长沙地区60354例患者人乳头瘤病毒感染情况及亚型分析

Analysis of HPV infection and subtypes in 60354 patients in Changsha

目的分析长沙地区2020—2022年人乳头瘤病毒(HPV)感染情况、亚型分布特征,以及行阴道镜和宫颈组织病理学检查HPV阳性患者的病理组织活检结局。方法回顾性分析2020年1月至2022年10月在湖南中医药大学第一附属医院妇科门诊、健康管理科及皮肤性病科就诊的60354例患者HPV感染状况,分为<25岁组(3250例)、25~34岁组(19406例)、35~44岁组(17297例)、45~54岁组(13104例)、55~64岁组(4793例)、≥65岁组(2504例)。女性采集宫颈脱落细胞,男性采集病变部位,HPV分型检测采用PCR及流式荧光杂交法,可检测27种HPV基因分型。分析不同就诊科室、不同年龄段患者HPV亚型分布情况;分析224例HPV阳性同时进行了阴道镜和宫颈组织病理学检查的患者其HPV各亚型感染情况与病理组织活检结局的关系。相关性分析采用皮尔逊相关检验,双侧P<0.05具有统计学意义;率的组间比较采用Pearson卡方检验或连续校正卡方检验,双侧P<0.05为差异有统计学意义;多个样本率之间的比较采用卡方分割检验,根据分组数量对检验水准进行校正后再比较,双侧P小于校准后的检验水准为差异有统计学意义。结果HPV总体阳性率为16.4%(9909/60354)。在所有HPV阳性患者中,HPV单一型占75.5%(7479/9909),HPV多重型占24.5%(2430/9909)。占比从高到低前6位的HPV型别依次为52型22.8%(2256/9909)、58型11.1%(1097/9909)、53型10.5%(1045/9909)、16型9.0%(890/9909)、61型7.8%(774/9909)及6型7.6%(750/9909)。各年龄段组间总体感染率差异具有统计学意义(χ2=536.90,P<0.001),其中<25岁组HPV感染率最高,为30.1%(978/3250),均高于25~34岁组15.6%(3035/19406)、35~44岁组14.2%(2464/17297)、45~54岁组16.1%(2115/13104)、55~64岁组19.1%(915/4793)及≥65岁组16.1%(402/2504),差异均有统计学意义(P均<0.001)。皮肤性病门诊就诊患者的HPV感染最高的型别是6型16.7%(378/2266)和11型10.5%(239/2266)。HPV16在宫颈上皮内瘤变(CIN)3级及宫颈癌患者中阳性率为12/17,高于炎性改变的病例[25.0%(35/140)]和CIN1级的病例[23.0%(11/48)],统计值分别为χ^(2)=15.02,P<0.001和χ^(2)=12.48,P<0.001,差异均具有统计学意义。结论<25岁人群HPV感染率最高;低危型HPV6和11型是引起皮肤性病的主要型别。全部就诊人群中,高危型HPV52型、58型及53型是长沙地区女性最常见的感染型别,但高级别宫颈上皮内瘤变及宫颈癌与HPV16型感染更为密切。

Objective Analysis of subtype distribution characteristics of human papillomavirus(HPV)infection,pathological findings of HPV-positive patients operated colposcopy and cervical histopathological examination in Changsha from 2020 to 2022.Methods Retrospective analysis of HPV infection status of 60354 patients was treated in the First Affiliated Hospital of Hunan University of Chinese Medicine from Jan.2020 to Oct.2022.They were divided into<25 years old group(3250 cases),25-34 years old group(19406 cases),35-44 years old group(17297 cases),45-54 years old group(13104 cases),55-64 years old group(4793 cases)and≥65 years old group(2504 cases).Cervical exfoliated cells were collected from women and specimen of lesion site were collected from men.HPV genotyping detection used polymerase chain reaction(PCR)and flow fluorescence hybridization,which could detect 27 HPV genotypes.Analyze the distribution of HPV subtypes in patients of different age groups and different treatment departments.Analyze the relationship between the infection of HPV subtypes and the outcome of 224 patients with HPV positive who also underwent colposcopy and cervical histopathology.Pearson correlation test was used for correlation analysis,and two-tailed P<0.05 was statistically significant;Pearson chi-square test or continuous correction chi-square test was used to compare the rates between groups,and two-tailed P<0.05 was statistically significant;Chi-square split test was used to compare multiple sample rates.The standard test was corrected according to the number of groups and then compared.The difference was statistically significant when the two-tailed P value was less than the corrected standard test.Results The overall positive rate of HPV was 16.4%(9909/60354).Among all HPV positive patients,affection of single type HPV accounted for 75.5%(7479/9909)and affection of multi-type HPV accounted for 24.5%(2430/9909).The top six HPV types with infection rates from high to low were:HPV5222.8%(2256/9909),HPV5811.1%(1097/9909),HPV5310.5%(1045/9909),HPV169.0%(890/9909),HPV617.8%(774/9909)and HPV67.6%(750/9909).The difference of overall infection rate between different age groups was statistically significant(χ^(2)=536.90,P<0.001).The HPV infection rate was the highest in the<25 years old group,30.1%(978/3250),and it is higher than the age groups of 25-34 years old,15.6%(3035/19406),group of 35-44 years old,14.2%(2464/17297),group of 45-54 years old,16.1%(2115/13104),group of 55-64 years old,19.1%(915/4793)and group of≥65 years old,16.1%(402/2504),with statistical significance(P<0.001 respectively).The most common types of HPV infection were type 6,16.7%(378/2266)and type 11,10.5%(239/2266)in dermatology clinics.The positive rate of HPV16 accounted for 12/17 in cervical intraepithelial neoplasia(CIN)3 and cervical cancer cases,it was significantly higher than that in the inflammatory cases,25.0%(35/140)and CIN1 cases,23.0%(11/48),the statistical values wereχ^(2)=15.02,P<0.001 andχ^(2)=12.48,P<0.001,respectively,all of which were statistically significant.Conclusions HPV infection rate is highest in young people under 25 years old.Low-risk HPV6 and 11 are the main types of skin and venereal diseases.Among the total cases,high-risk HPV52,58 and 53 are the most common types of infection with women in Changsha.However,high-grade cervical intraepithelial neoplasia and cervical cancer are more closely related to HPV16 infection.