HPV单一高危感染与多重感染对宫颈病变影响的临床分析

目的探讨人乳头瘤病毒(HPV)多重感染与宫颈病变的关系。方法对2013年1月—2016年12月闵行区115 463例妇科普查妇女的宫颈细胞标本采用巴氏涂片法联合HPV基因分型检测法行宫颈癌筛查,宫颈病变根据组织病理学诊断,比较不同类型宫颈病变HPV多重感染的比例及基因型分布。结果普查人群HPV感染率为11.18%,高危型HPV感染率10.93%,其中多重感染占21.02%,二重感染最常见,最多亚型是六重。604例宫颈病变者HPV感染率为94.21%,均为高危型,其中多重感染占23.73%,二重感染最常见,最多亚型是四重。多重HPV感染与单一HPV感染宫颈癌前病变/宫颈癌的发病率比较差异均无统计学意义(P＞0.05)。随着感染亚型的增加宫颈病变例数趋于减少,病变级别越高减少越明显,宫颈鳞癌组多重感染率仅为15.69%,与LSIL组及HSIL组比较HPV多重感染率差异有统计学意义(P＜0.05)。宫颈病变HPV单一感染亚型位于前5位的依次是HPV16、52、58、18、33型,HPV16型占38.71%。多重感染以合并HPV16型感染为主,占56.30%,宫颈鳞癌占比达100%。结论HPV多重感染不增加宫颈病变的机会,宫颈病变的严重程度与HPV感染型别无相关性,而与感染HPV的基因型有关。HPV16型的致癌性最强,普查后需严密随访和管理HPV16型特别是包含有HPV16型的多重持续性感染者。     

宫颈癌高发区妇女HPV感染及影响因素分析

目的 了解宫颈癌高发区妇女高危型人乳头瘤病毒(HPV)感染及其相关影响因素,为宫颈癌筛查、疫苗研制提供基础资料。方法 选取湖北省五峰县20~65岁智力正常已婚女性1 032人,进行问卷调查;采用阴道镜检查和实时荧光定量PCR法对宫颈脱落细胞样本进行HPV感染型别鉴定和DNA定量检测;应用SPSS 13.0软件对资料进行分析比较及描述性分析。结果 1 032例女性中,检出4例宫颈癌,患病率为3.88‰;宫颈脱落细胞标本1 032例中,HPV阳性123例,感染率为11.92%;20~25岁和51~55岁年龄组感染率较高,分别为16.67%(3/18)和14.46%(12/83),>55岁感染率较低,为8.62%(5/58);HPV感染阳性中,HPV 16型占25.18%(34/135),52型21.95%(27/123,),58型21.14%(26/123,),18/45型为8.15%(11/135);HPV阳性与HPV阴性妇女的初次性交年龄、初婚年龄、初产年龄、孕次、产次及性伴侣数等差异均无统计学意义。结论 HPV16、52、58型在该地区感染率较高;婚育及性行为等因素与HPV感染无明显相关性;病毒DNA载量与病情轻重的关系尚需进一步研究。     

黑龙江24 597例宫颈癌筛查女性HPV分型检测结果分析

目的分析黑龙江省女性人乳头瘤状病毒(human papillomavirus，HPV)感染现状，为宫颈癌的防治提供一定的参考依据。 方法收集2018年1月至10月24 597例送检的HPV病毒检测宫颈脱落细胞筛查标本，采用PCR反向点杂交法共检测23种型别。 结果HPV阳性率为32.16%，其中高危型别阳性率占总阳性率的77.33%，单一型别感染率和多重型别感染率存在极显著差异(P<0.01)；根据年龄由低到高共分为6组，其阳性率呈"U"形曲线，感染率排在前五位的型别为16型、52型、58型、53型、51型，感染率分别为5.04%、4.34%、3.00%、2.92%、2.31%。 结论女性HPV感染率以高危型别为主，且与年龄关系密切，30岁以下及50岁以上的女性感染率明显较高，该研究为HPV的检测以及宫颈癌的筛查提供一定的参考依据。     

