高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.     

农村妇女宫颈癌和乳腺癌筛查的实践与探讨

目的通过对农村妇女宫颈癌和乳腺癌的筛查实践,探讨宫颈癌和乳腺癌联合筛查的模式及效果。方法 2009年—2011年襄垣县妇幼保健院对该县适龄农村妇女开展宫颈癌和乳腺癌筛查。结果此次筛查共完成27 517名妇女的宫颈癌筛查,6 122名妇女的乳腺癌筛查,其中宫颈上皮内瘤变Ⅱ级(CINⅡ)及以上病变的患病率为0.49%,早诊率为91.2%。乳腺良性肿瘤33例(0.53%);乳腺癌2例(0.03%),早诊率为50。%结论宫颈癌检查有筛查基础,筛查及早诊、早治效果明显。乳腺癌筛查仍需规范,须加强技术培训,提高筛查水平。筛查体系和技术队伍建设是基层妇女保健服务的保证,对农村妇女同时进行宫颈癌、乳腺癌联合筛查优于单一项目筛查。     

高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.     

城市和农村妇女高危型人乳头瘤病毒感染的危险因素分析

目的:探讨影响我国城市和农村地区高危型人乳头瘤病毒(HR-HPV)感染的危险因素,为HR-HPV感染和子宫颈癌的防治工作提供依据。方法:采用横断面调查方法对城市地区(北京和上海)1 569人、农村地区(山西和河南)1 763人进行流行病学调查和妇科检查及高危型人乳头瘤病毒检测(HC-Ⅱ)。利用χ2检验和非条件Logistic回归模型分析HR-HPV感染的危险因素。结果:多因素分析结果显示,影响城市地区HR-HPV感染的危险因素为丈夫婚外性行为、生殖器感染史(STD)、流产次数和吸烟,而细胞学检查史是保护因素。影响农村地区HR-HPV感染的危险因素为初次性交年龄、近5年性伴侣数、丈夫婚外性行为、性生活年限和饮酒。结论:影响城市与农村地区妇女感染HR-HPV的危险因素存在着较大差异。提示,在制定预防和控制宫颈癌以及HR-HPV感染的措施时要因地制宜。     

细胞学检测为非典型鳞状细胞且人乳头瘤病毒阴性妇女的宫颈癌患病风险评估

目的 评估宫颈癌筛查中非典型鳞状细胞(ASC-US)但人乳头瘤病毒(HPV)阴性的妇女罹患中度及以上宫颈上皮内瘤样病变(CIN2+)的风险。方法 汇总1999-2008年在我国开展的17项以人群为基础的宫颈癌筛查横断面研究,共30371名17~59岁妇女参加筛查,所有妇女均进行了液基细胞学检查(LBC)、HPV检测(hybrid capture 2, HC2)和醋酸染色肉眼观察法(VIA),任一结果阳性者转诊阴道镜。最终28810名具有完整细胞学、HPV、病理检测结果的妇女纳入分析,分别以细胞学正常且HPV阴性组(LBC-/HPV-)、细胞学正常组(LBC-)为参照,评估细胞学为ASC-US且HPV阴性组(ASC-US/HPV-)的CIN2+患病风险。结果 LBC-/HPV-、LBC-和ASC-US/HPV-组分别有22003、24139和1834名妇女,CIN2+的患病率分别为0.05%、0.36%和0.16%。分别以LBC-/HPV-组、LBC-组为参照,ASC-US/HPV-组罹患CIN2+的风险分别为3.00(95%CI:0.85~10.65)和0.46(95%CI:0.15~1.45),其校正OR值分别为4.00(95%CI:1.08~14.87)、0.47(95%CI:0.15~1.49)。结论 ASC-US/HPV-妇女CIN2+的患病风险介于LBC-和LBC-/HPV-妇女之间。依据"同等风险、同等管理"的原则,可采用对LBC-者的3年筛查间隔,而对于卫生资源相对匮乏地区可采用对LBC-/HPV-者的5年筛查间隔。     

