高危型HPV载量与宫颈细胞学病变相关性分析

Analysis of correlations between high risk human papillomavirus loads and cervical cytology lesions

目的通过高危型人乳头状瘤病毒(HR-HPV)载量与不同宫颈细胞学病变相关性分析,进一步研究病毒载量在HR-HPV阳性女性中的分流作用。方法选取2016年1月至2018年9月济南金域医学检验中心接检的6337例宫颈细胞学和HR-HPV双检测进行宫颈癌筛查女性作为研究对象。回顾性分析4431细胞学判读为无上皮内病变或恶性病变(NILM),1284例细胞学判读为低级别鳞状上皮内病变(LSIL),622例判读为高级别鳞状上皮内病变(HSIL)和鳞状细胞癌(SCC)(≥HSIL)女性与高危型HPV病毒载量间的相互关系。结果HR-HPV阳性率在NILM、LSIL和≥HSIL中分别为6.3%、83.5%和92.4%,呈明显增高趋势,差异具有统计学意义(P<0.001)。HR-HPV阳性的NILM和细胞学检查异常(LSIL和≥HSIL组)女性在低、中和高病毒载量组中的分布趋势差异具有统计学意义(P<0.001)。低、中和高载量组中,HR-HPV阳性的NILM女性呈明显降序排列,差异具有统计学意义(P<0.001),而LSIL和≥HSIL女性呈明显升序排列,差异具有统计学意义(P<0.001),但LSIL和≥HSIL女性分布差异无统计学意义(P=0.625)。同时,HR-HPV阳性LSIL和≥HSIL组的平均病毒载量,在<30岁组、30岁~49岁组、≥50岁组和总人群中,均要明显高于NILM组(均P<0.05),但LSIL和≥HSIL组间均无明显差异(均P>0.05)。结论不同病毒载量对区分细胞学筛查正常者和异常者有较好价值,但对LSIL和≥HSIL病变区分无意义。

Objective To analyze the correlations between high risk human papillomavirus(HR-HPV)loads and different cervical cytology lesions,in order to provide further evidence for the triage of HR-HPV loads in HR-HPV-positive females.Methods 6337 women received cervical cytology and HR-HPV detection for cervical cancer screening in Jinan KingMed Diagnostics from January 2016 to September 2018 were selected.The correlations were documented and retrospectively analyzed between HR-HPV loads and different cervical cytology results in 4431 cases with negative for intraepithelial lesions or malignancy(NILM),1284 cases with low grade squamous intraepithelial lesions(LSIL),and 622 cases with high grade squamous intraepithelial lesions(HSIL)or squamous cell carcinomas(SCC)(≥HSIL).Results HR-HPV infections increased significantly in NILMs,LSIL and≥HSIL lesions(P<0.001),with positive rates of 6.3%,83.5%and 92.4%,respectively.HR-HPV positive NILMs and cytological abnormalities(LSILs and≥HSILs)showed significantly different distribution trends in low,medium and high viral load groups(all P<0.001),with a descending order in the NILMs(P<0.001),but an obviously ascending trend in both LSILs and≥HSILs(P<0.001).However,no significant differences were observed in the distribution of LSILs and≥HSILs in all viral load groups(P=0.625).The average viral loads of the LSILs and≥HSILs in HR-HPV positive females were significantly higher than those in the NILMs(all P<0.05),but no statistically significant difference was found between the LSILs and≥HSILs in<30-year-old group,30-49-year-old group,over 50-year-old group and the total population(all P>0.05).Conclusions Viral loads can effectively differentiate normal and cytological abnormalities,but not between the LSIL and≥HSIL lesions.