不同年龄组妇女HPV感染流行病学研究

目的:了解不同年龄组妇女人类乳头瘤病毒(HPV)感染状况及子宫颈癌前病变或子宫颈癌发病情况,为子宫颈癌防治提供依据。方法:整群抽样调查深圳市福田区教育系统女性职工,并进行HPV感染检测及子宫颈癌与癌前病变流行病学调查,评价不同年龄组妇女HPV感染及子宫颈癌前病变或子宫颈癌检出情况。结果:纳入研究的健康妇女2 052例,HPV阳性率12.03%,C INⅠ以上病变检出率1.71%;HPV阳性率高峰年龄在<30岁及40～44岁年龄组,阳性率分别为13.40%和14.70%;35～44岁年龄组C INⅠ以上病变检出率2.28%,显著高于其他年龄组,差异具有统计学意义(P<0.05)。结论:30岁以下年轻妇女高危型HPV阳性多为一过性感染,不推荐HPV检测作为年龄<30岁妇女的子宫颈癌前病变或子宫颈癌的筛查方案,子宫颈防治的重点人群应是35岁以上的妇女。     

Prevalence of genital HPV infection in urban and rural women in the Eastern Brazilian Amazon

This study investigated the prevalence and risk factors for genital infection with HPV in women from rural and urban areas in two different regions of the Eastern Brazilian Amazon. A cross-sectional survey was performed in Pap screening programs, with a total sample of 444 women (233 urban and 211 rural). Uterine cervical swabs were collected for the detection of HPV DNA with the established PCR assay using MY09-MY11. All volunteers answered an epidemiological questionnaire. Bivariate and multivariate logistic regression analyses were performed to identify risk factors associated with HPV infection. Overall prevalence of HPV infection was 14.6% (15% in urban women and 14.2% in rural). The only factor associated with HPV was marital status in the 13-25-year-old rural population, with higher HPV prevalence among single and divorced women and widows. The findings indicate the need for risk factor control strategies targeted specifically to women in rural and urban areas.     

妇科疾病患者HPV感染及其影响因素分析

目的 了解妇科疾病患者人乳头瘤病毒（HPV）感染情况及其影响因素,为临床防治提供参考依据。方法 收集2010年1月-2015年10月在山东省医学科学院附属医院妇科门诊就诊的1 680例妇科疾病患者的病历资料。结果 1 680例妇科疾病患者中,HPV感染者590例,HPV感染率为35.12%。590例HPV感染妇科患者中,单一型感染453例（76.78%）,双重感染95例（16.10%）,多重感染42例（7.12%）;低危型感染194例（32.88%）,高危型感染396例（67.12%）。多因素非条件logistic回归分析结果显示,怀孕次数≥2次和性伴侣数量≥2个是妇科疾病患者HPV感染的危险因素,文化程度大专及以上、首次性生活年龄≥21岁和使用避孕套避孕是妇科疾病患者HPV感染的保护因素。结论 妇科疾病患者HPV感染以单一型、高危型感染为主;文化程度、首次性生活年龄、怀孕次数、是否使用避孕套避孕和性伴侣数量是妇科疾病患者HPV感染的主要影响因素。     

中国妇女人乳头瘤病毒感染和子宫颈癌的流行病学研究现状及其疫苗预防前景

子宫颈癌是一种严重危害妇女健康的恶性肿瘤，在发展中国家尤其如此。据世界范围统计，其发病率在女性恶性肿瘤中居第二位，仅次于乳腺癌。2002年全球估计有49．3万的子宫颈癌新发病例，27．4万妇女死于该病，其中83％的子宫颈癌发生在发展中国家，占发展中国家女性肿瘤的15％；[第一段]     

