672例宫颈癌前病变及浸润性癌患者HPV感染状况分析

HPV infection in 672inpatients with precancerous cervical lesions and invasive cervical cancer

目的探讨甘肃省肿瘤医院住院的宫颈癌前病变(cervical intraepithelial neoplasia,CIN)及浸润性宫颈癌(invasive cervical cancer,ICC)患者人乳头瘤病毒(human papilloma virus,HPV)感染情况。方法选取2016年5月—2021年9月甘肃省肿瘤医院收治住院、经宫颈活检或锥形切除、全子宫及广泛子宫切除等手术明确诊断的CIN及ICC患者为研究对象,将其术后宫颈病理石蜡切片作为检测样本,采用PCR-反向点杂交法进行HPV基因分型检测,分析CIN及ICC患者HPV感染率及感染模式、类型、基因型分布特征。结果672例患者中HPV检出率90.33%(607例);宫颈低度鳞状上皮内病变(low grade squamous intraepithelial lesion,LSIL)患者中HPV感染率69.44%,宫颈高度鳞状上皮内病变(high grade squamous intraepithelial lesion,HSIL)患者中HPV感染率87.76%,ICC患者中HPV感染率93.28%,随着宫颈病变程度的加重,HPV检出率也逐渐增加,宫颈病变程度与患者HPV感染率的关联性差异有统计学意义(r=0.225,P<0.01)。LSIL患者中HPV单一感染、双重感染、三重感染、四重感染占比分别为51.39%、15.28%、1.39%、1.39%;HSIL患者中占比分别为59.18%、18.37%、10.20%、0%;ICC患者中占比分别为75.14%、16.33%、1.81%、0%;不同宫颈病变程度的HPV感染模式总体分布差异有统计学意义(H=6.07,P=0.048)。ICC患者中鳞癌患者HPV感染率94.02%,腺癌患者HPV感染率68.75%,两组感染率比较差异有统计学意义(χ^(2)=12.058,P=0.001);不同程度宫颈病变患者HPV感染均以高危型HPV感染为主,且主要是单一高危型感染,其HPV型别占比由高到低前四位分别为HPV16、18、58、52型;在多重感染中又以双重感染为主,HPV型别占比由高到低前四位分别为HPV16/18、16/58、16/52、16/33混合型。结论HPV感染与CIN及ICC的发病密切相关,LSIL、HSIL、ICC三组患者HPV感染率、感染模式差异有统计学意义;在基因型别分布上均以16型及含16型的双重感染为主,而18、58、52在单一型感染占比中排名为第二、第三、第四位,双重感染中亦见与HPV16型的合并感染,因而除了HPV16型以外,也应该对本地区妇女18、58、52型感染状况引起重视。

Objective To understand the prevalence of human papilloma virus(HPV)infection among inpatients with precancerous cervical lesions and invasive cervical cancer in Gansu Cancer Hospital.Methods A total of 672inpatients with confirmed precancerous cervical lesions and invasive cervical cancer in Gansu Cancer Hospital from May 2016to September 2021were enrolled into the study.Postoperative cervical pathological paraffin sections were used to determine the genotype of HPV by PCR-reverse dot blot hybridization method.The prevalence of HPV infection,HPV infection pattern,HPV type and genotype distribution in patients with precancerous cervical lesions and invasive cervical cancer were analyzed.Results The overall HPV infection rate was 90.33%(607/672),and it was 69.44%in patients with low grade squamous intraepithelial lesion(LSIL),87.76%in patients with high grade squamous intraepithelial lesion(HSIL)and was 93.28%in those with invasive cervical cancer(ICC).With the progression of cervical lesions,the detection rate of HPV increased gradually,and the correlation difference between cervical lesions and HPV infection rate was statistically significant(r=0.225,P<0.01).The proportions of single,double,triple and quadruple genotype of HPV infection were 51.39%,15.28%,1.39%and 1.39%in patients with LSIL,were 59.18%,18.37%,10.20%and 0%ients with HSIL and were 75.14%,16.33%,1.81%and 0%in patients with ICC.The differences of HPV genotype distribution among patients with different cervical lesions were statistically significant(H=6.07,P=0.048).The HPV infection rate was higher in squamous-ICC cases than those with adeno-ICC(94.02%vs 68.75%;χ^(2)=12.058,P=0.001).High risk HPV infection was predominant in patients with all types of cervical lesions,and was mainly a single type of infection.The most common HPV type was HPV16,followed by HPV18,58and 52.In the multiple HPV infection,double infection was predominant,and the most common double infection was HPV16/18,followed by HPV16/58,16/52and 16/33.Conclusions HPV infection is closely related to precancerous cervical lesions and invasive cervical cancer.The HPV infection rate and genotype distribution vary significantly among patients with LSIL,HSIL and ICC.HPV16is the most common type in both single and double infection,while HPV18,58and 52are also frequent in single infection.