新疆巴楚县维吾尔族妇女HPV感染和宫颈高级别病变及宫颈癌与血清维生素的关系

Relationship of human papilloma virus infection,high-grade cervical lesions including cervical cancer and serum vitamins of Uyghur women in Bachu County,Xinjiang

目的探讨新疆巴楚县维吾尔族妇女HPV感染、宫颈高级别病变及宫颈癌与血清维生素的关系,为预防及早期诊断提供科学依据。方法 2014年3月1日-6月15日,通过整群抽样的方法,在新疆巴楚县的9个乡镇进行维吾尔族妇女的宫颈癌筛查,共筛查5 045名妇女。选择细胞学ASC-US及以上、care HPV检测阳性或VIA/VILI阳性者646例进入研究队列。选择2011年3月1日-2014年6月15日在新疆医科大学附属肿瘤医院妇科住院确诊的来自巴楚县的宫颈疾病患者187例进入研究队列。检出CIN2+级者作为病例组,慢性宫颈炎及CINⅠ级者作为对照组;HPV感染者作为阳性组,未感染者作为阴性组。研究对象均检测血清维生素的含量,使用care HPV方法检测Human papilloma virus(HPV)感染情况。结果 HPV阳性组与阴性组血清中维生素A、维生素D3、叶酸和和维生素B12的水平差异有统计学意义,而血清中维生素C和维生素E的水平无明显差异。维生素D3≥49.643 4 ng/L是新疆喀什地区巴楚县维吾尔族妇女HPV感染的危险因素,叶酸≥17.670 5 ng/L是新疆喀什地区巴楚县维吾尔族妇女HPV感染的保护因素。病例组血清中维生素C、维生素A和维生素D3的水平有升高的趋势(P均<0.05),而病例组与对照组血清中维生素E、叶酸和维生素B12的水平无明显差异。维生素C≥0.685 7μg/L是新疆喀什地区巴楚县维吾尔族妇女宫颈高级别病变及宫颈癌的保护因素。结论宫颈癌患者血清中叶酸和维生素C的水平在一定范围时对宫颈病变的发生及HPV感染起保护作用,维生素D3是新疆喀什地区巴楚县维吾尔族妇女HPV感染的危险因素.可通过改善妇女维生素的摄入状况,来降低宫颈病变的发生。

Objective To study the relationship between HPV infection and high-grade cervical lesions in-cluding cervical cancer and serum vitamins in Uyghur women in Bachu of Xinjiang to provide useful infor-mation for intervention of cervical cancer.Methods Six hundred and forty-six obj ects with ≥ASC-US or care HPV positive or VIA/VILI positive were enrolled through screening 5 045 Uyghur women in Bachu,＆amp;nbsp;Xinjiang from March 1st,2014 to June 15th,2014.In addition,187 objects with cervical disease from Ba-chu were enrolled in the Department of Gynecology in the Affiliated Tumor Hospital of Xinjiang Medical University.All participants underwent biopsy under colposcope for histopathologic examination.The par-ticipants with ≥ CIN2 were regarded as case group,and 〈 CIN1 as control group.The participants with HPV infection were regarded as HPV positive group,and without HPV infection as HPV negative group. All participants underwent epidemiological investigation,and the concentrations of vitamins in serum were detected.Univariate analysis was performed with chi-square test between HPV positive group and negative group,and between case group and control group,multivariate analysis were performed with Logistic re-gression.Results Serum vitamin A,vitamin D3 （VD3）,folic acid （FA）and vitamin B12 levels between HPV positive group and negative group had significant differences,while vitamin C （VC）and vitamin E levels in serum between HPV positive group and negative group had no significant differences.Vitamin D3 levels being bigger than 49.6434 ng/L was the risk factor for Uyghur HPV infected women in Bachu Coun-ty of Xinjiang,while the level of folic acid being greater than 17.6705 ng/L was a protective factor for it. For case group,serum vitamin C,vitamin A and vitamin D3 levels increased （P〈 0.05）,while serum vi-tamin E,folic acid and vitamin B1 2 had no significant difference between the case group and the control group.The level of vitamin C being greater than 0.6857 ug/L was the protective factor for Uygur women cervical high grade lesions and cervical cancer in Bachu county of Xinj iang.Conclusion The concentrations of FA and VC were protective factors for HPV infection and high cervical lesions including cervical cancer, The concentration of VD3 were risk factor for HPV infection.Therefore,reduction of the occurrence of cervical lesions should be taken by improving the levels of vitamins.