7199例宫颈疾病筛查分析

目的了解余姚地区高危型人乳头瘤病毒（HPV）亚型分布及宫颈疾病发病情况。方法对2006年10月至2008年12月在浙江省余姚市人民医院就诊的7 199例宫颈疾病患者进行HPV基因分型检测联合宫颈疾病“三阶梯程序”诊断。结果7199例患者HPV感染2 443例,感染率33.94%（2443/7199）,高危型HPV亚型分布依次为HPV-16,58,18,33,31;感染高峰年龄为21~30岁;农民、自由职业者、低文化水平者为高危人群。确诊慢性宫颈炎6 944例,占96.46%（6944/7199）;宫颈上皮内瘤变（CIN）206例,占2.86%（206/7199）;宫颈癌49例,占0.68%（49/7 199）。慢性宫颈炎与CIN之间HPV感染率及亚型分布比较,差异有统计学意义（P〈0.001）;不同级别CIN的HPV感染率及HPV-16亚型的感染率比较,差异有统计学意义（P〈0.001）。CIN的发病年龄集中在31-50岁,以31-40岁为最高峰;性生活年限≥16年者,CINⅢ发病率高于CINⅠ、Ⅱ,差异有统计学意义（P〈0.05）。结论本研究结果表明,本院就诊患者高危型HPV亚型分布依次为HPV-16,58,18,33,31;随着宫颈疾病的加重,HPV感染率提高,以HPV-16亚型致病力最强;从HPV感染至CIN病变的潜伏期约为10年。

Screening for human papillomavirus infection among 7199 cases with cervical diseases

Objective To find out the regional distribution of the high-risk human papillomavirus（HPV）subtypes and the incidence of cervical diseases.Methods A total of 7 199 cases of cervical diseases visited the People′s Hospital of Yuyao during October 2006 and December 2008 were subjected to HPV genotyping test and the three-step diagnosis of cervical diseases.Results Out of 7 199 cases,2 443 cases were infected with HPV.The infection rate was 33.94%（2 443/7 199）.The regional distribution of high-risk HPV subtypes ranked as follows：HPV-16,58,18,33 and 31.The peak age of infection was 21-30 years.Farmers,freelancers and low-educated persons were high-risk populations.There were 6 944 cases（96.46%）diagnosed with cervical mucous membrane inflammation,206 cases（2.86%）with cervical intraepithelial neoplasia（CIN）,49 cases（0.68%）with cervical cancer.There were significant differences in distributions of HPV subtypes and HPV infection rate between patients with cervical mucous inflammation and patients with CIN（P〈0.001）.There were signifcant differences in infection rates of HPV and HPV-16 subtype among patients with CIN of different degrees（P〈0.001）.The patients with CIN were mainly aged 31-50 years,and 31-40 years were the peak ages of incidences.The incidence of CIN Ⅲ was higher than those of CIN Ⅰ and CIN Ⅱ in patients having more than 16 years of sexual life（P〈0.005）.Conclusion The regional distribution of high-risk HPV subtypes is ranked as follows：HPV-16,58,18,33,31.The HPV infection rate increases with the increasing severity of cervical diseases.HPV-16 subtype shows the strongest pathogenicity.The latency from HPV infection to the occurrence of CIN lesions is about 10 years.