宫颈病变患者高危HPV感染筛查方法及应用

Screening methods of high-risk HPV infection among cervical lesion patients and their application

目的探究宫颈病变患者高危人乳头瘤病毒(HR-HPV)感染筛查方法及应用.方法选择2018年6月-2020年12月解放军总医院第一医学中心妇产科诊治的1405例宫颈病变患者为研究对象,分析不同程度宫颈病变患者的HR-HPV感染分布情况,单一型、混合型HR-HPV感染、DNA拷贝量情况,探讨各种筛查策略的有效性.结果宫颈癌病变患者中炎症613例、低度鳞状上皮内病变(LSIL)461例、高度鳞状上皮内病变(HSIL)311例、宫颈癌(CC)20例.最易导致宫颈病变的HR-HPV感染分型为:82、31、16、68、39、33、35、18;宫颈癌与癌前病变患者易感的HR-HPV分型略有不同:CC组为HPV16、18,癌前病变组为HPV16、58、52、51、31、58、66.在单一型HR-HPV感染中,HPV31、16、52、58、56、18与宫颈病变发生的相关性更高;当DNA拷贝量≥10E4时宫颈病变发生风险升高.在混合HR-HPV感染中,含16、18任两种亚型混合感染组的HSIL及以上占比高于任两种亚型混合感染不含16、18组(P<0.05).单独采用HR-HPV感染筛查的病理阳性率和病理HSIL+占比与单独采用TCT相当,二者联合筛查并未增加病理阳性检出的敏感度,而联合DNA拷贝量将增加筛查敏感度.结论以HR-HPV分型感染联合DNA拷贝量检测为主的宫颈病变筛查策略是有效的,应注意将不同型别HR-HPV感染与病变的关系纳入临床建议参考.

OBJECTIVE To explore the screening methods of high-risk human papillomavirus(HR-HPV)infection among the patients with cervical lesions and observe their application.METHODS A total of 1405 patients with cervical lesions who were treated in obstetrics and gynecology department of the First Medical Center of Chinese PLA General Hospital from Jun 2018 to Dec 2020 were recruited as the research subject.The distribution of the patients with HR-HPV infection among the cervical lesion patients,single type,mixed types of HR-HPV infections and DNA copies were observed.The effectiveness of the screening strategies was explored.RESULTS Among the enrolled patients with cervical lesions,613 had inflammation,461 had low-grade squamous intraepithelial lesion(LSIL),311 had high-grade squamous intraepithelial lesion(HSIL),and 20 had cervical cancer(CC).The HR-HPV 82,31,16,68,39,33,35 and 18 were the genotypes that were most likely to lead to cervical lesions.There was slight difference in the HR-HPV genotype between the CC patients and the precancerous lesion patients:HPV16 and HPV18 genotypes for the CC group;HPV16,58,52,51,31,58 and 66 genotypes for the precancerous lesion group.Among the patients with single genotype of HR-HPV infection,the occurrence of cervical lesions showed closer association with the HPV31,16,52,58,56 and 18 genotypes.The risk of cervical lesions was increased when the DNA copies were no less than 1OE4.Among the patients with mixed HR-HPV infections,the percentage of the patients with HSIL was higher in the mixed infection group with any two subtypes of HPV16 and 18 than in the mixed infection group without any two subtypes of HPV16 and 18(P<0.05).The positive rate of single pathological examination for screening of HR-HPV infection and pathological HSIL+was fairly similar to single TCT,the combination of the two screening methods did not increase the sensitivity of positive pathological detection,but the combination with DNA copy increased the sensitivity of screening.CONCLUSION The genotyping of HR-HPV infection combined with DNA copies is effective for screening of cervical lesions.It is necessary to attach great importance to the association between the genotypes of HR-HPV infections and the lesions so as to provide clinical recommendations.