某医院4084例妇科门诊患者HPV感染特征分析

Characteristics of HPV infection among 4084 gynecological outpatients

目的调查不同年龄女性人乳头瘤病毒(human papillomavirus,HPV)感染亚型的分布及其与宫颈病变的关联。方法将2015年1月至2020年6月于我院就诊,行阴道镜病理检查和HPV分型检测的4084例患者进行横断面研究。根据年龄分为5组,根据病理结果分为6组:宫颈炎、CINⅠ、CINⅡ、CINⅢ、宫颈原位癌、宫颈癌(cervical cancer,CC)组。采用χ2检验比较组间差异,分析HPV感染的总体状况及不同年龄组中阳性检出率、亚型分布、单一和多重基因亚型感染的差异,比较不同年龄组的HPV多重基因亚型感染情况。采用Spearman相关性分析比较不同年龄组和不同宫颈病变组中的HPV感染和亚型分布特征和不同宫颈病变在各年龄组的分布情况。结果4084例患者中,HPV阳性检出率为93.24%,且不同年龄组的阳性检出率存在差异(χ^(2)=11.400,P=0.022);单一基因亚型感染占比64.67%,单一和多重基因亚型感染在不同年龄组间的差异具有统计学意义(χ^(2)=70.736,P<0.001);检出的23种HPV亚型中,检出率前5的亚型是HPV16(31.88%)、HPV52(25.20%)、HPV58(14.57%)、HPV18(11.12%)和HPV51(7.81%);在不同宫颈病变组间,阳性检出率的差异具有统计学意义(P<0.05)。宫颈癌中,感染最多的亚型是HPV16、HPV18、HPV52、HPV58和HPV33。Spearman相关性分析表明年龄和宫颈病变相关性显著(r=0.051,P=0.001),各年龄组中CC检出率分别是0.29%(18~29岁),1.08%(30~39岁),3.52%(40~49岁),4.09%(50~59岁),10.37%(60~82岁)。结论HPV16、HPV52、HPV58和HPV18在妇科就诊女性中是易感染的基因亚型;宫颈癌的发生与HPV16和HPV18感染存在相关性,>40岁女性的宫颈癌风险显著偏高,且随年龄增加,就诊女性宫颈癌检出率也随之增大。

Objective To investigate the distribution of human papillomavirus(HPV)subtypes in women with different age and analyze the relationship between HPV and cervical lesions.Methods A cross-sectional study was conducted on 4084 patients who underwent colposcopy for pathological examination and HPV genotyping assay in our hospital from January 2015 to June 2020.The patients are classified into 5 groups in respect to the age and 6 groups(the cervicitis,CINⅠ,CINⅡ,CINⅢ,cervical carcinoma in situ and cervical cancer groups)in respect to pathological results respectively.Chi-square test was used to analyze the difference among groups mentioned and to analyze the overall situation of HPV infection,the positive rate of detection of HPV,subtype distribution,infection with single and multiple HPV genotypes among different age groups.Spearman’s correlation analysis was used to analyze distribution characteristics of HPV subtypes infection and cervical lesion among different age groups.Results The positive rate of HPV was 93.24%(3808/4084)different in 5 age groups(Chi-square=11.400 P=0.022).The single subtype infection accounted for 64.67%,and the difference of single subtype infection and multiple subtypes infection was statistically significant among different age groups(Chi-square=70.736,P<0.001).HPV16(31.88%)、HPV52(25.20%)、HPV58(14.57%)、HPV18(11.12%)and HPV51(7.81%)were the top 5 among 23 subtypes of HPV detected.The distribution difference of positive rate of HPV was statistically significant among different lesion groups(P<0.05).In the cervical cancer group,most patients were infected with HPV16,HPV 18,HPV 52,HPV 58,and HPV 33.Spearman’s correlation analysis showed there was a significant correlation between age and cervical lesions(r=0.051,P=0.001).Positive rate of cervical cancer were 0.29% in age 18~29,1.08% in 30~39,3.52%in age 40~49,4.09% in age 50~59 and 10.37%in age 60~82.Conclusion HPV16,HPV 52,HPV 58 and HPV 18 are the most prevalent subtypes among 4084 patients.HPV16 and HPV18 are relevant with cervical cancer.The risk of cervical cancer is significantly higher for women older than 40.The positive rate of cervical cancer increases with the age.