北京市宫颈癌筛查妇女中高危型HPV感染状况及在宫颈癌前病变中的分布

Prevalence of high-risk HPV and its distribution in cervical precancerous lesions among 35-64 years old women who received cervical cancer screening in Beijing

目的 了解北京市宫颈癌筛查妇女中感染高危型HPV感染状况及在宫颈癌前病变中的分布.方法 2014年1月至2015年3月,以前往北京市宫颈癌筛查机构接受宫颈癌免费筛查的35-64岁妇女为研究对象,采用分层整群随机抽样法,从中抽取31091名妇女,接受妇科检查、高危HPV分型检测,其中HPV16/18型以外的其他高危型阳性者接受宫颈细胞学检测;HPV16/18型阳性者、宫颈细胞学检测不明意义的非典型鳞状细胞（ASCUS）及以上者,妇科宫颈检查发现可疑异常者转诊阴道镜检查,阴道镜检查结果可疑或异常者进行组织病理学检查.分析不同特征研究对象高危型HPV感染情况、宫颈癌及癌前病变检出率.结果 31091名研究对象的年龄分布为35-64岁,35-49岁年龄组人数占44.3%（13780名）,50-64岁年龄组人数占55.7%（17311名）;农村妇女占66.1%（20536名）.高危型HPV总感染率为7.4%（2305例）,其他高危型感染率为5.7%（1758例）,混合感染检出率为1.5%（477例）.45-49、50-54岁者的感染率较高,为7.8%（463例）、7.9%（1044例）（χ2=14.07,P=0.015）.城市妇女高危型HPV感染率为6.2%（507例）,农村妇女为7.9%（1798例）（χ2=25.75,P〈0.001）.HPV16型感染者占17.0%（391例）,HPV18型占6.9%（161例）,HPV52型、HPV51型、HPV58型感染者分别占8.6%（20例）、5.2%（12例）、7.7%（18例）.宫颈癌及癌前病变检出率为395.6/10万（123例）.在高级别病变中,HPV16和18型感染占60.5%（72例）.50-54岁者HPV16型感染率及高级别病变检出构成比均较高,分别为（1.5%,107例）（χ2=11.54,P=0.042）.结论 北京市35-64岁妇女常见高危型HPV感染型别依次为HPV16、18、52、51和58型.HPV16和18型在高级别病变中的感染率较高.50-54岁者HPV16型感染率及高级别病变检出率较高.

Objective To study the prevalence of high-risk HPV （HR HPV） in women who accepted cervical cancer screening in Beijing and its distribution in cervical precancerous lesions. Methods From January 2014 to March 2015,all women aged 35-64 years old and received free screening in institutions of cervical cancer in Beijing were recruited. Stratified cluster random sampling method was used in selecting 31 091 women for gynecological examination and genotyping of HR-HPV.Those positive for HR-HPV（except for HPV 16/18）were examined for cervical cell.For those atypical squamous cells of uncertain significance（ASCUS）and above,who were positive for HPV 16/18 and with uncertain results for cervical cell,were transferred for colposcopy examination.For those with suspicious or abnormal results for colposcopy, were transferred for histopathology. The prevalence of HR-HPV, cervical cancer and precancerous lesions among the participants were analyzed. Results Totally 31 091 women aged from 35-year-old to 64-year-old,with 44.3%（13 780 women）in the 35-49 age group and 55.7%（17 311 women） in the 50-64 age group.66.1%（20 536 women）were rural women.The infection rate of HR-HPV was 7.4%（2 305 cases） among the women. High-risk infection rates of HPV except HPV 16/18 were 5.7% （1 758 cases）, and multi-infection rate was 1.5% （477 cases）. The highest infection rate was 7.9% （1 044 cases） among the 45-49 year-old and 50-54 year-old age groups（χ2=14.07,P=0.015）.The rate in rural women was significantly higher than that of the urban women（6.2%,507 cases;7.9%,1 798 cases）（χ2=25.75,P〈0.001）. The proportion of HPV16,HPV18,HPV52,HPV51,HPV58 was 17.0%（391 cases）,6.9%（161 cases）,8.6% （20 cases）, 5.2% （12 cases） and 7.7% （18 cases）, respectively. The detection rate of cervical cancer and precancerous lesions in the population was 395.6/100 000 （123 cases）. In high-grade squamous intraepithelial lesions （HSIL）, HPV16 and 18 infections accounted for 60.5% （72 cases） of all. HPV16 infection rate and detection rate of HSIL were the highest in 50-54 year-old group which were 1.5%（107 cases） and 25.2% （30 cases） （χ2=11.54, P=0.042）. Conclusion Top five types of HR-HPV infection in women who accepted cervical cancer screening in Beijing were HPV16,18,52,51 and 58.The infection rate of HPV16 and 18 increased significantly in HSIL women.HPV16 infection rate and detection rate of HSIL were the highest in 50-54 year-old age group.