广西壮族自治区柳州市18～45岁社区女性人乳头瘤病毒感染及型别分布的横断面调查

目的 评价广西壮族自治区柳州市18～45岁女性HPV感染及型别分布特点，为宫颈癌筛查及疫苗研发提供流行病学依据。方法 2013年3－7月在柳州市招募2 300名18～45岁社区女性，采集宫颈脱落细胞进行液基细胞学和HPV DNA检测，并根据临床规范进行阴道镜检查。结果 2 300名女性HPV总感染率为22.7%（95%CI：21.0%～24.4%），其中，高危型HPV感染率为17.3%（95%CI：16.0%～19.1%），在18～25岁和41～45岁呈双峰状态，且随细胞学和组织学病变严重程度增加呈上升趋势。高危型HPV感染率前5位为HPV 52、16、51、58和39型。≥26岁女性的高度宫颈上皮内瘤变（CIN 2+）患病率为1.7%（95%CI：1.0%～2.4%），与18～25岁人群（1.2%，95%CI：0.5%～1.9%）相比，差异无统计学意义（Z=-0.73，P=0.314）。HPV 16/18二价和HPV 6/11/16/18/31/33/45/52/58九价疫苗相关高危型别在CIN2+病例中的检出率分别为44.1%和97.1%。结论 柳州地区18～45岁女性人群HPV感染率随年龄变化呈双峰态势，26～45岁人群的宫颈癌疾病负担不可忽视，急需推进九价HPV疫苗的研究，以期更为有效地预防宫颈癌的发生。

Prevalence of type-specific human papillomavirus infection among 18-45 year-old women from the general population in Liuzhou, Guangxi Zhuang Autonomous Region: a cross-sectional study

Objective To analyze the type-specific prevalence of human papillomavirus (HPV) among women aged 18-45 years from the general population in Liuzhou, Guangxi Zhuang Autonomous Region. Methods Totally, 2 300 women aged 18-45 years old were enrolled in Liuzhou,from March to July, 2013. Cervical exfoliated cells were collected for liquid based cytological and HPV DNA tests. Women were referred to colposcopy exam, based on the clinical practice guideline. Results Overall, the prevalence rates of any HPV or oncogenic HPV appeared as 22.7% (95%CI: 21.0%-24.4%) and 17.3% (95%CI: 16.0%-19.1%), respectively in this population under study. The high-risk HPV prevalence peaked at the age groups of 18-25 and 41-45, increasing along with the severity through cytological and histological tests. Statistically significant differences between the prevalence of CIN2+ (Cervical intraepithelial neoplasia 2+) in women older than 26 years (1.7%, 95%CI: 1.0%-2.4%) and 18-25 years (1.2%, 95%CI: 0.5%-1.9%) of age, were not observed. Among samples diagnosed as CIN2+, positivity of HPV bivalent (16/18) and nine-valent (6/11/16/18/31/33/45/52/58) vaccine, related high risks on the types of HPV types appeared as 44.1% and 97.1%. Conclusions The age-specific HPV prevalence rates in the general women aged 18-45 in Liuzhou presented as having bimodal distribution, suggesting that the disease burden of cervical diseases in women aged 26-45 years should not be ignored. Nine-valent HPV vaccine might provide more effective prevention outcomes on cervical cancer in China.