2018—2020年贵阳地区女性宫颈癌HPV、TCT及DNA倍体联合筛查结果分析

Analysis of joint detection of HPV,TCT and DNA ploidy analysis in Guiyang area,2018-2020

目的:探讨贵阳地区妇科门诊女性高危型人乳头瘤病毒(high risk human papillomavirus,hrHPV)检测、DNA倍体分析(DNA ploidy analysis)及宫颈薄层液基细胞学检查(thinprep cytologic test,TCT)联合检测结果的分布特点。方法:收集2018年5月—2020年7月共计11046例由贵州医科大学附属医院妇科门诊收治患者的病理资料。采用χ~2检验或Fisher精确检验分析hrHPV检测病例在不同TCT诊断中的分布情况,采用Kruskal-Wallis检验分析DNA倍体检测结果及年龄分段资料,并用Spearman进行相关性分析。结果:贵阳地区hrHPV总感染率为12.4%(1371/11046),其中HPV16感染率为2.3%(259/11046),HPV18和(或)HPV45感染率为0.6%(61/11046),HPV16及HPV18/45同时感染者为0.07%(8/11046),其他类型hrHPV感染率为9.5%(1051/11046)。hrHPV阳性感染患者中,未见上皮内病变或恶性病变(negative for intraepithelial lesion or malignancy,NILM)、非典型鳞状细胞-意义不明确(atypical squamous cells-unclear meaning,ASC-US)、低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)、非典型鳞状细胞-不排除高级别鳞状上皮内病变(atypical squamous cells-do not rule out high grade squamous intraepithelial lesions,ASC-H)、高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)、宫颈鳞状细胞癌(squamous cell carcinoma,SCC)和非典型性腺细胞(atypical glandular cells,AGC)所占百分比分别为74.1%、14.7%、3.5%、4.3%、0.7%、0.1%和0.1%;DNA倍体诊断为阴性、可疑阳性和阳性者分别为61.6%、17.4%和20.9%。在HSIL病例中,HPV感染率为HPV16>其他类型hrHPV>HPV18;SCC病例中,HPV感染率为HPV16>HPV18>其他类型hrHPV;NILM和LSIL病例中,hrHPV感染率则为其他类型hrHPV>HPV18>HPV16。TCT阳性率为6.5%(716/11046),其中AUS-US、LSIL、ASC-H、HSIL、SCC和AGC所占百分比分别为4.5%、0.6%、0.8%、0.4%、0.1%和0.1%。DNA倍体异常的阳性率4.2%(469/11046);DNA倍体为阳性的患者中,NILM、AUS-US、LSIL、ASC-H、HSIL、SCC和AGC所占百分比分别为10.9%、45.2%、13.4%、17.1%、9.8%、2.3%和1.3%。>40岁的女性中,hrHPV阳性率有升高趋势,≤20岁患者中hrHPV感染率较高为14.2%(高于总感染率)。TCT及DNA倍体分析阳性率随年龄升高有上升趋势。Spearman进行相关性分析提示,hrHPV、TCT及DNA倍体检测均呈正相关。结论:贵阳地区门诊女性HPV感染状况、TCT和DNA倍体检测结果存在一定的地域特点,与患者的年龄相关;本研究结果体现了贵阳地区宫颈上皮病变的流行特点,以期为本地区宫颈癌的防治策略提供一些可靠的参考依据。

Objective:To investigate the distribution characteristics of high-risk human papillomavirus(hrHPV)detection,DNA ploidy analysis and thinprep cytologic test(TCT)in female outpatient in Guiyang area.Methods:A total of 11046 cases of female outpatients from May 2018 to July 2020 in the Affiliated Hospital of Guizhou Medical University were collected.The results of hrHPVE6/E7 mRNA,TCT and DNA ploidy were analyzed in detail.The chi-square test was used to analyze the distribution of hrHPV detection cases in different TCT diagnosises,DNA ploidy detection in different TCT diagnosises,and DNA ploidy analysis in hrHPV positive patients.For the correlation between the detection results of the two methods,Spearman correlation analysis was used,and the Kruskal Wallis test was used to analyze the ordered data of DNA ploidy analysis and age group.Results:The infection rate of hrHPV was 12.4%(1371/11046)in Guiyang,among which HPV16 was 2.3%(259/11046),HPV18 and/or HPV45 was 0.6%(61/11046),HPV16 and HPV18/45 were 0.07%(8/11046),other types of hrHPV were 9.5%(1051/11046).Among the patients with positive hrHPV,negative for intraepithelial lesion or malignancy(NILM),atypical squamous cells-unclear meaning(ASC-US),low-grade squamous intraepithelial lesion(LSIL),atypical squamous cells-do not rule out high grade squamous intraepithelial lesions(ASC-H),high-grade squamous intraepithelial lesion(HSIL),squamous cell carcinoma(SCC)and atypical glandular cells(AGC)accounted for 74.1%,14.7%,3.5%,4.30%,0.7%,0.1%and 0.1%,respectively;the patients with negative DNA ploidy,suspicious positive DNA ploidy and positive DNA ploidy accounted for 61.6%,17.4%and 20.9%.HPV infection rate was HPV16>other types of hrHPV>HPV18 in HSIL cases,and HPV16>HPV18>other types of hrHPV in SCC cases.For NILM and LSIL,the infection rate of hrHPV was other types of hrHPV>HPV18>HPV16.The positive rate of TCT was 6.5%(716/11046),in which ASC-US,LSIL,ASC-H,HSIL,SCC and AGC were 4.5%,0.6%,0.8%,0.4%,0.1%and 0.1%,respectively.The positive rate of DNA ploidy abnormality was 4.2%(469/11046).In patients with positive DNA ploidy,NILM,ASC-US,LSIL,ASC-H,HSIL,SCC and AGC were 10.9%,45.2%,13.4%,17.1%,9.8%,2.3%and 1.3%.The positive rate of HPV infection in patients over 40 years old increased.Among women under the age of 20,the infection rate of hrHPV accounted for 14.2%(higher than the total infection rate).The ratio of TCT to DNA ploidy increased with age.Spearman correlation analysis showed that hrHPV detection,TCT detection and DNA ploidy detection were positively correlated.Conclusion:The results of HPV infection,TCT and DNA ploidy analysis of outpatients in Guiyang have a certain regionality and are related to age.The results of the study can provide reference for exploring the epidemiological characteristics of cervical epithelial lesions in this area and further exploring the prevention and treatment strategies of cervical cancer.