医院就诊人群HPV感染的流行病学特征及其与宫颈癌/癌前病变的关系

Analysis of Epidemiological Characteristics of HPV Infection and Its Relationship with Cervical Cancer/Cervical Precancerous Lesions in Hospital Patients

目的探究医院就诊人群人乳头瘤病毒(HPV)感染的流行病学特征,并进一步探讨HPV感染与宫颈癌/宫颈癌前病变的关系。方法收集2016年9月1日至2017年4月29日期间就诊于徐州市中心医院,同时接受HPV分型定量检测的年龄14~73岁的7694名患者临床数据,其中421名接受病理学检查。按年龄将患者分为6组:<20岁,20~岁,30~岁,40~岁,50~岁,60~岁组。结果 (1)7694名就诊患者中有1637名为HPV阳性,感染率为21.28%。在不同的年龄组中,均以高危型HPV感染最为常见。(2)HPV感染率在年龄上呈V型分布,感染率较高的年龄组为60~岁组与<20岁组,分别为23.23%与33.33%,30~岁组感染率最低,为18.96%。(3)HPV多重感染中以二重感染最为多见,占多重感染患者的74.72%,感染亚型数越多,感染率越低。最常见的多重感染类型分别为:HPV16与HPV52共感染、HPV52与HPV58共感染、HPV16与HPV56共感染。(4)在校正了年龄因素后,1×104个宫颈脱落细胞中所有高危型HPV载量每升高10倍,宫颈上皮瘤变风险提高1.35倍。(5)在校正了年龄因素后,病理学分级越高,患者HPV感染可能性显著提高。结论医院就诊人群不同年龄组HPV感染率不同,低年龄组与高年龄组HPV感染率、高危型HPV感染率、多重感染率均较高。高危型HPV总载量提高,宫颈癌变风险提高且HPV感染与宫颈细胞学病变和宫颈组织学病变的发生发展呈正相关。HPV分型定量检测方法能区分更多的基因型别,能呈现给临床医生更多的参考信息,也能指导临床医生对患者进行个性化的临床管理。

Objective To investigate epidemiological characteristics of human papillomavirus infection in hospital population,and further explore the relationship between HPV infection and precancerous lesions of cervix.Methods Medical data were collected from 7694 patients aged 14 to 73 years who admitted to the Xuzhou Center Hospital and received quantitative HPV detection from September 1,2016 to April 29,2017.Totally 421 patients took pathological examination among them.All the patients were divided into 6 groups according to age（years）：20,20-,30-,40-,50-,60-groups respectively.Results（1）1637 out of 7694 patients were HPV positive,and the infection rate was 21.28%.High-risk HPV infections were most common in different age groups.（2）The HPV infection rate is V-type distribution according to age,and the age groups with high infection rate were60 group and20 group,the rate was 23.23% and 33.33%respectively.The lowest infection rate was 18.96%in30-group.（3）Superinfection was most common in HPV multiple infections,accounting for 74.72% of multiple infections,and the rate of infection decreased with the increased number of infected subtypes.The most common types of multiple infections were HPV16 and HPV52 co-infection,HPV52 and HPV58 co-infection and HPV16 and HPV56 co-infection.（4）After adjusting for the factor of age,with the number of high-risk HPV loads increased 10 times in 1×104 cervical exfoliated cells,the risk of cervical intraepithelial neoplasia was increased by 1.35 times.（5）After correction of the age factor,the patients with the higher pathological grade would be more likely to be positive for HPV.Conclusion The infection rates of HPV varied in different age groups.HPV infection rate,high-risk HPV infection rate and multiple infection rate in the young age group and the old age group are higher.The risk of cervical cancer increased with the increase of total high risk HPV load,and the infection of HPV is positively related to the development of cervical cytological lesions and cervical histological lesions.HPV genotyping method can distinguish gene subtypes,provide more information for clinicians,and help clinicians guide the patients＇ clinical management more rationally and individually.