宫颈病变中人乳头瘤病毒基因型分布研究

Study of human papillomavirus genotypes distribuiton in cervical lesions

目的研究不同宫颈病变中人乳头瘤病毒(HPV)基因型的分布特点,探讨HPV感染与宫颈病变的临床关系。方法以病理诊断为金标准,选取我院2014年10月至2017年12月宫颈病变患者300例,其中慢性宫颈炎45例,宫颈上皮内瘤变(CIN)Ⅰ74例,CINⅡ65例,CINⅢ68例,宫颈癌48例。采用PCR-反向点杂交法检测HPV基因型别。结果 300例患者总体HPV阳性率为87.33%(262/300),CINⅠ、CINⅡ、CINⅢ和宫颈癌各组HPV阳性率分别为91.89%、95.38%、97.06%和95.83%,高于慢性宫颈炎组的44.44%,差异具有显著性统计学意义(P<0.01),但HPV阳性率在CINⅠ、CINⅡ、CINⅢ及宫颈癌各组间差异并无统计学意义(P>0.05)。单一HPV感染率在慢性宫颈炎、CINⅠ、CINⅡ、CINⅢ、宫颈癌组分别为37.78%、63.51%、69.23%、70.59%和81.25%,高危型HPV(HR-HPV)检出率在慢性宫颈炎、CINⅠ、CINⅡ、CINⅢ、宫颈癌组分别为33.33%、71.62%、80.00%、92.65%及95.83%,五组的单一HPV感染率及HR-HPV检出率比较,差异均有显著性统计学意义(P<0.01);且HR-HPV感染率随着慢性宫颈炎、CINⅠ、CINⅡ、CINⅢ及宫颈癌的病理组织学诊断升级而升高。宫颈癌及癌前病变中,在HPV阳性者共检出25种亚型:高危亚型15种,3种疑似高危型,低危亚型7种;其中低危亚型HPV6、61、83型未检出;居前5位的HR-HPV基因亚型别为HPV16(23.60%)、52(16.57%)、58(13.76%)、18(8.99%)、33(4.21%)型。结论宫颈病变与HPV感染密切相关,以单一HPV感染和HR-HPV感染最常见,HPV16、52、58、18和33型在深圳地区最常见。HPV分型检测有利于宫颈病变的早期诊治,为判断宫颈病变程度以及宫颈癌防治提供参考依据,具有重要的临床应用价值。

Objective To study the distribution characteristics of human papillomavirus（HPV） genotypes in different cervical lesions, and to explore the clinical relationship between HPV infection and cervical lesions. Methods According to the golden standard of pathological diagnosis, 300 patients with cervical lesions in our hospital from October 2014 to December 2017 were selected, including 45 cases of chronic cervicitis, 74 cases of cervical intraepithelial neoplasia（CIN） Ⅰ, 65 cases of CIN Ⅱ, 68 cases of CIN Ⅲ and 48 cases of cervical cancer. PCR-reverse dot blot was used to detect HPV genotypes. Results The overall HPV positive rate of 300 patients was87. 33 %（ 262/300）, and the positive rates in the CIN Ⅰ, CIN Ⅱ, CIN Ⅲ and cervical cancer group were 91.89%,95.38%, 97.06% and 95.83% respectively, which were significantly higher than 44.44% in the chronic cervicitis group, and the differences were statistically significant（ P〈0.01）. But there were no significant differences in the positive rates among the CINⅠ, CINⅡ, CINⅢ and cervical cancer group（P〈0.05）. The single HPV infection rates in the chronic cervicitis, CIN Ⅰ, CINⅡ, CINⅢ and cervical cancer group were 37.78%, 63.51%, 69.23%, 70.59% and81.25% respectively; the detection rates of high-risk HPV（HR-HPV） in the chronic cervicitis, CIN Ⅰ, CINⅡ, CINⅢand cervical cancer group were 33.33%, 71.62%, 80.00%, 92.65% and 95.83% respectively; there were significant differences in the single HPV infection rate and HR-HPV detection rate among the 5 groups（ P〈0.01）. With the promotion of histopathological diagnosis about chronic cervicitis, CIN Ⅰ, CIN Ⅱ, CIN Ⅲ and cervical cancer, the HR-HPV infection rates increased. In cervical cancer and precancerous lesions, a total of 25 subtypes were detected in HPV positive patients, including 15 high-risk subtypes, 3 suspected high-risk subtypes and 7 low-risk subtypes.Among them, the low-risk subtypes of HPV 6, 61 and 83 were not detected and the top five of HR-HPV genotypes were HPV 16（23.60%）, 52（16.57%）, 58（13.76%）, 18（8.99%） and 33（4.21%）. Conclusion Cervical lesions are closely related to HPV infection, with single HPV infection and HR-HPV infection being the most common and HPV16, 52, 58, 18 and 33 are the most common HR-HPV genotypes in Shenzhen. HPV type detection is beneficial to the early diagnosis and treatment of cervical lesions and provides a reference for judging the degree of cervical lesions and cervical cancer prevention and treatment, which has important clinical value.