基于潜类别模型的男男性行为人群HPV感染风险分类研究

Risk classification of HPV infection among men who have sex with men based on Latent Class Model

目的探讨潜类别模型对确定男男性行为人群(MSM)人乳头瘤病毒(HPV)感染高危人群的意义。方法2016年3月至2017年4月在乌鲁木齐市采用滚雪球法招募MSM,通过调查问卷收集包括人口学特征、性行为特征及性传播感染史和包皮环切术的信息,采集肛管内脱落细胞并使用37型HPV检测试剂盒进行分型鉴定,用潜类别模型对其进行HPV感染风险分类,根据潜类别模型Akaike信息准则(AIC)选定潜类别数3为最优模型;基于3组潜类别人群的性行为特征、性传播感染史和包皮环切术,将其命名为:HPV感染高风险组、中风险组和低风险组。结果共招募704例MSM,HPV感染高风险组(49.3%)、中风险组(26.1%)和低风险组(24.6%),其HPV感染结局在3组间的差异有统计学意义(χ^2=8.816,P=0.012)。HPV感染高风险组中自我认知性取向为同性恋的条件概率为0.803,近6个月同性性伴数2个和3个及以上的条件概率分别为0.307和0.462,有性传播感染史者和未行包皮环切术的条件概率为0.100和0.663,都高于其他两组。结论潜类别模型确定MSMHPV感染高危人群具有可行性,该人群在MSM中占一定比例且HPV感染风险最高。

Objective To identify the high-risk group of human papilloma virus (HPV) infection among men who have sex with men (MSM) using Latent Class Model. Methods MSM were recruited using snowball sampling scheme in Urumqi from March 2016 to April 2017.Information on the demographic,sexual behavioral characteristics,sexually transmitted infections (STI) history and circumcision of MSM were collected by questionnaires.Anal exfoliated cells were collected for HPV type identification using type 37 HPV test kits.Latent Class Model was used to classify the risk of HPV infection.Number of latent class 3 was chosen as the optimal model as suggested by Akaike information criterion (AIC).Three HPV infection subgroups were named as the high-risk group,the moderate-risk group and the low-risk group depending on their sexual behavioral characteristics,sexually transmitted infections history and circumcision. Results A total of 704 MSM cases were recruited including the high-risk group (49.3%),the moderate-risk group (26.1%) and the low-risk group (24.6%).HPV infection outcomes are significant differences among the three subgroups (χ^2= 8.816 , P=0.012).The conditional probability of self-reported orientation as homosexual is 0.803,having 2 and 3 or more same-sex partners in the past 6 months was 0.307 and 0.462,respectively.The conditional probability of having sexually transmitted infections history is 0.100 and no circumcision is 0.663 in high-risk group,which were higher than the other two groups. Conclusion It is possible to identify the high-risk group of HPV infection among MSM by using Latent Class Model,whom accounts for largest proportion of MSM and also has the highest rate of HPV infection.