高危型人乳头瘤病毒感染与宫颈上皮内瘤样病变的关系

Relations between high-risk human papillomavirus infections and cervical intraepithelial neoplasia

目的研究不同高危型HPV感染在宫颈上皮内瘤样病变（CIN）中的作用。方法收集浙江省瑞安市红十字医院妇科2012年7月至2014年7月间经阴道镜取组织活检确诊的CINⅠ、CINⅡ、CINⅢ患者各200例，问卷收集患者的基本信息，并采用第二代杂交捕获HPVDNA技术（HCⅡ）行高危型HPV检测，采用多因素Logistic回归分析法探讨CIN发生的危险因素。结果入组病例高危型HPV的感染率达80．33％（482／600）。与未感染者相比，感染患者发生CIN的危险度均升高，其中HPV31亚型感染者发生CINⅡ的OR值为11．02，发生CINⅢ的OR值为69．75。多因素Logistic回归分析发现，与CINⅠ相比，性伴侣≥2个（OR=0．76，95％CI：1．05-2．96）、感染HPV16（OR=2．70，95％CI：1．77-4．10）和感染HPVl8（OR=1．96，95％CI：1．06-3．63）感染是CINⅡ的独立危险因素；性伴侣≥2个（OR=3．91，95％CI：1．84-8．33）、未使用安全套（OR=1.82，95％CI：1．18～2．80）、感染HPV16（OR=2．85，95％CI：1．85～4．41）、感染HPV18（OR：2．04．95％CI：1．10～3．79）和感染HPV31（OR=4．17，95％CI：1．66—10．49）是CINⅢ发生的独立危险因素。结论HPV16、HPV18、HPV58和HPV31可能是CIN的主要致病亚型，或可作为癌前病变筛查的标志物。

Objective To study the role of different subtypes of high-risk human papillomavirus （HPV） infections in cervical intraepithelial neoplasia （CIN）. Methods Two hundred cases of each CIN Ⅰ , CIN Ⅱ and CINⅢ patients with confirmed diagnose by colposcopy and biopsy of tissue were collected basic information were investigated by a questionnaire survey, and the subtypes of high-risk HPV were detected by the second-generation hybrid capture HPV DNA technology （HC Ⅱ ）. The risk factors of CIN were analyzed by Logistic regression. Results The overall high-risk HPV infection rate was 80.33% （482/600）. Compared with the patients without high-risk HPV infection, the infection ones had high CIN incidence rate. HPV31 carriers had 11.02-fold increased risk to have CIN Ⅱ, 69.75-fold increased risk to have CIN Ⅲ. Multivariate logistic regression analysis showed that, compared to the patients with CIN Ⅰ , the number of sexual partners≥2 （OR=1.76,95%CI：1.05-2.96）, HPV16 positive （OR =2.70, 95% CI：1.77-4.10） and HPV18 （OR =1.96,95% CI：1.06-3.63） positive were independent risk factors for CIN Ⅱ; the number of sexual partners≥2 （0R=3.91, 95%CI：1.84-8.33）, did not use a condom （0R=1.82, 95%CI：1.18-2.80）, HPV16 positive （OR=2.85, 95%CI：1.85-4.41）, HPV18 positive （OR = 2.04, 95%CI：1.10-3.79） and HPV31 positive （OR=4.17, 95%CI： 1.66-10.49） were the independent risk factors for CINⅢ. Conclusions HPV16, HPV18, HPV58 and HPV31 may be the major pathogenic subtypes of CIN, or can be treated as a marker for screening precancerous lesion of cervical cancer.