人乳头瘤病毒亚型与子宫颈病变的关系

The relationship between human papillomavirus genotypes and cervical lesions

目的：了解徐州地区子宫颈癌及癌前病变中人乳头瘤病毒（HPV）感染及各亚型分布情况，探讨不同HPV亚型的致瘤性。方法采用凯普医用核酸分子杂交技术行生殖道HPV分型检测。依据病变程度，将688例经阴道镜下活组织检查证实为子宫颈病变的患者分为3组：低度病变（LSIL）组187例、高度病变（HSIL）组359例、子宫颈癌组142例。分析比较各组HPV感染及亚型分布情况。结果LSIL组、HSIL组、子宫颈癌组HPV感染率分别为68.98%（129／187）、94.99%（341／359）、95.78%（136／142），差异有统计学意义（P＜0.05）。随子宫颈病变程度的加重，高危HPV感染率逐渐升高，低危HPV感染率逐渐降低，差异均有统计学意义（P＜0.05）。LSIL组前5位常见HPV亚型依次为16、52、58、18、31型，HSIL组依次为16、58、33、31、52型，子宫颈癌组依次为16、31、58、18、33型。累积Logistic回归模型分析显示，与子宫颈病变发生的相关程度由高到低的HPV亚型分别为HPV16（OR＝7.215，P＜0.05）、HPV31（OR＝2.768，P＜0.05）、HPV33（OR＝1.846，P＜0.05）、HPV58（OR＝1.726， P＜0.05）。结论在徐州地区，随子宫颈病变程度的加重高危HPV感染率升高。导致子宫颈癌的主要HPV亚型为16、31、33、58型。 HPV18致瘤性较强，但在该地区不多见；HPV52致瘤性较弱，但在该地区感染率较高。

Objective To investigate the prevalence and genotype distribution of human papilloma virus （HPV） infection among patients with cervical carcinoma or precancerous lesions in Xuzhou region. Methods 688 patients with cervical lesions confirmed by colposcopic biopsy were assigned to three groups：low-grade squamous intraepithelial lesion （LSIL） （187 cases）, high-grade squamous intraepithelial lesion （HSIL） （359 cases） and cervical carcinoma （142 cases）. The genotypes of HPV were determined by nucleic acid hybridization technique. The prevalence and genotype distribution of HPV were further analyzed. Results The infection rates of HPV in LSIL , HSIL and ICC group were 68.98 % （129/187）, 94.99 % （341/359）, 95.78 % （136/142）, respectively. These rates were statistically significant different （P〈 0.05）. With the aggravation of cervical lesions, HR-HPV infection rate was gradually increased and LR-HPV infection rate was gradually decreased. The most common HPV types were listed below in order of decreasing prevalence. LSIL：HPV16, 52, 58, 18, 31; HSIL： HPV16, 58, 33, 31, 52; cervical carcinoma： HPV16, 31, 58, 18, 33. Based on the cumulative logistic regression model, confidence intervals of the relevance between the overall HPV prevalence and occurrence of cervical lesions were calculated： HPV16 （OR= 7.215, P〈 0.05）, HPV31 （OR=2.768, P〈0.05）, HPV33 （OR=1.846, P〈0.05）, HPV58 （OR=1.726, P〈0.05） Conclusions The prevalence of HR-HPV infections increased with the aggravation of cervical carcinoma in Xuzhou region. In order of decreasing prevalence, the most prevalent of HPV types are HPV16, 31, 33, 58. The results indicate that HPV18 have strong tumorigenicity, but is not popular in Xuzhou region. By contrast HPV52 is more common in LSIL than that in cervical carcinoma.