HPV感染型别与宫颈细胞学异常程度的相关性研究

Association between HPV subtypes and abnormal cervical cytology

目的探讨在子宫颈癌筛查中不同型别人乳头状瘤病毒（HPV）感染者的管理模式。方法对2010-2012年在北京大学第一医院同时行宫颈细胞学与HPV检测,HPV阳性的7 892例感染者的临床资料进行总结,分析HPV感染型别与细胞学异常程度的相关性。结果在7 892例HPV阳性妇女中细胞学异常检出率为32.8%（2 585/7 892）,细胞学异常妇女中低级别异常者2 013例,占25.5%,HPV感染检出率依次为16（21.0%）、58（18.9%）、52（19.6%）、53（14.4%）、66（10.1%）、33（9.5%）、31（5.7%）、68（4.8%）、18（4.8%）等;细胞学高级别异常者572例,占7.2%,其中HPV感染检出率依次为16（58.7%）、58（17.8%）、33（14.9%）、52（9.1%）、31（7.3%）、18（6.3%）等。将年龄、HPV感染型别按细胞学低级别与高级别两种程度进行Logistic回归分析,发现感染者的年龄及HPV16、31、33亚型与细胞学高级别异常相关（OR：1.021、4.294、2.000、2.301;CI：1.013~1.029、3.560~5.179、1.187~2.372、1.773~2.986）,HPV52、53、66与细胞学低级别异常相关。结论 HPV16、31、33亚型与细胞学高级别异常关系密切,在子宫颈癌筛查中应重视此类感染者的管理。

Objective To explore the management mode of different HPV subtypes infected patients in cervical cancer screening. Methods Clinical data of 7 892 HPV positive samples who took both cervical cytology and HPV test between 2010 and 2012 were summarized to analyze the association between HPV subtypes and abnormal cervical cytology. Results Among 7 892 cases with positive HPV,the rate of abnormal cervical cytology was 32. 8%（ 2 585 /7 892）,including 2013 cases of low grade lesion（ 25. 5%）. Detection rate of HPV16,58,52,53,66,33,31,68 and 18 was 21. 0%,18. 9%,19. 6%,14. 4%,10. 1%,9. 5%,5. 7%,4. 8% and 4. 8%,respectively.There were 572 cases of high level lesion（ 7. 2%）,and detection rate of HPV16,58,33,52,31 and 18 was 58. 7%,17. 8%,14. 9%,9. 1%,7. 3%,6. 3%,respectively. Logistic regression analysis revealed that high level abnormal cervical cytology was associated with patients＇ age and HPV16,31,33 infections（ OR value was 1. 021,4. 294,2. 000 and 2. 301,95% CI was 1. 013- 1. 029,3. 560-5. 179,1. 187- 2. 372 and 1. 773- 2. 986）,and low level abnormal cervical cytology was associated with HPV 52,53 and 66 infections.Conclusion There is a close correlation between HPV16,31,33 infection and high level abnormal cervical cytology,and attention should be paid to the management of patients with HPV16,31,33 infections in cervical cancer screening.