医院机会性筛查人群HR-HPV感染的流行病学特征及与宫颈癌前病变的关系

目的研究医院机会性筛查人群高危型人乳头瘤病毒(high risk-human papillomavirus,HR-HPV)感染的流行病学特征,探讨HR-HPV感染与宫颈癌前病变的关系。方法收集2012年1月1日至2012年12月31日期间,就诊于首都医科大学附属北京朝阳医院妇科门诊,同时接受HR-HPV和宫颈薄层液基细胞学检查(thinprep cytologic test,TCT)符合纳入标准的2 305例患者资料。采用二代杂交捕获法(hybird capture II,HC-II)进行HR-HPV检测。结果 1)医院机会性筛查人群HR-HPV感染率为34.84%,年轻女性(20~24岁)感染率最高(50.0%),随着年龄的增加,感染率逐渐下降,45~49岁女性感染率最低(24.18%),≥55岁者感染率升高(47.02%),感染率呈双高现象。宫颈薄层液基细胞学异常率的年龄分布特点,与HR-HPV感染率的年龄分布特点一致。2)TCT结果为正常或者炎性反应、不典型鳞状上皮细胞(atypical squamous cells undetermined significance,ASCUS)、低度鳞状上皮内瘤样病变(low squamous intraepithelial lesion,LSIL)、高度鳞状上皮内瘤样病变(high squamous intraepithelial lesion,HSIL)、宫颈鳞状细胞癌(squamous of cervical carcinoma,SCC)中,HR-HPV的感染率分别是23.98%、66.47%、87.21%、98.04%、100%。宫颈组织活检病理为正常或炎性反应、宫颈上皮内瘤样病变1级(cervical intraepithelial lesions-Ⅰ,CIN-Ⅰ)、CIN-Ⅱ、CIN-Ⅲ、SCC患者HR-HPV的感染率分别为67.44%、86.96%、88.24%、94.57%、90.48%。3)在ASCUS患者中,宫颈高级别病变(≥CIN-Ⅱ)的发生率31.73%,HRHPV阳性组宫颈高级别病变(≥CIN-Ⅱ)的检出率36.93%,HR-HPV阴性组宫颈高级别病变(≥CIN-Ⅱ)的检出率21.43%,两组间的差异具有统计学意义(χ2=4.13,P=0.042)。4)在LSIL患者中,宫颈高级别病变的发生率34.40%,HR-HPV阳性组宫颈高级别病变的检出率37.37%,HR-HPV阴性组宫颈高级别病变的检出率14.29%,两组间的差异具有统计学意义(χ2=5.76,P=0.016)。结论不同年龄,HR-HPV感染率及TCT异常率不同,<24岁和≥55岁为HR-HPV感染及异常宫颈薄层液基细胞学高峰年龄。HRHPV感染率和宫颈病变严重程度呈显著正相关。HR-HPV检测不能作为ASCUS和LSIL患者分流管理的唯一手段,HR-HPV阴性的ASCUS和LSIL不能排除≥CIN-Ⅱ级病变,仍然需要做阴道镜检查。

Epidemiologic characteristics of high risk human papillomavirus(HR-HPV) infection in population undergone hospital opportunistic health screening and the relationship between cervical cancer lesion and HR-HPV infection

Objective To study epidemiological characteristics of population who underwent opportunistic screening for high risk-human papillomavirus(HR-HPV) infection, and to explore the relationship between HR-HPV infection and cervical precancerous lesions. Methods Data from 2 305 patients, according the inclusion criteria, who underwent HR-HPV DNAs and cervical cytology tests at the outpatient department of OB & GYN, Beijing Chaoyang Hospital from January 1, 2012 to December 31, 2012, were collected. HR-HPV DNAs were detected by hybrid capture-Ⅱ(HC-Ⅱ) method, cervical exfoliated cells were collected and inspected. SPSS 18.0 software was used for statistical analysis. Results 1) The infection rate of HR-HPV of the screening crowd was 34.84%, of which the young women(20-24 years old) is the highest(50.0%). With aging, the rate decreased gradually, the lowest rate of women aged 45-49 years(24.18%). It increased again after the age of 55 years(47.02%), showing second peak of infection. The age distribution of positive rate of cervical cytology tests also had two peaks, consistent with characteristics of age distribution of HR-HPV infection rate. 2) HR-HPV infection rates were respectively 23.98%, 66.47%, 87.21%, 98.04% and 100% in normal or inflammation, atypical squamous cells undetermined significance(ASCUS), low squamous intraepithelial lesion(LSIL), high squamous intraepithelial lesion(HSIL), squamous of cervical carcinoma(SCC), thin preparation test(TCT) results, respectively. HR-HPV infection rates of subjects with normal cervical biopsy or inflammation, cervical intraepithelial lesions(CIN)-Ⅰ, CIN-Ⅱ, CIN-Ⅲ, ASCUS, LSIL, HSIL and SCC were 67.44%, 86.96%, 88.24%, 94.57%, 90.48%, respectively. With the increasing level of cervical cytology lesions and cervical histological lesions, the rate of HR-HPV infection significantly increased. 3) In ASCUS patients, the incidence of high-grade cervical lesions was 31.73%, which in HR-HPV positive group was 36.93% and in negative group was 21.43%. The difference was statistically significant between the two groups(χ²=4.13, P=0.042). 4) In LSIL patients, the incidence of high-grade cervical lesions was 34.40%, which in HR-HPV positive group was 37.37% and in negative group was 14.29%. The difference was statistically significant between the two groups(χ²=5.76, P=0.016). Conclusion The infection rate of HR-HPV and the abnormal rate of cervical cytology are different with different age. Younger than 24 years and ≥ 55 years were peak of both of HR-HPV infection and abnormal cytology. HR-HPV infection and cervical lesion severity was positively correlated. Patients for ASCUS and LSIL of cervical cytology, if HR-HPV positive, will increase the probability of CIN-Ⅱ and above lesions, but negative patients cannot be excluded from high-grade cervical lesions, the colpscopic examination is necessary.