive group was 37. 37% and in negative group was 14. 29%. The difference was statistically significant between the two groups（ X2=5. 76, P=0. 016）. Conclusion The infection rate of HR-HPV and the abnormal rate of cervical cytology are different with different age. Younger than 24 years and ≧55 years were peak of both of HR-HPV infection and abnormal cytology. HR-HPV infection and cervical lesion severity was positively correlated. Patients for ASCUS and LSIL of cervical cytology, if HR-HPV positive, will increase the probability of CIN-Ⅱ and above lesions, but negative patients cannot be excluded from high-grade cervical lesions, the colpscopic examination is necessary.