摘要
目的高危型人乳头瘤病毒(HR-HPV)的持续感染是鳞状细胞宫颈癌(SCC)发病的首要因素,并且是进展为高级别鳞状上皮内病变(HSIL)的先决条件。一些性传播疾病病原体可能起到人乳头瘤病毒(HPV)共因子的作用。方法选取2017年8月至2018年3月在南京同仁医院参加宫颈癌筛查项目及接受阴道镜检查的420例患者作为研究对象。应用多重聚合酶链式反应技术同时检测淋球菌、阴道毛滴虫、单纯疱疹病毒1型(HSV-1)、单纯疱疹病毒2型(HSV-2)、梅毒螺旋体等在不同宫颈细胞学检查结果中与HPV的共感染率。结果在HR-HPV和淋球菌合并感染的情况下,未明确意义的非典型鳞状上皮细胞及更高级别上皮细胞病变(≥ASC-US)的发生风险增加[相对危险度(RR)3.338,95%置信区间(CI)2.453-4.542,P<0.005],且主要为HSIL(RR 6.242,95%CI 2.901-13.433,P<0.005)。HPV与HSV-2共感染仅表现出发生≥ASC-US的风险增加(RR 3.248,95%CI 2.306-4.575,P<0.005),而不增加发生HSIL的风险(RR 1.639,95%CI 0.260-10.332,P=0.478)。结论淋球菌是与HR-HPV相关的主要病原体,两者共感染提高了所有级别宫颈异常发生的风险,尤其是HSIL。提示其在宫颈病变进展中可能起到与HPV的协同作用。HSV-2与HPV的共感染仅增加了发生≥ASC-US的风险。提示其对于细胞的初始转化是必要条件,但并非SCC进展的必要条件。
Objective Persistent infection of high-risk human papillomavirus(HR-HPV) is the primary cause of squamous cell carcinoma(SCC) and a prerequisite for progression to high-grade squamous intraepithelial lesions(HSIL). Some pathogens of sexually transmitted diseases may be co-factors of human papillomavirus(HPV). Methods A total of 420 cases who underwent in the cervical cancer screening program and received colposcopy were selected in Nanjing Tongren Hospital from August 2017 to March 2018. The co-infection rates of Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus type 1(HSV-1), herpes simplex virus type 2(HSV-2) and Treponema pallidum with HPV were detected by multiplex polymerase chain reaction. Results In the cases of HR-HPV and Neisseria gonorrhoeae co-infection, the risk of atypical squamous cells of undetermined significance or higher grade lesions(≥ASC-US) was increased [relative risk(RR) 3.338, 95% confidence interval(CI) 2.453-4.542, P<0.005], mainly HSIL(RR 6.242, 95%CI 2.901-13.433, P<0.005). In the cases of HPV and HSV-2 co-infection, there was an increased risk of ≥ASC-US(RR 3.248, 95%CI 2.306-4.575, P<0.005), and no increased risk of HSIL(RR 1.639, 95%CI 0.260-10.332, P=0.478). Conclusions Neisseria gonorrhoeae is the main pathogen associated with HR-HPV. Their co-infection increases the risk of cervical abnormalities at all levels, especially HSIL, suggesting that Neisseria gonorrhoeae may be a co-factor with HPV in the progression of cervical lesions. The co-infection of HSV-2 and HPV only increases the risk of ≥ASC-US, suggesting that HSV-2 is necessary for initial cell transformation, but not necessary for SCC progression.
作者
万彬
陈静
童华诚
王德望
WAN Bin;CHEN Jingi;TONG Huacheng;WANG Dewang(Department of Gynecology,Nanjing Tongren Hospital to School of Medicine of Southeast University,Nanjing 211100,Jiangsu,China;Laboratory Department,Nanjing Tongren Hospital to School of Medicine of Southeast University,Nanjing 211100,Jiangsu,China;Department of Pathology,Nanjing Tongren Hospital to School of Medicine of Southeast University,Nanjing 211100,Jiangsu,China)
出处
《中国性科学》
2019年第9期132-136,共5页
Chinese Journal of Human Sexuality
关键词
宫颈癌
人乳头瘤病毒
共因子
性传播疾病
高级别鳞状上皮内病变
Cervical cancer
Human papillomavirus(HPV)
Co-factor
Sexually transmitted disease(STD)
High-grade squamous intraepithelial lesion(HSIL)