贵州省部分地区妇女宫颈人乳头瘤病毒感染现状调查及分析

目的 了解贵州省部分地区妇女宫颈人乳头瘤病毒(HPV)感染的分布情况及高危因素,为该地区宫颈癌防治及疫苗的投入使用提供一定的依据.方法 采用导流杂交技术对2339例有性生活妇女宫颈脱落细胞进行21种HPV基因型检测及宫颈液基细胞学检测,对其中部分HPV阳性携带者和(或)宫颈液基细胞检查阳性结果 者在阴道镜下取组织活检进行病理检查.分析HPV感染高危因素及各型宫颈病变中HPV亚型感染分布特点.结果 在被调查的2339例妇女中HPV感染总阳性率为30.31%(709/2339),共有20种HPV亚型被检测出来.HPV感染阳性排在前5位的亚型从高到低依次为HPV16、52、18、58、和11,感染率从高到低分别为9.87%(231/2339)、5.64%(132/2339)、4.95%(116/2339)、4.19%(98/2339)和2.99%(70/2339).HPV感染的高峰年龄为31～35岁,初次性生活越早,HPV感染率越高(经趋势X2检验,X2=15.933,P<0.05).病理学检查确诊了366例宫颈上皮内瘤变(CIN)患者及181例宫颈浸润癌患者,CIN患者HPV感染率依次为CIN Ⅰ 34.26%(74/216)、CIN Ⅱ77.78%(56/72)、CIN Ⅲ82.05%(64/78).181例宫颈浸润癌患者中,宫颈鳞癌的HPV感染率为84.52%(131/155),宫颈腺癌的HPV感染率为38.46%(10/26).HPV阳性宫颈鳞癌中16型占61.83%(81/131)、腺癌18型占60%(6/10),HPV16与宫颈鳞癌关系密切(X2=11.948,P<0.001,OR鳞癌/腺癌=5.946),HPV18亚型在宫颈鳞癌和腺癌中分布比较差异无统计学意义(P>0.05).结论 贵州省HPV亚型感染分布以16、52、18、58型为主.宫颈病变程度与HPV感染密切相关,HPV感染高发于中青年妇女,初次性生活年龄较早是HPV感染的高危因素,长期持续高危型HPV感染可能导致宫颈癌.高度鳞状上皮内病变及宫颈癌主要由高危型HPV感染所致.HPV16亚型与宫颈鳞癌关系密切,HPV18亚型在宫颈鳞癌与腺癌中的分布无明显差异.本地区可考虑应用HPV16/18二价疫苗降低宫颈癌的发病率.

The Investigation of present situation of Human papilloma virus infection of women cervixes in parts of Gnizhou Province

Objective To investigate the distribution of different Human papilloma virus(HPV) subtype infection of women cervixes in parts of Guizhou Province and the high risk factors of HPV infection,in order to offer some evidences for the use of vaccine of cervix eaneers in the region, and offer a group of reliable data for the screen-ing statistics of cervix eaneer in the world. Methods A total of 2339 women having sexual life were checked for 21 HPV genotypes by DNA flow-through hybridization technique and liquid-hased pap test(LPT) in their exfoliated cer-vical cells. Cervix tissues were taken in some HPV positive women and (or) LPT positive women among them for bi-opsy by the vaginoscope. The high risk factors of HPV infection and the distribution feature of HPV subtype infection in the different cervix diseases were anlayzed. Results The total positive rate of HPV infection was 30.31% (709/ 2339 ) in the 2339 women. There were 20 HPV subtypes to be detected. HPV subtype infection from high to low were HPVI6,52,18,58 and 11. The rates of HPV subtype infection were 9.87% (231/2339) ,5.64% ( 132/2339), 4.95% (116/2339 ) ,4.19% (98/2339)and 2.99 % (70/2339). The peak age of HPV infection ranged from 31 to 35 years old. The earlier the first sexual life,the higher HPV infeetion (tendeney X2 test,P <0.05). 366 CIN pa-tients and 181 patients of invasive cervix carcinoma( ICC)were diagnosed through pathology examination. The rate of HPV infection were 34.26% (74/216)in CIN Ⅰ ,77.78% (56/72)in CIN Ⅱ ,82.05% (64/78)in CIN Ⅲ. Among the 181 ICC,the rate of HPV infection was 84.52% (131/155)in squamous carcinoma of the cervix (SCC) and 38.46% (10/26) in adenocareinoma of uterine cervix (AUC). The infeetion rate of HPV16 was 61.83% ( 81/131 ) in the SCC of HPV positive. The infection rate of HPV18 was 60% (6/10)of the AUC of HPV positive. HPV16 was related closely with SCC ( X2 = 11. 948 ,P < 0.001 , ORSCC/AUC = 5. 946). There was no significant difference be-tween HPV 18 in SCC and AUC( P > 0.05). Conclusions The major HPV subtypes are 16,52,18,58 in Guizhou province. There is a close correlation between HPV infection and cervix diseases. HPV infection often occurs in young and middle-aged women. The first sexual life is a high factor of HPV infection. High risk HPV infecting would cause cervix cancer. CIN and cervix cancers are caused by high risk HPV infection. HPV16 is related closely with SCC. There is no significant difference between HPV18 in SCC and AUC. HPV16/18 vaccine could be considered to re-duce the incidence of cervical carcinoma in Guizhou province.