医院机会性筛查人群高危型人乳头瘤病毒感染患者病毒自然清除的流行病学研究

Clearance of High Risk Human Papillomavirus in Population of Hospital Opportunistic Screening: An Epidemiologic Study

目的研究医院机会性筛查人群高危型人乳头瘤病毒(HR-HPV)感染患者病毒自然清除的规律、特征及其影响因素。方法采用描述性纵向随访研究的方法对2013年3月1日至2015年12月31日就诊于首都医科大学附属北京朝阳医院妇科门诊HR-HPV阳性患者随访观察,随访时间6~33个月。应用病毒自然消退曲线的拟合曲线计算HR-HPV各亚型持续感染时间及持续感染比率。Kaplan-Meier生存分析估计病毒自然清除时间及病毒自然消退曲线,Cox比例风险回归分析病毒自然清除及持续性感染的相关因素。结果该医院机会性筛查人群中HR-HPV感染患者病毒自然清除曲线特征:1年内病毒快速自然清除,持续感染率快速下降,12~14个月后病毒自然清除比例明显降低,大部分1年内不能自然清除的患者呈持续感染状态。除HPV45型外,各亚型病毒自然清除曲线特征相近,但各亚型持续感染时间及持续感染比率不同。持续感染时间与病毒在筛查人群中的感染率呈正相关。各亚型HR-HPV感染患者感染状态的构成比不同,HPV31、HPV33、HPV35感染率低,但感染后病毒自然清除比率低,持续感染比例高。Cox比例风险回归模型示:感染时年龄、多病毒混合感染及病毒载量是病毒自然清除的影响因素(P<0.05),感染时年龄是病毒持续感染的影响因素(P<0.01)。结论医院机会性筛查人群各亚型HR-HPV感染患者的自然清除具有确切的规律和特征,患者年龄是影响病毒的自然清除及持续性感染的主要因素。

Objective To study the regularity,characteristics and influencing factors of high-risk human papillomavirus（ HR-HPV） infected population from hospital opportunistic screening. Methods Descriptive longitudinal follow-up study was employed. Between Mar. 1 st,2013 and Dec. 31 st 2015,the HR-HPV patients were followed up for 6-33 months. The continuous infection time and persistent infection rate of each subtype of HR-HPV were calculated by fitting the curve of the natural virus regression curve. Kaplan-Meier curves were performed to estimate the time to HPV clearance. The Cox proportional-hazards regression model methods was used to estimate the association between all independent variables with the response variable. Results The natural clearance curve of HR-HPV infected patients in this hospital has the following features： the natural clearance rate of virus declined rapidly in 1 year,the rate of continuous infection decreased rapidly,and the natural clearance ratio of the virus decreased significantly after 12-14 months,and most of the patients showed a continuous infection state whose virus could not be naturally removed within 1 year. Except for type HPV45,the natural clearance curves of all subtypes of virus were similar,but the duration of infection and the continuous infection rate of different subtypes were different. The duration of persistent infection was positively correlated with the infection rate of the virus in the screening population. The infection status of the subtype HR-HPV infected patients was different： the infection rate of HPV31,HPV33 and HPV35 was low,but the natural clearance rate of the virus after infection was low and the proportion of persistent infection was high. The Cox proportional risk regression model showed that the age of infection,mixed infection of the virus and viral load were the factors affecting the natural clearance of the virus（ P〈0. 05）. The age of the infection was the influencing factor of the persistent infection（ P〈0. 01）. Conclusion The natural clearance of HR-HPV infection has shown some definite features. The age is the major factor influencing the natural clearance of HR-HPV and persistence infection.