人乳头瘤病毒感染与宫颈病变临床资料分析

目的：评价人乳头瘤病毒（ HPV）感染在宫颈病变早期筛查中的作用，为宫颈病变进一步诊断和判断预后提供依据。方法回顾性分析来温州市中西医结合医院进行宫颈癌筛查，因宫颈液基薄层细胞学检查（ TCT）存在异常细胞的413例妇女的资料，平均年龄39．40岁（年龄范围21～77岁），所有研究对象均进行阴道镜下组织活检和HPV-DNA分型。结果上皮内瘤样病变（ CIN）Ⅰ患者中以非典型鳞状上皮细胞（ ASCUS）检出符合率最高，CINⅡ患者中以低度鳞状上皮内病变（ LSIL）检出符合率最高，CINⅢ患者中以高度鳞状上皮内病变（ HSIL）检出符合率最高。慢性宫颈炎患者一种或多种高危型HPV（ HR-HPV）感染率要低于CIN患者（χ^2＝32．105，P＝0．000），宫颈癌HR-HPV感染率为100％。慢性宫颈炎患者与CIN患者低危型HPV（LR-HPV）感染率比较，差异无统计学意义（χ^2＝0．205，P＝0．650）。宫颈病变患者以单一HR-HPV亚型感染率更常见，其与多重感染相比，差异有统计学意义（χ^2＝56．350，P＝0．000）。结论宫颈癌及癌前病变与HPV感染密切相关。 HR-HPV基因检测及分型对宫颈病变的预后判断、疗效监测等方面具有重要价值。

Clinical analysis of human papillomavirus in screening cervical cancer and precancerous lesions

Objective To estimate the influence of human papillomavirus （HPV） infection in early screening of cervical lesions , and provide evidence for its diagnosis and prognosis .Methods Retrospective study was conducted to analyze the clinical data of 413 women with abnormal cells at TCT in cervical cancer screening performed in Integrated Chinese and Western Medicine Hospital of Wenzhou , and their median age was 39.40 （ranging from 21 to 77）.All subjects underwent cervical tissue biopsy under colposcopy and HPV -DNA gene typing.Results The detection rate of atypical squamous cells （ ASCUS ） was highest in patients with cervical intraepithelial neoplasia （CIN）Ⅰ, detection rate of low squamous intraepithelial lesion （LSIL） was highest in patients with CIN Ⅱ, high squamous intraepithelial lesion （ HSIL ） in patients with CIN Ⅲ.One or more high risk HPV （ HR-HPV ） types were detected in fewer patients with chronic cervicitis than CIN patients（χ^2 =32.105,P=0.000）, HR-HPV infection rate was 100% in cervical cancer patients.The prevalence of low risk HPV （LR-HPV） types was similar between patients with chronic cervicitis and CIN groups （χ^2 =0.205, P=0.650）.Single HR-HPV infection was more common subtypes in cervical lesions patients , which was significantly different from multiple infection （χ^2 =56.350,P=0.000）.Conclusion Cervical cancer and precancerous lesions are intimately associated with HPV infection .HR-HPV gene detection and gene typing are important in predicting prognosis and monitoring curative efficacy .