人乳头状瘤病毒感染与宫颈癌年轻化的关系探讨

目的探讨35岁及以下宫颈癌的发病趋势及与人乳头状瘤病毒（HPV）感染的关系。方法共收集浙江省肿瘤医院妇瘤科1990年1月至2007年7月底9519例新发宫颈癌患者病例，分析1990年起每两年35岁及以下宫颈癌患者占宫颈癌总人数的构成比的变化趋势；利用导流杂交基因芯片定性检测了其中910例宫颈浸润癌患者宫颈涂片中21型人乳头状瘤病毒感染情况。SPSS12．0软件，妒检验统计分析35岁及以下宫颈浸润癌患者（年轻组）和35岁以上宫颈浸润癌患者（对照组）HPV感染率及其分布的差异。结果35岁及以下宫颈浸润癌新发病例每两年的构成比呈上升趋势。910例宫颈浸润癌患者HPV总感染率为75．38％（686／910），年轻组和对照组分别为82．05％（96／117）和74．40％（590／793），两组比较差异无统计学意义；910例宫颈浸润癌患者中HPV高危型、中国人常见亚型和低危型感染率分别是73．96％、3．41％和1．65％。HPV感染常见亚型无论在宫颈浸润癌的年轻组还是对照组均为HPV16亚型，其感染率分别为58．97％（69／117）和46．03％（365／793），但两组比较差异有统计学意义（P=0．01），其他各亚型的阳性率比较两组差异无统计学意义（P〉0．05）。结论年轻宫颈癌患者发病率呈上升趋势，高危型HPV感染和宫颈浸润癌的发生密切相关。虽然年轻组宫颈癌患者的HPV总感染率并不高于对照组，但HPV16亚型感染率在年轻组明显高于对照组，HPV16亚型感染可能是宫颈浸润癌年轻化的主要原因。

Causal Relation between HPV Infection and Cervical Cancer in Young Women

Objective To investigate the prevalence trend of cervical cancer in young women(less than or equal to 35 years)and analyze the causal relation between HPV infection and cervical cancer in young women.Methods A total of 9 519 new cervical carcinoma cases were collected from Jan.1990 to July 2007 in Zhejiang Cancer Hospital,and the prevalence trend of cervical carcinoma was analyzed in young women.Of 9 519 cases of invasive cervical carcinoma,910 patients were examined for 21 types of human papillomavirus(HPV)by DNA flow-through hybridization genotyping technique.SPSS 12.0 software, Pearson Chi-square test were used to analyze the difference of HPV infection in carcinoma of cervix between young women(less than or equal to 35 years)and older women(more than 35 years).Results The constituent rate of new cervical cancer in young women was increasing every two years from Jan.1990 to July 2007.The overall HPV infection rate in the 910 patients of cervical cancer was 75.38%(686/910),in young women and older women was 82.05%(96/117)and 74.40%(590/793) respectively,with no significant difference between the two groups.The infection rate of high risk types,Chinese common types and low risk types was 73.96%,3.41% and 1.65% respectively in the 910 cases of cervical cancer.The most common subtype of HPV was type 16,which was found not only in the young patients,but also in the older patients.However,the infection rate of subtype HPV16 in the young patient group was statistically higher than that in the older patient group(58.97% versus 46.03%, P=0.01).No significant difference of other subtypes of HPV was found in the two groups.Conclusion The incidence of new cervical cancer in young women showed increasing tendency.High risk HPV was the most common type in the invasive cervical cancer.Subtype HPV16 might be mainly accounted for the trend toward progressively younger age of cervical cancer onset.