北京地区35～64岁农村妇女高危型HPV感染情况分析

Analysis of high-risk type HPV infection in 35 to 64 years old rural women in Beijing

目的通过采用高危型人乳头瘤病毒（HPV）作为宫颈癌初筛方法,了解北京地区35~64岁农村妇女高危型HPV感染现状及高危型HPV作为初筛的效果。方法回顾性分析2014年10月至2015年3月北京市5个农村两癌筛查区县,年龄35~64岁农村户籍人口20 076名,以高危型HPV作为初筛进行宫颈癌筛查试点的结果,使用SPSS17.0软件对数据进行描述性分析。结果北京地区35~64岁20 076名农村妇女中,高危型HPV总感染率为7.6%（1 535/20 076）,其中单一感染排前五位的高危亚型分别是HPV16型219例,占14.3%,HPV52型146例,占9.5%,HPV58型101例,占6.6%,HPV18型84例,占5.5%,HPV51型66例,占4.3%。高危型HPV混合感染率为7.6%（116/1 535）,最多同时感染四种高危亚型。35~40岁、41~45岁、46~50岁、51~55岁、56~60岁、61~64岁高危型HPV检测率分别为50.0%（192/384）、38.9%（330/848）、33.0%（388/1 177）、6.3%（298/4 757）、3.4%（251/7 438）和1.4%（76/5 472）。除高危型HPV16/18感染者外,其他型感染者细胞学阳性检出率为13.0%（154/1 188）;转诊阴道镜检查率为2.3%（461/20 076）;阴道镜下活检组织病理学检出CIN2 27例,CIN3 39例,宫颈微小浸润癌2例,浸润癌1例,癌及癌前病变检出率为343.7/10万,宫颈癌检出率为14.9/10万,早诊率为98.6%（68/69）;在宫颈高级别病变及癌中,HPV16/18亚型感染占71.0%（49/69）。结论 HPV16、52和58型是北京地区35~64岁农村妇女单一感染的主要基因亚型,高危型HPV检出率最高为35~40岁,HPV16/18感染是导致宫颈高级别病变及癌的主要亚型。用高危型HPV作为初筛方法,初筛阳性病历检出率提高,而且用高危型HPV分流后,细胞学的工作量明显减少。

Objective Usinghigh-risk HPV test as primary cervical cancer screening, to detect the situation of high-risk HPV infection in 35 to 64 years old women inruralareas of Beijingand the effect of this methodology. Methods Data of 20 076 women among 35 - 64 years lived in in five rural areasof Beijing including Haidian District, Changping District, Shunyi District, Tongzhou District and Miyun County under went cervial cancer screening by using high-risk HPV test as primary screening in 2014. Results Total high-risk HPV infection rate was 7.6% of the 20 076 cases, of which the top five high-risk subtypes of single infectioni case was HPV16 （219/20 076, 14.3%）, HPV52 （ 146/20 076, 9.5%）, HPV58 （101/20 076, 6.9%）, HPV18 （84/20 076, 5.5%）, and HPV51 （66/20 076, 4.3%）. Co-infection rate of high- risk HPV infection was 7.6% （ 116/20 076）, the most serious infection was four types of high-risk HPV subtypes are detected in one woman. High-risk HPV infection rates of 35 - 40 years old, 41 - 45 years old, 46 - 50 years old, 51 - 55 years old, 56- 60 years old, and61- 64 years old were 50.0 % （192/384）, 38.9% （330/848）, 33.0% （388/1 177）, 6.3% （298/4 757）, 3.4% （251/7 438） and 1.4% （76/5 472）, respectively.In addition, cytology positive rate was 13.0% among high-risk HPV infections except HPV16/18. 461 cases accepted colposcopy, which was 2.3%~ among these, CIN2 was 27cases, CIN3 was 39 cases, microinvasive carcinoma was 2 cases, and 1 case of invasive cancer. Detection rate of precancerous lesion was 343.7/100 000 and detection rate of cervical cancer was 14.9/100 000, early diagnosis rate of cervical cancer was 98.6%. For HSIL and cervical cancers, HPV16/18 subtype infection accounted for 71.0%. Conclusion Major high-risk HPV infection of 35 - 64 years old women in rural Beijing was HPV16, 52 and 58. The highest high-risk HPV detection rate was found among 35 - 40 years old women, HPV16/18 infections are major cause of HSIL and cervical cancer. Started with high-risk HPV detection cervical cancer screening, detection rate of screening positive results has increased while significantly reducing the workload of cytologists.