西藏林芝地区藏族女性宫颈机会性筛查高危HPV感染的特征及与子宫颈病变的关系

Characteristics of high-risk human papilloma virus infection in Tibetan women in the city of Nyingchi undergone opportunistic screening and the relationship with cervical lesions

目的研究林芝地区医院机会性筛查的藏族女性高危型人乳头瘤病毒(human papilloma virus,HPV)感染的流行病学特征,探讨藏族女性高危型HPV感染的高危因素及其与子宫颈病变的关系。方法对2019年7月10日至2020年8月31日期间就诊于林芝市人民医院妇产科且符合纳入标准的300名藏族女性进行高危HPV和宫颈薄层液基细胞学(liquidbased thinprep cytology test,TCT)检测,对其中有完整资料的252例患者数据进行分析。结果(1)林芝地区藏族女性医院机会性宫颈筛查高危型HPV感染率为36.11%,年轻女性(≤24岁)感染率最高(47.62%),随着年龄的增加,高危HPV感染率下降,40~44岁感染率最低(23.08%),随后感染率有上升趋势,年龄≥55岁者感染率达第二小高峰(39.53%),藏族女性高危HPV感染率呈双峰现象。TCT的阳性率为23.81%,45~49岁TCT阳性率最低(11.11%)。35~54岁年龄段高危HPV感染率及TCT阳性率处于相对低值,但子宫颈高级病变(high squamous intraepithelial lesion,HSIL/宫颈癌)率处于相对高值,检出率为5.08%。(2)城市居住(OR=5.114,95%CI 1.72~15.2;P=0.003)和多个性伴侣(OR=15.06,95%CI 4.32~52.53;P<0.001)为高危HPV感染的独立危险因素。(3)本研究中藏族女性通过机会性宫颈筛查筛出低度鳞状上皮内瘤样病变(low squamous intraepithelial lesion,LSIL)患者23例(9.13%),筛出HSIL患者7例(2.78%),筛出宫颈癌2例(0.79%)。其中LSIL患者中,16型、18型HPV感染率为13.04%,其他高危HPV感染率为82.61%,TCT阳性率为56.52%;HSIL患者中,高危HPV感染率为100%,其中16型、18型HPV感染率为77.78%,其他高危HPV感染率为22.22%,TCT阳性率为77.78%。结论西藏林芝地区藏族女性经过机会性宫颈筛查发现存在较高的高危HPV感染率,与近年来林芝地区城市化及多个性伴侣有关,≤24岁和≥55岁为高危HPV感染的高峰年龄。藏族女性高危HPV感染,特别是16型、18型HPV感染与宫颈病变密切相关。

Objective To study the epidemiological characteristics of high-risk human papilloma virus(HPV)infection in Tibetan women undergone opportunistic screening in Nyingchi City People’s Hospital,and to explore the high-risk factors of high-risk HPV infection in Tibetan women and itsrelationship with cervical lesions.Methods300 Tibetan women were performed High-risk HPV andcervical thin layer cytology test(TCT)in the Department of Obstetrics and Gynecology,Nyingchipeople’s Hospital from July 10,2019 to August 31,2020,and the data of 252 patients withcomplete data were analyzed.Results(1)The high-risk HPV infection rate of opportunistic cervicalscreening in Tibetan women from Nyingchi city was 36.11%,and the infection rate of young women(≤24 years old)was the highest(47.62%).With the increase of age,the high-risk HPV infectionrate decreased,and the infection rate of women aged 40~44 was the lowest(23.08%).Then theinfection rate tended to rise,and the infection rate of women aged≥55 years old reached a secondsmall peak(39.53%).The high-risk HPV infection rate of Tibetan women from Nyingchi city showed adouble peak phenomenon.The positive rate of TCT was 23.81%,and the positive rate of TCT inwomen aged 45~49 was the lowest(11.11%).The high-risk HPV infection rate and TCT positive ratein the age group of 35~54 years were relatively low,but the rate of advanced cervical lesions[highgrade squamous intraepithelial neoplasia(HSIL)or cervical cancer]was relatively high,with thedetection rate of 5.08%(6/252).(2)Urban residents(OR=5.114,95%CI 1.72~15.2;P=0.003)and multiple sexual partners(OR=15.06,95%CI 4.32~52.53;P<0.001)were independent riskfactors for high-risk HPV infection.(3)In this study,23 cases(9.13%)of low-grade squamousintraepithelial neoplasia(LSIL),7 cases(2.78%)of HSIL and 2 cases(0.79%)of cervical cancerwere screened out by opportunistic cervical screening.Among the patients with LSIL,the infectionrate of type 16 or 18 HPV was 13.04%,the infection rate of other type high-risk HPV was 82.61%,and the positive rate of TCT was 56.52%;Among patients with advanced cervical lesions,theinfection rate of high-risk HPV was 100%,of which the infection rate of type 16 or 18 HPV was77.78%,the infection rate of other type high-risk HPV was 22.22%,and the positive rate of TCT was77.78%.ConclusionsTibetan women in Nyingchi city have a high rate of high-risk HPV infectionafter opportunistic cervical screening,which is related to the urbanization of Nyingchi in recent yearsand multiple sexual partners.The peak age of high-risk HPV infection is≤24 years old and≥55 years old.High-risk HPV infection in Tibetan women,especially with type 16 or 18 HPV infection,is closely related to cervical lesions.