汉族和蒙古族女性HPV感染率及型别分布的差异分析

目的 评价我国汉族和蒙古族女性自然人群及不同宫颈病变级别中的高危人乳头瘤病毒型别分布及感染状况,为不同民族宫颈癌筛查和疫苗防控策略的制定提供理论依据。方法 2017年6月在我国山西省襄垣县、阳城县和内蒙古自治区鄂托克旗3个农村地区开展以人群为基础的多中心宫颈癌筛查研究,共纳入研究对象9 517名。所有研究对象均通过自我采样方法采集2份宫颈阴道分泌物标本,分别进行careHPV及PCR HPV检测（不分型）,并对任意阳性标本进行基于PCR方法的HPV分型检测。上述两种方法任意阳性者转诊阴道镜,阴道镜下若有病变于病变处直接活检,阴道镜下不满意者行宫颈管搔刮术。病理结果作为最终疾病诊断金标准。结果 汉族女性HPV感染者1 842人（21.83%）,蒙古族女性HPV感染者269人（24.93%）,两个民族HPV感染率差异有统计学意义（χ²=5.328,P=0.021）。蒙古族女性宫颈上皮内瘤样变1级的检出率[2.83%（30/1 059）]高于汉族女性[0.87%（73/8 378）],差异有统计学意义（χ²=33.509,P<0.001）,但宫颈上皮内瘤样变2级及以上的检出率差异无统计学意义[蒙古族：1.04%（11/1 059）;汉族：0.95%（80/8 378）,χ²=0.069,P=0.793]。两民族宫颈上皮内瘤样变2级及以上女性HR-HPV型别分布排在前三位的均是HPV16、52、58型。汉族和蒙古族女性多重感染率分别为41.37%、44.35%,两民族间差异无统计学意义（χ²=0.764,P=0.382）。结论 蒙古族女性的HPV感染率高于汉族女性,对汉族和蒙古族女性进行宫颈癌的综合防控时,应提高对HPV16、52、58型的重视。     

中国城市职业女性对人乳头状瘤病毒疫苗认知与接受度调查及健康教育效果评价

目的 了解中国城市职业女性对子宫颈癌、人乳头状瘤病毒（HPV）及HPV疫苗的认知与接受度,同时评价健康教育的作用。方法 采用多中心横断面调查方法,在北京、杭州、长沙、成都和广州5个城市选择16家单位,对职业女性进行健康教育,调查健康教育前后女性对子宫颈癌、HPV及预防性HPV疫苗的认知和态度。结果 2011年8月至11月共调查1 146名职业女性,平均年龄37.03岁（16～67岁）,对子宫颈癌、HPV和HPV疫苗的知晓率分别为95.06 %、27.98 %和12.82 %,仅20.68 %知晓子宫颈癌与HPV持续感染相关。经健康教育后,知晓子宫颈癌与HPV持续感染相关的女性比例（89.26 %）比健康教育前提高3.32倍,差异有统计学意义（χ2＝93.414,P＜0.001）;不愿意给孩子接种疫苗的比例虽有所降低,但仍占19.25 %,主要原因是担心疫苗的安全性（23.52 %）,认为孩子太小,没有患子宫颈癌的危险性（21.92 %）,疫苗还没有大范围推广使用（13.01 %）和担心疫苗的有效性（12.79 %）。结论 我国城市职业女性人群对HPV及疫苗的认知率普遍较低,经健康教育后明显提高,人群对HPV疫苗防治子宫颈癌总体上持积极支持的态度,大部分女性能够接受为孩子接种HPV疫苗,但HPV疫苗的有效性和安全性仍然是公众关注的主要焦点。     

中国宫颈癌防治研究20年历程与成就

宫颈癌是全球女性第四大常见恶性肿瘤,我国发病人数占全球的18.6%,防控形势严峻。经过20年的探索与努力,我国形成了宫颈癌流行病学及病因学科学证据,HPV预防性疫苗取得突破进展,筛查技术日渐成熟以及初步提出适用于不同经济水平条件地区的多种宫颈癌筛查方案。尽管如此,基层卫生服务能力亟待提高,以缩小其与实际需求之间的差距,加速实现全球消除宫颈癌的宏伟目标。     

高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.     

人乳头瘤病毒预防性疫苗的研究进展及应用前景

过去50多年,在子宫颈癌的防治研究进程中,有两大历史性的发现使得人们在人类历史上率先实现了采用一级预防与二级预防相结合的方式有效地控制甚至消除癌症成为可能.第1个历史性的发现是:被誉为"现代细胞学之父"的希腊医生Papanicolaou在1941年,首次阐述了阴道(宫颈)细胞学涂片对诊断子宫颈癌的价值,之后巴氏涂片作为一种子宫颈癌的筛查方法被引入临床,并成为临床医学中最有效的筛查方法[1].