人乳头瘤病毒感染亚型与宫颈病变的关系

Analysis of the Relationships between the Different Subtypes of Human Papillomavirus Infection and Cervical Lesions

目的:探讨HPV感染与宫颈病变发生的关系。方法将病理检查确诊宫颈有病变的187例患者分为3组:慢性炎症组(n=41)、宫颈上皮瘤变(CIN)组(n=62)和宫颈癌组(n=84)。采用人乳头瘤病毒核酸扩增分型技术对患者宫颈脱落细胞样本作HPV基因分型检测,分析HPV感染状况及HPV基因型在各组疾病中的分布。结果 1187例患者中共检出HPV阳性者136例,阳性率为72.72%(136/187),其中高危型HPV感染阳性率为95.58%(130/136)。在被测的21个HPV亚型中最常见的6个类型依次为16型(46.32%、63/136),58型(21.32%、29/136),52型(15.44%、21/136),18型(12.50%、17/136),33型(9.56%、13/136),31型(8.09%、11/136),未检测出44型、43型及6型。2慢性炎症组HPV阳性率为14.63%(6/41);CIN组HPV阳性率为85.48%(53/62)、其中CINⅠ组、CINⅡ组、CINⅢ组中HPV感染率分别为62.50%(10/16)、90.47%(19/21)、96.00%(24/25);宫颈癌组HPV阳性率91.67%(77/84)。CIN及宫颈癌组HPV阳性率均高于炎症组,而CINⅡ~CINⅢ组及宫颈癌组HPV阳性率又明显高于CINⅠ组。3组阳性表达率差异有统计学意义(P<0.05)。3HPV阳性者中单一感染率为67.65(92/136),多重感染率为32.35%(44/136),其中以双重感染为主,占79.55%(35/44)。4HPV感染患者年龄以30~59岁最高,但各年龄段HPV感染检出率比较无统计学差异(P>0.05)。5慢性炎症组、CIN组和宫颈癌组的16型感染率分别为16.67%(1/6)、47.16%(25/53)、48.05%(37/77)。CIN组和宫颈癌组的16型感染率高于慢性炎症组,差异具有统计学意义(P<0.05)。结论 HPV感染与宫颈病变发生、发展密切相关,HPV基因分型诊断对宫颈病变高危人群的筛查、预防、临床诊断、治疗可提供重要的理论依据。

Objective To discuss the relation between human papillomavirus ( HPV) infection and the pathogenes of cervical lesions.Methods 187 cases of pathologically confirmed cervical lesions were divided into 3 groups,chronic flammation (n=41) group,cervical intraepithelial neoplasia (CIN)(n=62) group and cervical cancer (n=84)group.The characterization of genotypes of HPV in cervical cells was detected by human papillomavirus PCR method ( Kaipu) ,and the situation of HPV in-fection and distribution of genotypes of HPV in patients of each group were analyzed .Results 136 patients were infected with HPV,the positive rate was 72.72%(136/187),and 87 patients were infected with HR-HPV(high risk HPV,95.58%). HPV-16(46.32%,63/136) was the most common of the 21 subtypes of HPV,followed by subtypes HPV-58(21.32%,29/136),HPV-52(15.44%,21/136),HPV-18(12.50%,17/136),HPV-33(9.56%,13/136),HPV-31(8.09%,11/136),and there was no HPV-44 or HPV-43 or HPV-6.The positive rate of HPV in chronic flammation group was 14.63%(6/41),The positive rate of HPV in group of patients with CIN was 85.48%(53/62),and the positive rate of HPV in each typing of CINⅠ、CINⅡ、CINⅢwas 62.50%(10/16)、90.47%(19/21)、96.0%(24/25).The positive rate of HPV in group of patiens with cervical cancer was 91.67%(77/84).CIN level and cervical cancer patients of poitive rate of HPV were significantly higher than patients with cervi -cal disease ,and the positive rates of HPV in CIN Ⅱ~Ⅲlevel and cervical cancer group were significantly higher than type CINⅠgroup.The positive rates of the 3 groups were statistically different .HPV-positive rate was 67.65 in single infection ( 92/136),mixed infection rate was 32.35%(44/136),of which dual infection (35/44) rate was 79.55%.The peak age of HPV in-fection was 30-59 years old,there was no significant difference in the HPV-positive rates between each group (P<0.05).HPV-16 infection rates of the chronic in flammation,cervical in traepithelial neoplasia and cervical cancer group were 16.67%(1/6),47.16%(25/53)、48.05%(37/77),respectively.HPV-16 infection rates in cervical in traepithelial neoplasia and cervical canc-er group were higher than that of chronic in flammation group ,there was significant difference in the positive rate results .( P<0.05).Conclusion HPV infection is closely associated with occurrence and development of cervical lesions ,the characterization of HPV-DNA typing can provide significant theoretical basis for screening ,prevention ,cure and clinical diagnosis of high risk pop-ulation .