人乳头瘤病毒基因亚型与宫颈病变的关系研究

目的研究人乳头瘤病毒基因亚型(HPV-DNA)与宫颈病变程度的关系,以探讨本地区不同基因型的致癌性及分型检测在临床诊断和判断预后的应用价值。方法选择我院妇科门诊患者5000例,利用核酸分子快速导流杂交基因分型技术进行21种HPV-DNA亚型检测,阳性者行TCT及阴道镜下定位活检。根据病理学诊断分组:①正常与炎症组;②LSIL组;③HSIL组。对≥CINⅡ或CINI无随访条件者予手术或物理治疗,术后于3、6、12个月行HPV-DNA、TCT、阴道镜检查。分析三组宫颈病变感染各种HPV亚型的阳性率、多重感染率及术后转阴率。结果①HSIL组的HPV-H阳性率明显高于另两组,组间差异显著,P<0.001;IHPV-H在HSIL组的阳性率递减顺序前五位是16、52、58、18、33,其中HPV-16型在HSIL组的阳性率为50.1%,明显高于另两组,p<0.001,尤其宫颈癌患者.HPV-16型阳性率最高占90.6%,其次HPV-18型占8.0%。②HSIL组的HPV多重感染率为50.2%,明显高于另两组,p<0.001。③手术与物理治疗共708例,在HSIS组、LSIL组、正常与炎症组累计12个月HPV-H转阴率分别为86.4%、91.9%、95%,p<0.05。术后HPV转阴性者未发现有宫颈病变存在。12个月内发现宫颈病变11例,同期检出的HPV-H为16、52、58、18型。结论宫颈病变级别越高,高危亚型阳性率和多重感染率越高;导致清远市妇女发生宫颈病变的主要HPV亚型是16、52、58、18、33;致癌性最强的亚型是16型,其次是18型,可作研究特异疫苗的参考依据。手术与物理治疗可有效促使HPV转阴与病灶消除,HPV分型检测用于CINⅡ、CINⅢ的诊断和判断病灶残留、复发、预示发展状况的可靠指标之一,具有临床推广应用价值。

RELATIONSHIP BETWEEN HUMAN PAPILLOMAVIRUS TYPES AND CERVICAL DISEASE

Objective To investigate HPV types detected in patients with non - career, precancer and cancer lesions at cervix and to analyze the oncogenesis of the various HPV types, and to evaluate its value of diagnosing and prognosing the cervical disease. Methods 5 000 women were selected for 21 HPV genotypes detection by HybfiMax, all of the positive patients received TCT and colposcopy. According to pathological diagnosis, they were divided into three groups ： ① normal or inflammatory group ;② LSIL ; ③HSIL. To treat the patients of more CIN Ⅱand CIN I unpossible being follow- up with operation or physical therapy, 3,6,12 months after treatment determine the 21 HPV - DNA types and take TCT, vaginoseopy. Then analyze the positive rate of cervical lesion infected with different types of HPV, multiple infection rate and turning negative rate of three groups. Results ① In HSIL group HPV - H was tested positive in 99.3% significantly more than in the other two groups p 〈0. 001 ; the positive rate of types is descending as 16,52,58,18,33 ,in which the HPV - 16 positive rate in HSIL group is 50.1%, obviously greater than in other two groups p 〈 0. 001, especially in cervical cancer patients its positive rate is greatest as 90. 6%, secondly is that of HPV - 18 as 8. 0%. ② The multiple infection rate in HSIL group is 50. 2%, significantly higher than in the other two groups. ③ Total 708 cases were treated with operation or physical therapy, follow the post - operation cases for twelve months, HPV - H was tested negative in normal or inflammatory, LSIL and HSIL groups at 95%, 91.9% and 86.4,p 〈0. 001. No cervical lesion has been found in tuming negative cases. 11 cervical lesions founded within 12 months and in the same time the detached HPV - H were 16,52,58,18 type. Conclusion The higher grading is the cervical lesion, the higher is the positive rate of infection of HPV - H and multiple infection. In Qingyuan district, HPV types 16,52,58,33,18 are more common in cervical disease and more oncogenic than other HPV types. The most oncogenic is 16 and the next is 18 type, this is available in making special vaccine. Surgical operation and physical therapy can effectively induce HPV turning negative and elimination of lesion, HPV subtype detection is rehable index for diagnosing CIN II ,CIN m and judge lesion residue and relapse, and foreshow the future development. So it is worthy to wider use in clinical practice.