青海藏族宫颈癌患者诱发因素的多因素分析

Multivariate analysis on predisposing factors of cervical cancer patients of Tibetan nationality in Qinghai area

目的探讨行为和生物学因素与藏族妇女宫颈癌发生的关系。方法采用病例对照研究,选取2014年1月-2015年9月在青海省人民医院、青海大学医学院确诊的100例藏族宫颈癌患者为宫颈癌组,另选取同期医院就诊的200例非宫颈癌患者为非宫颈癌组。采用非条件Logistic回归模型分析。结果 100例藏族宫颈癌患者HPV阳性84例,感染率84%;高危型HPV感染为主,其中HPV16型60例,占71.43%;HPV18型14例,占16.67%。200例非宫颈癌患者中HPV阳性感染者89例,阳性率44.50%;HPV高危型85例,占95.50%。单因素分析宫颈癌诱发与HPV感染、初潮年龄,月经持续时间、经期性行为、初次性行为年龄、初次生育年龄、生育次数、流产史、婚外性行为、避孕方式、外阴清洗和伴侣清洗与宫颈癌发生均有关联,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,HPV感染(OR=5.92,95%CI:2.17,16.14)、月经持续时间(OR=5.62,95%CI:1.06,29.70)、经期性行为(OR=11.24,95%CI:4.16,30.38)、初次生育年龄(OR=3.78,95%CI:2.27,6.30)、流产史(OR=3.74,95%CI:1.34,10.44)、婚外性行为(OR=1.69,95%CI:1.06,2.68)、初次性行为年龄(OR=0.10,95%CI:0.03,0.30)、避孕方式(OR=0.17,95%CI:0.06,0.48)、外阴清洗(OR=0.27,95%CI:0.13,0.58)和伴侣清洗(OR=0.36,95%CI:0.17,0.80)与宫颈癌发生有关。结论高危型HPV持续感染和不健康的行为方式是导致藏族妇女诱发宫颈癌的重要影响因素,早期筛查和行为学干预是经济有效的预防措施。

Objective To explore the relationship between behavioral and biological factors and cervical cancer in Tibetan women.Methods A case-control study was performed,100 Tibetan women diagnosed as cervical cancer in Qinghai Provincial People＆#39;s Hospital and Medical College of Qinghai University from January 2014 and September 2015 were selected as cervical cancer group;200 cases without cervical cancer who were diagnosed in the hospital during the same period were selected as non-cervical cancer group.Unconditional logistic regression model was used for data analysis.Results Among 100 Tibetan patients with cervical cancer,there were 84 cases with positive HPV,the infection rate was 84.0%.The high-risk HPV was main type of HPV infection,there were 60 cases with HPV16 （71.43%） and 14 cases with HPV18 （16.67%）.In non-cervical cancer group,there were 89 cases with positive HPV,the infection rate was 44.50%,high-risk HPV infection accounted for 95.50% （85 cases）.Univariate analysis showed that cervical cancer was associated with HPV infection,menarche age,menstruation duration time,menstrual sexual behavior,age of initial sexual behavior,the first fertility age,number of delivery,history of abortion,extramarital sexual behavior,contraceptive methods,genital cleaning and partner cleaning,there were statistically significant differences （P〈0.05）.Multivariate logistic regression analysis showed that HPV infection （OR=5.92,95% CI：2.17,16.14）,menstruation duration time （OR=5.62,95% CI：1.06,29.70）,menstrual sexual behavior （OR=11.24,95% CI：4.16,30.38）,the first fertility age （OR =3.78,95% CI：2.27,6.30）,history of abortion （OR =3.74,95 % CI：1.34,10.44）,extramarital sexual behavior （OR =1.69,95 % CI：1.06,2.68）,age of initial sexual behavior （OR =0.10,95% CI：0.03,0.30）,contraceptive methods （OR=0.17,95% CI：0.06,0.48）,vulvar cleaning （OR=0.27,95% CI：0.13,0.58）,and sex partner cleaning （OR=0.36,95% CI：0.17,0.80） were associated with the oncogenesis of cervical cancer.Conclusion Persistent infection of high-risk HPV subtypes and unhealthy behaviors are important factors that lead to cervical cancer in Tibetan women.Early screening and behavioral intervention are economic and effective preventive measures.