尖锐湿疣患者人乳头瘤病毒感染状况及影响因素研究

Infection Status and Influencing Factors of Human Papillomavirus in Patients with Condylomata Acuminata

目的了解我国内地尖锐湿疣(CA)患者的人乳头瘤病毒(HPV)感染状况,并探讨其影响因素。方法系统检索Pub Med、Science Direct Online、中国知网、万方数据知识服务平台、维普网中关于我国内地CA患者HPV检测的文献,检索时间均为1990年1月—2013年12月。根据样本量对各文献HPV感染率进行加权合并,计算CA患者的HPV及各基因型合并感染率,并分析不同研究年份、研究地区CA患者的HPV合并感染率,采用多因素Logistic回归分析探讨CA患者感染/检出HPV的影响因素。结果共纳入文献67篇,累计CA患者10 757例,感染HPV 9 328例(86.7%)。CA患者的HPV合并感染率为95.7%〔95%CI(95.2%,96.2%)〕,其中合并感染率较高的前3种基因型为HPV6/11〔81.2%,95%CI(77.1%,85.2%)〕、HPV6〔43.8%,95%CI(35.2%,52.5%)〕、HPV11〔38.3%,95%CI(32.8%,43.8%)〕。1990—2003、2004—2013年CA患者的HPV合并感染率分别为96.6%〔95%CI(95.8%,97.5%)〕、94.6%〔95%CI(94.0%,95.3%)〕;东、中、西部患者的HPV合并感染率分别为95.1%〔95%CI(94.4%,95.7%)〕、91.7%〔95%CI(89.3%,94.1%)〕、96.5%〔95%CI(95.4%,97.6%)〕。多因素Logistic回归分析结果显示,研究年份、研究地区、标本类型、诊断方法是CA患者感染/检出HPV的影响因素(P<0.05)。对不同基因型进行分析,结果显示,研究年份、研究地区、标本类型、诊断方法是CA患者感染/检出HPV6的影响因素,研究年份、研究地区为西部、标本类型、诊断方法是CA患者感染/检出HPV11的影响因素,研究地区为中部、标本类型是CA患者感染/检出HPV16的影响因素,研究地区、标本类型、诊断方法是CA患者感染/检出HPV18的影响因素(P<0.05)。结论我国内地CA患者的HPV感染以HPV6、HPV11基因型为主,感染率近10年来有所下降,东部地区感染率较高。病理检查确诊、采用剥落细胞进行DNA检测,可以提高CA患者的HPV检出率。

Objective To study the infection status of human papillomavirus（HPV） in patients with condylomata acuminata（CA） in China's Mainland and explore its influencing factors. Methods The literatures on HPV detection of CA patients in China's Mainland published between January 1990 and December 2013 were systematically retrieved from Pub Med,Science Direct Online, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and the VIP database. According to the sample size,HPV infection rates of each literature were weighted and combined and the infection rates of HPV and the combined infection rate of each genotype of CA patients were calculated,and the combined infection rate of HPV of CA patients in different years and areas of study was analyzed. Multivariate Logistic regression analysis was used to investigate the influencing factors of CA patients infected / detected with HPV. Results A total of 67 literatures were included in the study. The number of CA patients accumulated to 10 757,and 9 328 cases（86. 7%） infected with HPV. The combined infection rate of HPV in patients with CA was 95. 7% 〔95% CI（95. 2%,96. 2%） 〕,and the top three genotypes with high infection rate were HPV6 /11 〔81. 2%,95% CI（77. 1%,85. 2%） 〕, HPV6 〔43. 8%,95% CI（35. 2%,52. 5%） 〕, HPV11〔38. 3%,95% CI（32. 8%,43. 8%） 〕. The combined infection rate of HPV in patients with CA between 1990 and 2003 and between 2004 and 2013 was 96. 6% 〔95% CI（95. 8%,97. 5%） 〕and 94. 6% 〔95% CI（94. 0%,95. 3%） 〕respectively;the combined infection rate of HPV of patients in eastern, middle and western areas was 95. 1% 〔95% CI（94. 4%,95. 7%） 〕,91. 7% 〔95% CI（89. 3%,94. 1%） 〕,and 96. 5% 〔95% CI（95. 4%,97. 6%） 〕respectively. Multivariate Logistic regression analysis showed that the year of study,areas of study,type of specimen and methods of diagnosis significantly influenced the infection and detection of HPV in CA patients（P 0. 05）. After analyzing different genotypes, the results showed that the year of study,areas of study,types of specimen, and methods of diagnosis were influencing factors for CA patients infected / detected with HPV6,the year of study,western studied area,types of specimen,and methods of diagnosis were influencing factors for CA patients infected / detected with HPV11,the middle studied area and types of specimen were influencing factors for CA patients infected / detected with HPV16,and the areas of study,types of specimen and methods of diagnosis were influencing factors for CA patients infected / detected with HPV18（P〈0. 05）. Conclusion HPV6 and HPV11 genotypes are the main types of HPV infection in patients with CA in China's Mainland. The infection rate has declined in the past10 years,relatively high rate of infection is found in the eastern region. Definite diagnosis by pathological examination and the use of exfoliated cells for DNA detection can improve the detection rate of HPV in patients with CA.