外阴湿疣及宫颈炎症与宫颈HPV亚临床感染的相关性研究

目的探讨外阴湿疣和宫颈炎症与宫颈人乳头状瘤病毒(HPV)亚临床感染(SPI)之间的相关性,为预防HPV感染提供依据。方法选取2012年6月-2013年9月126例接受治疗的患者作为研究对象,根据病因分为外阴湿疣组69例和宫颈炎症组57例,选取同期正常女性50名作为对照组;采用阴道镜检查并镜下取组织进行病理诊断,以判断是否有HPV亚临床感染;同时对3组个体镜下所取组织标本进行荧光定量PCR检测、HC2-HPV-DNA检测,以判断个体是否有高危型HPV感染,并对患者进行密切随访。结果外阴湿疣组与宫颈炎症组患者HPV亚临床感染分别为36、13例,感染率52.17%、22.81%,两者之间差异有统计学意义(P<0.05),两组感染率与对照组相比,差异有统计学意义(χ2=30.95、7.82,P<0.01);通过杂交捕获试验,外阴湿疣组、宫颈炎症组与对照组高危HPV感染分别为29、15、4例,高危HPV感染率分别为42.03%、26.32%与8.00%,外阴湿疣组与宫颈炎症组患者之间差异无统计学意义,但与对照组相比,差异有统计学意义(χ2=16.75、6.12,P<0.05)。结论外阴湿疣、宫颈炎症患者宫颈HPV亚临床感染率和高危HPV感染率高于正常人群,要高度关注外阴湿疣和宫颈炎症患者,做好随访和宣传工作,以预防由HPV感染引起的其他妇科疾病的发生。     

TCT 及 HPV 检测在绝经后妇女宫颈癌筛查中的应用

目的评价高危型HPV-DNA和薄层液基细胞学检查（ TCT）在绝经后妇女宫颈癌筛查中的应用价值。方法随机选择南通市妇幼保健院参加宫颈普查的绝经后妇女346例,同时进行高危型HPV-DNA和TCT检查,发现阳性者即进行病理学活检。结果 HPV-DNA和TCT两种筛查方法的灵敏度比较,差异无统计学意义（P＞0．05）。 TCT及HPV-DNA两种筛查方法的阳性预测值分别为19．05％和44．64％,统计学上有显著差异（χ2值分别为12．91AB和12．17AC,P＜0．05）,与TCT联合HPV筛查的双阳性结果比较,单独HPV筛查的阳性预测值差异无统计学意义（P＞0．05）。以病理诊断结果为金标准,ASCUS、LSIL、HSIL、SCC阳性符合率分别为5．56％,27．03％,40．00％,85．71％。结论单一高危型HPV-DNA检测可以作为绝经后妇女宫颈癌筛查的首选方法。     

Prevalence of HIV,syphilis and genital chlamydial infection among women in north-west Ethiopia.

The prevalence of sexually transmitted diseases (STD) among women visiting antenatal (ANC) and gynaecological clinics in Gondar, north-west Ethiopia, was investigated. Between April and August 1995, 728 women consented to enter the study. Prevalence rates were 5.9% (41/693) for chlamydial antigen in cervix, 18.8% (113/600) for syphilis (Treponema pallidum haemagglutination assay [TPHA]) and 25.3% (150/593) for HIV. Active syphilis (RPR)+, TPHA+ was detected in 74% (44/597). HIV infection rate was higher among women with higher age of first marriage and low gravidity. It was significantly associated with young age, urban residence, and presence of genital ulcer (odds ratio [OR] = 6.3), and lymphadenopathy (OR = 2.8) on examination. Women seropositive for syphilis had married at an earlier age, were significantly older and had changed husbands. Low gravidity and age < 30 were independently significant risk factors for cervical chlamydial antigen positivity which was predominantly asymptomatic. Significant association was observed between HIV infection and syphilis (OR = 2.6). Active syphilis was associated with chlamydial (OR = 3.4) and HIV infection (OR = 4.1). The rate of 23.4% and 15.1% of HIV seropositivity among ANC attenders and rural women respectively is an indicator of the rapid progression of the HIV epidemic in the area.     

