宫颈癌临床特征及人乳头瘤病毒感染情况分析

Clinical characteristics of cervical cancer and analysis of human papillomavirus infection

目的分析本地区宫颈癌患者临床特征及人乳头瘤病毒(Human papilloma virus,HPV)感染情况。方法本院接诊的248例宫颈癌患者为研究对象,同时选取患者组织病理活检为宫颈上皮内瘤变(CIN)Ⅰ级、Ⅱ级、Ⅲ级各60例。收集患者临床资料,按照年龄分组,对比两组患者的临床特征。采集患者分泌物,采用PCR-反向点杂交法(PCR-RDB)检测HPV感染情况,主要包括13种高危亚型(HPV16、18、31、33、35、39、45、51、52、56、58、59、68)及6种低危亚型(HPV6、11、42、43、44、83)。采集患者分泌物进行支原体培养和鉴定。结果248例宫颈癌患者,按照年龄分为老年组(≥60岁)45例,非老年组(<60岁)203例。两组患者首发症状为阴道不规则流血差异有统计学意义(P<0.05),宫颈浸润、宫体浸润、神经浸润、宫旁转移、宫腔淋巴结转移及首发临床症状为接触性阴道出血、查体发现、阴道分泌物异常、阴道排液、腰痛或者腹痛差异无统计学意义(P>0.05)。248例宫颈癌患者进行HPV筛查,219例HPV阳性,阳性率为88.31%,其中176例为单一感染,36例为两种混合感染,7例为三种及三种以上混合感染。单一感染中,主要为HPV16、HPV18、HPV58型感染。两种混合感染中,主要为HPV16型+HPV52型感染。三种及三种以上混合感染中,主要为HPV16型+HPV51型+HPV58型感染。对比宫颈癌患者与CINⅠ、CINⅡ、CINⅡ三组患者的高危型HPV16型与HPV18型感染情况,FIGOⅡ组患者HPV16型的感染率为38.71%,显著高于其他分组患者,差异有统计学意义(P<0.05),HPV16型感染与宫颈癌及高级别病变呈正相关性(r=0.267,P<0.05)。FIGOⅡ组患者HPV18型的感染率为7.74%,略高于其他分组患者,差异无统计学意义(P>0.05),HPV18型感染与宫颈癌及高级别病变无相关性(r=0.029,P>0.05)。248例宫颈癌患者中,133例宫颈支原体阳性,阳性率为53.63%,主要为解脲支原体单一感染。HPV阳性宫颈癌患者中,宫颈支原体阳性率为56.16%(123/219),HPV阴性宫颈癌患者中,宫颈支原体阳性率为34.48%(10/29),两组患者的宫颈支原体阳性率,差异有统计学意义(P<0.05),宫颈癌患者宫颈支原体感染与HPV感染呈正相关性(r=0.140,P<0.05)。结论老年宫颈癌患者临床首发症状主要为阴道不规则流血,HPV感染主要以高危型HPV16、HPV18、HPV58单一感染为主。高危型HPV16与宫颈癌及高级别病变呈正相关性。HPV阳性宫颈癌患者的宫颈支原体阳性率高于HPV阴性宫颈癌患者,宫颈癌患者宫颈支原体感染与HPV感染呈正相关性。

Objective To analyze the clinical characteristics and human papilloma virus(HPV)infection status of cervical cancer patients in this region.Methods 248 cervical cancer patients admitted to our hospital were selected as the study subjects,and 60 patients with cervical intraepithelial neoplasia(CIN)grade I,II,and III were selected for pathological biopsy.The clinical data of patients were collected,grouped by age,and the clinical characteristics of the two groups of patients were compared.The patient secretions were collected and HPV infection were detected by PCR reverse dot blot(PCR-RDB),mainly including 13 high-risk subtypes(HPV16,18,31,33,35,39,45,51,52,56,58,59,68)and 6 low-risk subtypes(HPV6,11,42,43,44,83).The patient secretions were collected for mycoplasma culture and identification.Results 248 patients with cervical cancer were divided into an elderly group(≥60 years old)of 45 cases and a non elderly group(<60 years old)of 203 cases according to age.There was a statistically significant difference(P<0.05)between the two groups of patients with the first symptom of irregular vaginal bleeding.There was no statistically significant difference(P>0.05)in the comparison of cervical infiltration,uterine body infiltration,nerve infiltration,parametrial metastasis,uterine lymph node metastasis,and the first clinical symptom of contact vaginal bleeding,physical examination findings,abnormal vaginal secretions,vaginal discharge,low back pain,or abdominal pain.248 cervical cancer patients underwent HPV screening,of which 219 were positive,with a positive rate of 88.31%.Among them,176 were single infections,36 were mixed infections of two types,and 7 were mixed infections of three or more types.In a single infection,the main types were HPV16,HPV18,and HPV58 infections.Among the two mixed infections,the main one was HPV16+HPV52 infection.Among three or more mixed infections,the main ones were HPV16+HPV51+HPV58.Comparing the high-risk HPV16 and HPV18 infections among cervical cancer patients with CIN I,CIN II,and CIN II groups,the infection rate of HPV16 in the FIGO II group was 38.71%,significantly higher than that of other groups of patients,and the difference was statistically significant(P<0.05).HPV16 infection was positively correlated with cervical cancer and high-grade lesions(r=0.267,P<0.05).The infection rate of HPV18 type in FIGO II group patients was 7.74%,slightly higher than other groups of patients,and the difference was not statistically significant(P>0.05).HPV18 type infection was not correlated with cervical cancer and high-grade lesions(r=0.029,P>0.05).Among 248 cervical cancer patients,133 were positive for cervical mycoplasma,with a positive rate of 53.63%,mainly due to single infection with ureaplasma urealyticum.Among HPV positive cervical cancer patients,the positive rate of cervical mycoplasma was 56.16%(123/219),while among HPV negative cervical cancer patients,the positive rate of cervical mycoplasma was 34.48%(10/29).The difference in the positive rate of cervical mycoplasma between the two groups of patients was statistically significant(P<0.05).There was a positive correlation between cervical mycoplasma infection and HPV infection in cervical cancer patients(r=0.140,P<0.05).Conclusion The first clinical symptom of elderly cervical cancer patients was mainly irregular vaginal bleeding,and HPV infection was mainly caused by high-risk HPV16,HPV18,and HPV58 single infections.High risk HPV16 was positively correlated with cervical cancer and high-grade lesions.The positive rate of cervical mycoplasma in HPV positive cervical cancer patients was higher than that in HPV negative cervical cancer patients,and there was a positive correlation between cervical mycoplasma infection and HPV infection in cervical cancer patients.