维吾尔族和汉族患者人乳头瘤病毒载量与宫颈病变程度的相关性研究

Correlation between human papillary virus load and degree of cervical lesion in Uygur and Han nationality

目的 探讨新疆地区维吾尔族和汉族患者中人乳头瘤病毒（HPV）病毒载量与宫颈病变程度的相关性.方法 回顾性分析2009年1月至2012年12月于新疆维吾尔自治区人民医院接受HPV DNA载量检测和阴道镜下宫颈多点活检的患者3 016例,其中汉族1 294例,维吾尔族1 722例.将HPV DNA载量南低至高分为1、2、3和4级,将宫颈病变分为宫颈炎性病变、宫颈上皮内瘤变（CIN）Ⅰ级、CINⅡ级、CINⅢ级和宫颈癌.比较维吾尔族和汉族患者总体和不同程度宫颈病变HPV阳性率差异;比较不同程度宫颈病变级别HPV DNA载量差异;分析HPV DNA载量与宫颈病变级别相关性;评估不同HPV DNA载量宫颈癌发生风险.结果 汉族患者中,宫颈炎性病变980例、CIN Ⅰ级118例、CINⅡ～Ⅲ级144例、宫颈癌52例;维吾尔族患者中宫颈炎性病变1 197例、CIN Ⅰ级68例、CINⅡ～Ⅲ级145例、宫颈癌312例.汉族患者总体HPV阳性率为74.4％（963/1 294）,高于维吾尔族患者,差异有统计学意义[65.9％（1 134/1 722）] （P ＜0.05）,宫颈炎性病变和宫颈癌HPV阳性率汉族与维吾尔族患者比较差异有统计学意义[68.9％（675/980）比53.6％（641/1 197）、82.7％ （43/52）比95.2％（297/312）]（P＜0.01）,CIN Ⅰ级和CINⅡ～Ⅲ级HPV阳性率汉族与维吾尔族患者比较差异无统计学意义[90.7％（107/118）比89.7％（61/68）、95.8％ （138/144）比93.1％（135/145）]（P ＞0.05）.汉族和维吾尔族患者不同程度宫颈病变HPV载量差异均有统计学意义（P＜0.01）;HPV DNA载量均与宫颈病变级别呈正相关（r=0.481、0.604,均P＜0.01）.随着HPV DNA载量增加,宫颈癌发生风险增加,HPV DNA载量2级为1级的2.81倍（OR=2.81,95％ CI：1.78～4.61）,3级为1级和2级的13.33倍（OR=13.33,95％CI：8.35 ～ 22.01）和4.74倍（OR=4.74,95％CI：3.33 ～6.77）,4级为1级、2级和3级的27.59倍（OR=27.59,95％CI：17.83 ～ 44.50）,9.80倍（OR =9.80,95％CI：7.19 ～ 13.50）和2.07倍（OR =2.07,95％CI：1.50 ～2.88）（均P＜0.01）;维吾尔族发生宫颈癌的风险是汉族的6.74倍（OR=6.74,95％CI：4.93 ～ 9.40,P＜0.01）.结论 维吾尔族和汉族患者HPV DNA载量与宫颈病变程度均呈正相关,随HPV DNA载量增加,宫颈癌发生风险增加,维吾尔族患者宫颈癌风险高于汉族患者.

Objective To investigate the correlation between human papillary virus （HPV） load and degree of cervical lesion in Uygur and Han women.Methods Totally 3 016 patients,including 1 294 Han and 1 722 Uygur patients,undergoing HPV DNA content detection and multiple biopsy under colposcopy in Xinjiang Uygur Autonomous Region people＆#39;s Hospital from January 2009 to December 2012 were retrospectively analyzed.The HPV DNA content was classified into grade 1,2,3 and 4 ; the cervical lesions were classified into inflammatory lesion,cervical intraepithelial neoplasia （CIN） Ⅰ,CIN Ⅱ,CIN Ⅲ and cervical cancer.The HPV positive rate between Uigur and Han women was compared and the HPV DNA content in different degree of cervical lesion was compared.The correlation between HPV DNA content and degree of cervical lesion was analyzed.The effect of HPV DNA content on the risk of cervical cancer was assessed.Results There were 980 inflammatory lesion,118 CIN Ⅰ,144 CIN Ⅱ-Ⅲ,52 cervical cancer in Han patients,meanwhile 1 197 inflammatory lesion,68 CIN Ⅰ,145 CIN Ⅱ-Ⅲ and 312 cervical cancer in Uygur patients.The HPV positive rate of Han patients was 74.4% （963/t 294）,higher than that of Uygur patients [65.9% （1 134/1 722）] （P 〈 0.05） ; the HPV positive rates in inflammatory lesion and cervical cancer between Han and Uygur patients were significantly different [68.9% （675/980） vs 53.6% （641/1 197）,82.7% （43/52） vs 95.2% （297/312）] （both P 〈0.01） ; the HPV positive rates in CIN Ⅰ and CIN Ⅱ-Ⅲ between Han and Uygur patients showed no statistical differences [90.7% （107/118） vs 89.7% （61/68）,95.8% （138/144） vs 93.1% （135/145）].The HPV DNA content was positively correlated with the degree of cervical lesion in both Han and Uygur patients （r =0.481,0.604,both P 〈 0.01）.The risk of cervical cancer in HPV DNA grade 2 was 2.81 times higher than that in grade 1 （OR =2.81,95%CI：1.78-4.61） ; it was was as 13.33 times higher in grade 3 （OR =13.33,95% CI：8.35-22.0l） and 4.74 times higher （OR =4.74,95% CI：3.33-6.77） than that in grade 1 and 2 ; it was 27.59 times in grade 4 （OR =27.59,95% CI：17.83-44.50）,9.80 times （OR =9.80,95% CI：7.19-13.50） and 2.07 times （OR =2.07,95% CI：1.50-2.88） higher than that in grade 1,2,and 3 （all P 〈 0.01）.The risk of cervical cancer in Uygur patients was 6.74 times （OR =6.74,95% CI：4.93-9.40,P 〈 0.01） higher than that in Han patients.Conclusions In Uygur and Han patients,there is a positive correlation between the HPV DNA content and the degree of cervical lesion; the risk of cervical cancer increases with the raise of HPV DNA content; the risk of cervical cancer is higher in Uygur patients than that in Han patients.