医院就诊妇女HPV病毒感染情况分析

目的分析探讨汕头市潮南区某医院就诊妇女人乳头瘤病毒(Human papilloma virus,HPV)感染情况。方法选取该院妇产科门诊就诊和健康体检的1547例妇女为研究对象,收集其宫颈脱落细胞标本,采用Luminex 200的流式荧光技术检测HPV的基因型。结果妇女HPV感染率为14.87%(230/1547),感染249例次。其中高危感染率13.06%,感染亚型以52、16、58占比最高;低危感染率1.81%,感染亚型以81、11、43占比最高。门诊就诊妇女HPV感染率和HPV52、16、58亚型感染率显著高于健康体检妇女(P<0.05);不同年龄段HPV感染率、高危型HPV感染率和多重感染感染率比较差异有统计学意义(P<0.05)。结论门诊就诊妇女感染率较体检妇女高,HPV感染率随妇女年龄增长呈上升趋势。     

Developing an HPV vaccine to prevent cervical cancer and genital warts

The challenges of the journey from target identification through development of a prophylactic quadrivalent human papillomavirus (HPV) vaccine have been met in Gardasil. Cervical cancer is the second leading cause of cancer-related death in women worldwide. Approximately 70% of cervical cancer is caused by infection with HPV types 16 and 18 and approximately 90% of genital warts are caused by HPV types 6 and 11. The quadrivalent HPV vaccine was generated by expression of the major capsid protein (L1) of HPV types 16, 18, 6 and 11 in yeast. L1 proteins self assemble into pentamer structures and these pentamer structures come together to form virus-like particles (VLPs). The VLPs are antigenically indistinguishable from HPV virions. The VLPs contain no viral DNA and therefore the vaccine is non-infectious. Gardasil is composed of VLPs of HPV types 16, 18, 6 and 11 conjugated to a proprietary amorphous aluminum hydroxyphosphate sulfate adjuvant. The results of a rigorous clinical program have demonstrated that the vaccine is safe and highly efficacious in preventing dysplasias, cervical intraepithelial neoplasias (CIN 1-3) the precursors of cervical cancer and external genital lesions caused by vaccine-HPV types. In conclusion, Gardasil addresses a major medical need, that is, reduction of HPV-related disease including cervical cancer as a safe, immunogenic, and highly efficacious vaccine.     

HPV或TCT检测对农村地区妇女早期宫颈癌筛查价值对比分析

目的宫颈癌是排名第4的女性常见恶性肿瘤之一,且致病原因明确,可在早期进行预防。本研究以淄博市适龄农村妇女宫颈癌筛查项目为例,比较2种筛查方法在早期宫颈癌筛查中应用效果,旨在探讨合理筛查方案。方法将2014-07-01-2018-12-31参加张店区中埠镇卫生院宫颈癌免费筛查项目的9 788名农村妇女作为研究对象,采用液基细胞学检查(thinprep cytologic test,TCT)和人乳头瘤病毒(human papilloma virus,HPV)检测,并联合阴道镜下活检进行宫颈癌筛查,对比2种检查方法对宫颈癌、非典型鳞状上皮细胞(atypical squamous cell of undefined significance,ASCUS)及以上程度宫颈病变阳性预测值。结果 TCT初筛阳性者490例,阳性率为5.01%;HPV初筛阳性者465例,阳性率为4.75%,2种方法初筛阳性检出率差异无统计学意义,χ~2=0.688,P=0.249。经阴道镜及多点活检病理组织学检查,TCT初筛阳性者宫颈浸润癌6例,非宫颈癌45例,宫颈癌阳性预测值为0.76%,ASCUS及以上程度宫颈病变的阳性预测值为10.41%;HPV初筛阳性者宫颈浸润癌7例,非宫颈癌51例,宫颈癌阳性预测值为1.51%,ASCUS及以上程度宫颈病变的阳性预测值为12.47%,2种检测方法宫颈癌阳性预测值、ASCUS及以上程度宫颈病变阳性预测值比较,差异均无统计学意义,均P0.05。结论 TCT与HPV检测对适龄农村妇女宫颈癌筛查结果并无差异,可根据具体情况选择运用,但尚需扩大样本验证。     

