韶关市女性人乳头状瘤病毒感染筛查及宫颈病变结果分析

目的:探讨粤北地区门诊就诊人群人乳头状瘤病毒(HPV)感染不同亚型的分布情况和年龄特征以及HPV不同亚型引起宫颈癌的风险情况。方法:采用PCR体外扩增和DNA反向点杂交相结合的DNA芯片技术对3 247例不同年龄妇女进行宫颈细胞液基细胞学检查和23种HPV亚型感染检测,对HPV检测为阳性及细胞学诊断≥ASCUS的妇女阴道镜下进行宫颈组织活检,根据细胞异型性的程度和范围进行病理学分析。结果:①HPV总感染率23.19%(753/3 247),液基细胞学诊断≥AS-CUS为4.87%(158/3247)。在不典型鳞状上皮细胞(ASCUS)、低度鳞状上皮内瘤变(LSIL)、高度鳞状上皮内瘤变(HSIL)、鳞状细胞癌(SCC)病例中HPV的检出率分别为49.57%、68.97%、80.00%、100.00%。②细胞学诊断阳性≥LSIL(1.26%,41/3 247)与组织学诊断阳性≥CINⅠ(1.82%,59/3247)比较差异无统计学意义(P>0.05),组织学诊断CINⅠ、CINⅡ、CINⅢ和SCC病变中HPV检出率以62.50%、84.62%、100%和100%依次递增。③3247例样本中HPV感染22种亚型被检出,感染率最高的型别是HPV43,其他常见型别依次为52、16、58、11、6、18、33、66、68和42型;高危型感染18.02%,低危型感染9.45%,交叉型感染4.71%;单重感染17.31%,双重感染4.22%,多重感染1.66%。④3 247例HPV感染高峰年龄在<25岁占4.16%,45～49岁年龄段下降到2.37%,各年龄段HPV感染检出率差异有统计学意义(P<0.01)。结论:韶关地区门诊高危人群HPV感染率23.19%,宫颈病变常见型别为HPV43、52、16、58、11、6、18、33、66、68和42型,HPV16致癌性最强;人群感染高峰在<25岁年龄段。HPV分型检测准确性高并能明确基因类型,联合液基细胞学和宫颈组织学检测能提高筛查宫颈病变细胞的阳性率。

Screening of human papillomavirus infection and analysis of cervical lesions of the women in Shaoguan city

Objective:To explore the distribution situations of different subtypes of human papillomavirus(HPV) infection,age characteristics,and the risks of different HPV subtypes for cervical cancer in the women from outpatient departments in north Guangdong. Methods:PCR amplification in vitro and DNA chip technique(DNA reverse dot blot) were used to carry out cervical liquid-based cytological test and detect infection situations of 23 kinds of HPV subtypes in 3 247 women in different age groups,the women with positive HPV and cytological diagnosis as atypical squamous cells of undetermined significance(ASCUS) or above ASCUS underwent cervical biopsy under colposcope,then pathological analysis was conducted according to the degree and extent of atypia. Results:The total infection rate of HPV was 23.19%(753/3 247),4.87%(158/3 247) of the women were diagnosed as ASCUS or above ASCUS by cervical liquid-based cytological test.The detection rates of HPV in the women with ASCUS,low-grade squamous intraepithelial lesion(LISL),high-grade squamous intraepithelial lesion(HISL),and squamous cell carcinoma(SCC) were 49.57%,68.97%,80.00%,and 100.00%,respectively.There was no statistically significant difference between the proportion of women who were diagnosed as ISIL or above ISIL by cytological test(1.26%,41/3 247) and the proportion of women who were diagnosed as CIN Ⅰ by histological examination(1.82%,59/3247)(P>0.05).The detection rates of HPV in the women diagnosed as CINⅠ,CINⅡ,CINⅢ,and SCC by histological examination were 62.50%,84.62%,100%,and 100%,respectively,showing a gradual increasing trend.Among 3 247 women,22 kinds of HPV subtypes were detected,the infection rate of HPV43 was the highest,and the other common HPV subtypes from high to low were HPV52,HPV16,HPV58,HPV11,HPV6,HPV18,HPV33,HPV66,HPV68,and HPV42.The infection rates of high risk HPV and low risk HPV were 18.02% and 9.45%,respectively;the rate of cross-infection was 4.71%;the rates of single infection,double infection,and multiple infection were 17.31%,4.22%,and 1.66%,respectively.The peak age of HPV infection was less than 25 years,accounting for 4.16%,the infection rate of HPV in 45-49-year-old women reduced to 2.37%,there was statistically significant difference in the detection rate of HPV infection among the children in different age groups(P<0.01). Conclusion:The infection rate of HPV in high risk population in Shaoguan city was 23.19%,the common subtypes of HPV were HPV43,HPV52,HPV16,HPV58,HPV11,HPV6,HPV18,HPV33,HPV66,HPV68,and HPV42;the carcinogenicity of HPV16 was the strongest;the peak age of HPV infection was less than 25 years;detection of HPV subtypes has high accuracy and can determine the gene types,combined with liquid-based cytological test and cervical histological examination can improve the screening positive rate of cervical lesions.