高危型人乳头状瘤病毒感染在宫颈病变进展中的风险研究

Risk evaluation of high-risk human papillomavirus genotyping in cervical lesions progress

目的 探讨高危人乳头状瘤病毒（Human papillomavirus,HPV）基因分型检测在宫颈癌前病变诊断中的临床应用价值.方法 选取2012年12月至2015年3月在浙江省台州医院妇科初诊的4 095例宫颈癌筛查结果为HPV阳性者作为研究对象,分析HPV型别流行病学特征及HPV阳性者的宫颈组织病理学诊断结果;Logistic回归分析高危型HPV在宫颈癌前病变进展中的风险值.结果 浙江省台州地区女性宫颈HPV感染率从高到低依次为HPV52、16、58、39和56;宫颈上皮内瘤变（Cervical intraepithlial neoplasm,CIN）女性中HPV感染率从高到低依次为HPV16、52、58、33和31.Logistic回归分析显示HPV16、33感染者致CIN2＋风险性较大,回归系数OR分别为3.670（95％ CI：2.399 -5.612,P〈0.05）、2.045 （95％CI：1.087 -3.848,P〈0.05）.CIN2＋女性中,细胞学结果为NILM：Logistic回归分析结果显示HPV16感染者致CIN2＋的风险较大,回归系数OR=2.539（95％CI：1.622 -3.976,P=0.000）;细胞学结果为意义未明的非典型鳞状细胞（Atipical squamous cells of unknown significance,ASCUS）：Logistic回归分析结果显示HPV16、58感染者发生CIN2＋的风险较大,回归系数OR分别为1.911 （95％ CI：0.530 -6.893）、1.757（95％CI：0.557 -5.548）.结论 高危HPV基因分型检测在宫颈癌前病变诊断中具有重要的临床应用价值,尤其是对宫颈细胞学阴性、ASCUS患者临床处理时的重要参考指标,更精确宫颈癌筛查风险分层.

Objective To evaluate the clinical value of high-risk humam papillomavirus （HR-HPV） genotyping in diagnosis of cervical lesions.Methods Between December 2012 and March 2015,a total of 4 095 women who were diagnosed as cervical inflammation-related disease were chosen to be evaluated in gynecological clinic at Taizhou Hospital of Zhejiang Province.All the women experienced HPV genotyping,analysis of the epidemiological characteristics of HPV types in Taizhou area and theresult of histopathologic diagnosis of HPV positive women.Logistic regression analysis was used to estimate the risk of HR-HPV gcnotyping in cervical lesion progression.Results Overall,HPV52 was the most prevalent genotype,followed by HPV16,58,39 and 56.Among the women with cervical intraepithelial neoplasm （CIN）,HPV16 was the most frequent type,followed by HPV52,58,33 and 31.Logistic regression analysis showed that a higher risk of CIN2 ＋ for women infected with HPV16 or HPV33,the regression coefficients OR were 3.670（95% CI：2.399-5.612,P 〈 0.05） and 2.045 （95% CI：1.087-3.848,P 〈 0.05）,respectively.Logistic regression analysis showed that a higher risk of CIN2 ＋ for NILM with positive HPV16,and the regression coefficients OR were 2.539（95% CI：1.622-3.976,P =0.000）;the ASCUS with positive HPV16 and 58 had higher risk of CIN2 ＋,the regression coefficients OR were 1.911 （95% CI：0.530-6.893） and 1.757 （95% CI：0.557-5.548）,respectively.Conclusions HPV genotyping has important clinical value to detect precancerous cervical lesions,especially when cervical cytology is negative,in management of patiemts with atypical squamous cells of an undertermined significance （ASCUS） or low grade squamous intraepithelial lesion（LSIL）.