Prevalence and determinants of high-risk human papillomavirus (HPV) infection and cervical cytological abnormalities in imprisoned women

The aim of the study was to estimate the prevalence and risk factors associated with infection by high-risk human papillomavirus (HR-HPV) in cervix and squamous intra-epithelial lesions (SIL) in imprisoned women. This was done by a cross-sectional study of imprisoned women attending the gynaecological clinic in Foncalent prison in Alicante, Spain. The study period was from May 2003 to December 2005. HR-HPV infection was determined through Digene HPV Test, Hybrid Capture II (HC-II). HPV typing was determined by multiplex nested PCR assay combining degenerate E6/E7 consensus primers. Multiple logistic regression modelling was used for the analysis of associations between variables where some were considered possible confounders after checking for interactions. A total of 219 women were studied. HR-HPV prevalence was 27.4% and prevalence of SIL was 13.3%. HIV prevalence was 18%, higher in Spaniards than in migrant women (24.6% vs. 14.3%, P<0.05). In multivariate analyses, risk factors for HPV infection were younger age (P for trend=0.001) and tobacco use (OR 2.62, 95% CI 1.01-6.73). HPV infection (OR 4.8, 95% CI 1.7-13.8) and HIV infection were associated with SIL (OR 4.8, 95% CI 1.6-14.1). The commonest HPV types were HPV16 (29.4%), HPV18 (17.6%), HPV39 (17.6%) and HPV68 (17.6%). The prevalence of both HR-HPV infection and SIL in imprisoned women found in this study is high. Determinants for each of the outcomes studied were different. HPV infection is the most important determinant for SIL. A strong effect of HIV co-infection on the prevalence of SIL has been detected. Our findings reinforce the need to support gynaecological clinics in the prison setting.     

HPV vaccines to prevent cervical cancer and genital warts: an update

Cervical cancer is an important public health problem worldwide, and especially in developing countries. The link between cervical cancer and oncogenic human papillomavirus (HPV) infection has been clearly established. Furthermore, non-oncogenic HPV are responsible for the majority of genital warts. Two prophylactic HPV vaccines are available, which have the potential of considerably reducing HPV-related morbidity and mortality. Both vaccines are based on virus-like particles of the L1 capsid protein, and are highly efficacious and immunogenic if given before exposure to HPV, i.e. to adolescent girls between 9 and 13 years of age in a three-dose schedule. This review describes the immunology of natural HPV infections and the immune response evoked through vaccination. The current duration of protection is 8.4 years with the bivalent vaccine (HPV16/18) and 5 years with the quadrivalent vaccine (HPV6/11/16/18). Research is on-going to evaluate the efficacy of the current vaccines in a two-dose schedule, as compared to the recommended three-dose schedule. To increase the protection, the development and testing of a nine-valent prophylactic HPV vaccine (HPV6/11/16/18/31/33/45/52/58) is being undertaken. Research is also directed towards therapeutic vaccines and the development of a prophylactic L2 vaccine.     

