崇左地区人乳头瘤病毒亚型与宫颈上皮内瘤变相关性研究

目的探讨人乳头瘤病毒(human papillomavirus,HPV)亚型感染在崇左地区宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)患者中是否具有区域特异性。方法选取2016年1月至2020年1月崇左市人民医院妇科门诊因宫颈疾病就诊患者4877例,对宫颈脱落细胞液基细胞学检查显示异常的患者同时行宫颈脱落细胞HPV检测并经阴道镜宫颈活组织检查病理确诊CIN;观察不同分类CIN患者中HPV不同亚型的感染率、分布情况及其相关性。结果①4877例患者中有1087例感染HPV,检出率为22.29%。共计分离出1863株HPV。其中高危型病毒789株,占42.35%;低危型1074株,占57.65%。高危型检出前三位为HPV16型141株(7.57%)、HPV52型98株(5.26%)、HPV58型62株(3.33%);低危型检出前三位为HPV53型318株(17.07%)、HPV6型297株(15.94%)、HPV11型196株(10.52%)。②4877例患者按年龄分为25~35岁、36~50岁、>50岁3组,其HPV感染占比分别为21.68%、22.16%、23.48%,低度鳞状上皮内瘤变(low grade squamous intraepithelial neoplasia,LSIL)占比分别为22.51%、17.35%、11.98%,高度鳞状上皮内瘤变(high grade squamous intraepithelial neoplasia,HSIL)占比分别为2.25%、2.80%、4.44%。③CIN患者HPV的阳性率为69.39%(705/1016);将宫颈正常组(n=3832)、LSIL组(n=871)、HSIL组(n=145)的HPV阳性率、高危型阳性率进行对比:3组中HPV阳性率以及高危型阳性率呈升高趋势,差异均有统计学意义(P<0.05)。以HPV感染为自变量及是否发生CIN为因变量进行单因素Logistic回归分析结果为:OR=10.319,95%CI(8.816-12.080)。④LSIL组、HSIL组中3种检出率较高的高危型分别为HPV16、52、58,分别为75株、63株、39株及36株、21株、9株,在CIN组受试者(n=1016)中以高危型HPV感染、HPV16型、HPV52型、HPV58型为自变量及是否为HSIL为因变量,进行Logistic回归分析,结果显示:高危型HPV感染OR=2.649,95%CI(1.810-3.875)]、HPV16型OR=8.570,95%CI(5.238-14.022)]、HPV52型OR=4.598,95%CI(2.636-8.018)]、HPV58型OR=2.748,95%CI(1.282-5.888)]是发生HSIL的危险因素。结论崇左地区CIN者其HPV检出率高,不同HPV亚型与CIN分类的发生风险有显著相关性。

A study on the relationship between human papillomavirus subtypes and cervical intraepithelial neoplasia in Chongzuo area

Objective To investigate whether human papillomavirus(HPV)subtype infection has regional specificity in cervical intraepithelial neoplasia(CIN)patients in Chongzuo area.Methods A total of 4877 patients were selected from January 2016 to January 2020 due to cervical disease in Gynecological Outpatient Clinics of Chongzuo People's Hospital.Patients who showed abnormal cervical exfoliated cell liquid-based cytology were also tested for HPV cervical exfoliated cells and cervical biopsy by colposcopy to confirm the diagnosis of CIN;observed the infection rate and distribution of different subtypes of HPV in patients with different classifications of CIN and their correlation.Results①Among 4877 patients,1087 were infected with HPV,and the detection rate was 22.29%.A total of 1863 HPV strains were isolated.Among them,789 strains of high-risk viruses,accounting for 42.35%;1074 strains of low-risk viruses,accounting for 57.65%.The top three high-risk types detected were HPV16 type 141 strains(7.57%),HPV52 type 98 strains(5.26%),HPV58 type 62 strains(3.33%);the top three low-risk type detected were HPV53 type 318 strains(17.07%),HPV6 type 297 strains(15.94%),and HPV11 type 196 strains(10.52%).②4877 patients were divided into 25 to 35 years old,36 to 50 years old,and>50 years old,the proportions of HPV infection were 21.68%,22.16%,23.48%,and the proportions of LSIL were 22.51%,17.35%,11.98%,HSIL accounted for 2.25%,2.80%,and 4.44%respectively.③The positive rate of HPV in CIN patients was 69.39%(705/1016).The positive rates of HPV and high risk type were compared among the normal cervix group(n=3832),LSIL group(n=871)and HSIL group(n=145),the positive rate of HPV and high-risk type in the three groups increased and the differences were statistically significant(P<0.05).The results of univariate Logistic regression analysis with HPV infection as the independent variable and whether CIN occurred as the dependent variable were:OR=10.319,95%CI(8.816-12.080).④In LSIL group and HSIL group,HPV16,52 and 58 were the three high-risk types with high detection rate,which were 75 strains,63 strains,39 strains and 36 strains,21 strains,9 strains,respectively.In the CIN group(n=1016),with high-risk HPV infection,HPV16,HPV52,HPV58 as the independent variables and HSIL as the dependent variable,Logistic regression analysis was performed.The results showed:high-risk HPV infectionOR=2.649,95%CI(1.810-3.875)],HPV16 typeOR=8.570,95%CI(5.238-14.022)],HPV52 typeOR=4.598,95%CI(2.636-8.018)],HPV58 typeOR=2.748,95%CI(1.282-5.888)]were the risk factors of HSIL.Conclusion CIN patients in Chongzuo area have a high HPV detection rate,and different HPV subtypes have a significant correlation with the risk of CIN classification.