海南省普通人群宫颈HPV感染及临床信息分析

Analysis of cervical human papillomavirus infection and clinical information in general population in Hainan Province

目的了解评估海南普通人群的人乳头瘤病毒(HPV)感染情况及其相关的流行病学信息。方法采集2015年1月至2016年5月海南省19个市县5 959例普通人群宫颈脱落细胞,进行HPV分型检测,同时进行问卷调查收集相关信息。结果有5 959名女性纳入研究,总HPV检出率12.72%。检出的高危型别依次为HPV52(187例)、HPV16(98例)、HPV58(80例)、HPV39(59例)、HPV18(56例)、HPV66(44例)、HPV68(36例)、HPV51(29例)、HPV53和HPV56(20例)、HPV59和HPV33(16例)、HPV45(12例)、HPV31(10例)、HPV82(6例)、HPV35(4例)、HPV73(1例)。不同年龄段中HPV阳性率有显著性差异(χ~2=48.15,P=0.005),>60岁年龄段的HPV阳性率最高(22.73%),其次为20~30岁年龄段(17.84%)。不同职业中HPV阳性率有显著性差异(χ~2=9.59,P=0.025),以无业人员HPV阳性率最高(14.17%)。在参检人群的民族中,除外HPV检测阴性的少数民族,汉族人群的HPV感染率高于黎族人群(χ~2=41.19,P=0.005)。不同生育胎次之间HPV阳性率有显著性差异(χ~2=85.29,P=0.005),生育胎次多者HPV感染率较胎次少者为低。参检者的受教育程度与HPV感染率有一定关系,既文化程度较高者HPV感染率要小于文化程度低者(χ~2=97.81,P=0.005)。不同避孕方法中HPV阳性率有显著性差异(χ~2=92.81,P=0.005),输卵管结扎者的HPV感染率最低。在宫颈外观上,宫颈柱状上皮是否有异位及异位范围的大小与HPV感染无明显相关性(χ~2=7.15,P=0.100)。结论该地区人群总HPV阳性率不高,黎族则更低,文化程度高及30~60岁年龄段者的HPV阳性率较低,人们对宫颈癌早期筛查知晓率较低。

Objective To understand and evaluate the human papillomavirus （HPV） infection and related epidemiological information in general population in Hainan. Methods Cervical exfoliative cells of 5 959 general people in 19 cities and counties in Hainan Province were collected for HPV genotyping detection. Meanwhile the relevant information was collected by questionnaire survey. Results In 5 959 women enrolled in this study, the total HPV positive rate was 12.72%, and the high-risk types detected were 52 （187 cases）, 16 （98 cases）, 58 （80 cases）, 39 （59 cases）, 18 （56 cases）, 66 （44 cases）, 68 （36 cases）, 51 （29 cases）, 53/56 （20 cases）, 59/33 （16 cases）, 45 （12 cases）, 31 （10 cases）, 82 （6 cases）, 35 （4 cases） and 73 （1 case）. There were significant differences in HPV positive rates among women with different age （χ^2= 48.15, P = 0.005）. The women older than 60 years were of the highest positive rate （22.73%） followed by the women whose age were between 20 and 30 （17.84%）. There were significant differences in HPV positive rate among women with different occupations （χ^2= 9.59, P = 0.025）, and the unemployed women had the highest HPV positive rate （14.17%）. Among the enrolled women in different nationalities, besides some minorities with HPV negative rate, the HPV infection rate of women in Han nationality was higher than that of Li nationality （χ^2 =41.19, P=0.005）. There was significant difference in HPV positive rate among women with different number of children （χ^2= 85. 29, P =0.005）, and the HPV infection rate of women with many parity was lower than that of women with few children. The HPV infection rate was related to the educational level of the enrolled women, and the infection rate of women with higher educational level was lower than that of women with lower educational level （χ^2=97.81, P=0.005）. Significant difference was found in HPV positive rate among women adopting different contraceptive methods （χ^2 = 92.81, P =0.005） and the women adopting tubal ligation had the lowest HPV infection rate. In the appearance of cervix, there was no significant correlation between the ectopic cervix columnar epithelium and the size of the ectopic area and the HPV infection （χ^2= 7.15, P =0.100）. Conclusion In this area the total HPV positive rate of women is not high, and that of women in Li nationality is lower. Women with high educational level and those aged 30 - 60 years old have lower HPV positive rate. However, people in this area are of low awareness of early screening for cervical cancer.