妇科疾病患者HPV感染及其影响因素分析

  目的  探讨河北省承德地区人乳头瘤病毒（HPV）感染影响因素及不同治疗方法干预效果。  方法  选择2013年1月 — 2016年1月期间承德市8县3区自愿参加本研究并接受调查问卷的4 250名女性作为研究对象,对所有对象同时进行宫颈液基薄层细胞学检测及HPV DNA检测,对HPV16/18型和细胞学显示ASCUS及以上患者进行阴道镜检查、定点活检和病理检查。分析承德地区HPV感染现状及相关危险因素,同时对HPV感染高危患者采用不同的治疗方式加以临床护理,比较其治疗效果。  结果  承德地区4 250名研究对象中,有770例HPV感染患者,总感染率为18.12 %,其中高危亚型11种共710例,感染率为16.71 %,低危亚型3种共60例,感染率为1.41 %,高危亚型感染患者以16型、51型、53型、56型、58型为主,低危亚型感染患者以6型、11型、12型为主;单因素及多因素结果表明,承德地区HPV感染率与生活地址、首次性生活年龄、性伴侣数、生产次数、流产史、性伴侣包茎或包皮过长、生产方式、宫颈癌家族史均为HPV感染的危险因素（P < 0.05）;对于HPV感染高危患者药物治疗效果有效率明显低于手术治疗及物理疗法,手术治疗其治疗效果最佳,差异有统计学意义（P < 0.05）。  结论  承德地区HPV感染率较高,且发生率影响因素较多,应根据可能危险因素制定有效的措施进行干预,降低HPV感染。     

门诊健康体检妇女人乳头瘤病毒宫颈感染状况及持续性感染影响因素

目的 探讨门诊健康体检妇女人乳头瘤病毒(HPV)宫颈感染状况及持续性感染影响因素。方法 选择2019年1-12月于河南大学淮河医院门诊进行健康体检妇女为研究对象,收集体检妇女的流行病学调查问卷、宫颈液基薄层细胞检测(TCT)、宫颈上皮脱落细胞HPV分型检测。采用单因素及多因素Logistic分析高危型人乳头瘤病毒宫颈持续性感染影响因素。结果 10 472份HPV分型检查样本中阳性率为25.6%(2 685/10 472)。人乳头瘤病毒初筛阳性2 685例,随访2次后发现持续感染530例,持续感染率为19.7%;检出高危型人乳头瘤病毒阳性患者2 208例,其中持续性感染479例,持续感染率为21.7%。单因素分析结果,不同年龄、不同初次性生活年龄、不同避孕方式、不同性交频率、吸烟史、阴道宫颈炎症、性交后清洗是高危型人乳头瘤病毒宫颈持续性感染的影响因素(P<0.05)。多因素分析结果显示,年龄>50岁、非避孕套避孕是高危型人乳头瘤病毒宫颈持续性感染的独立危险因素。结论 河南大学淮河医院门诊健康体检妇女人乳头瘤病毒感染最为常见的亚型为HPV16、HPV58、HPV52,年龄>50岁、非避孕套避孕是高危型人乳头瘤病毒宫颈持续性感染的独立危险因素。     

宫颈癌与女性生殖道感染的相关性研究

目的观察宫颈癌与女性生殖道人乳头瘤病毒、单纯疱疹病毒Ⅱ型、沙眼衣原体、滴虫、细菌性阴道病感染的相关性。方法选择医院2012年1月-2015年12月宫颈癌患者100例为宫颈癌组,健康体检女性100名为对照组,检测生殖道人乳头瘤病毒、单纯疱疹病毒Ⅱ型、沙眼衣原体、滴虫、细菌性阴道病感染情况。结果宫颈癌组患者生殖道人乳头瘤病毒、单纯疱疹病毒Ⅱ型、沙眼衣原体、滴虫、细菌性阴道病的感染率均高于对照组,差异有统计学意义(P<0.05);宫颈癌组高危型人乳头瘤病毒检出率明显高于对照组,差异有统计学意义(P<0.05);宫颈癌组人乳头瘤病毒合并沙眼衣原体、人乳头瘤病毒合并滴虫、人乳头瘤病毒合并细菌性阴道病的感染率均高于对照组,差异有统计学意义(P<0.05);高危型人乳头瘤病毒感染和沙眼衣原体、滴虫、细菌性阴道病感染均呈正相关,差异有统计学意义(P<0.05)。结论宫颈癌的发生与生殖道感染有关,宫颈癌患者生殖道人乳头瘤病毒感染以高危型为主,高危型人乳头瘤病毒感染和沙眼衣原体、滴虫、细菌性阴道病感染均呈正相关。