CIN2+患者高危型HPV感染情况及治疗方法分析

目的研究宫颈上皮内瘤变(CIN)2级及以上(CIN2+)患者高危型人乳头瘤病毒(HPV)持续感染的可能因素和治疗方法。方法249例CIN2+合并高危型HPV感染患者接受环形电切术(LEEP)治疗,依据术后1年高危型HPV检测是否转阴分为术后转阴组(n=160)和持续感染组(n=89),依据治疗方式将89例持续感染组患者分为对照组(n=41)和联合组(n=48)。对照组患者接受重组人干扰素α2b阴道泡腾片治疗,联合组患者在此基础上联合保妇康栓治疗。比较术后转阴组和持续感染组患者术前高危型HPV分型及持续感染的相关因素,以及对照组和联合组患者药物治疗后高危型HPV转阴情况。结果持续感染组患者术前多重感染率为24.72%,高于术后转阴组的21.88%,但差异无统计学意义(P﹥0.05)。持续感染组和术后转阴组患者高危型HPV亚型均以HPV16和HPV58为主。持续感染组和术后转阴组CIN2+患者切缘情况、性伴侣人数、避孕方式、人工流产次数和CIN分级情况比较,差异均有统计学意义(P﹤0.01)。治疗后,联合组患者高危型HPV感染转阴率为79.17%,高于对照组患者的58.54%,差异有统计学意义(P﹤0.05)。结论应加强对有不健康性行为史、宫颈锥切术切缘阳性、高级别CIN患者的术后随访,预防高危型HPV的持续感染,发现持续感染应及时行抗病毒治疗。保妇康栓联合重组人干扰素α2b阴道泡腾片可能使接受LEEP手术的CIN2+合并HPV持续感染的患者获益。     

HPV基因亚型分布及其与CIN的相关性研究

[目的]探讨健康体检妇女HPV基因亚型分布状况,及HPV感染后宫颈上皮内瘤变的发生情况。[方法]2012年5月至2013年10月于深圳市妇幼保健院行健康体检HPV分型检测阳性的妇女,所有研究对象均进行宫颈HPV分型检测、阴道镜检查及宫颈组织活检。[结果]本研究共纳入妇女2578例,年龄18~70岁,病理结果为正常或炎症者1983例,CINⅠ为278例,CINⅡ/Ⅲ为308例,宫颈浸润癌9例。HPV基因亚型构成前5位高危型HPV为HPV52、43、16、58、56;CINⅠ中HPV基因亚型构成前5位依次为HPV52、16、58、56、43,CINⅡ/Ⅲ中HPV基因亚型构成前5位依次为HPV16、58、52、33、18;随着感染HPV亚型增多,CIN构成比升高,差异具有统计学意义（P〈0.01）;高度宫颈上皮内病变（CINⅡ/Ⅲ）以25~44岁年龄段相对多见。[结论]深圳市妇幼保健院健康体检妇女HPV基因亚型分布与其他地域存在差异。不同程度宫颈癌前病变HPV亚型分布可能存在差异,而HPV16、52、58在宫颈病变中均占有重要地位;HPV多重感染者,CIN风险明显增加;25~44岁有性生活妇女应为宫颈癌筛查的侧重点人群。     

宫颈高级别病变与HPV感染型别分析

目的探讨HPV在宫颈高级别病变中的感染率及感染型别。方法采用导流杂交法分别检测CINII～Ⅲ30例和宫颈癌患者160例HPV基因型别,比较HPV感染与宫颈病变的关系。结果CINⅡ～III和宫颈癌患者HPV感染率均为90％,且以单型别感染为主,分别为70．37％（19／27）、81．94％（118／144）;在CIN II～Ⅲ中HPV58型、52型感染居多,宫颈癌则以HPV16型、18型感染最常见;无论宫颈鳞癌还是宫颈腺癌,以HPV16型检出率最高。结论HPV16型、18型是宫颈癌的主要致病型,不同病理类型并无HPV型别上的差异;宫颈上皮高级别内瘤变则以HPV58型、52型感染为主;对HPV58型、52型感染者应重视随访。     

HPV和TCT检测对LEEP治疗CIN效果的监测意义

目的：探讨Leep治疗CIN的疗效和是否能有效消除HPV感染，以此评估该治疗方法对CIN治疗的有效性。方法：对98例TCT异常，高危型HPV阳性，组织学检查证实为CIN1—3的妇女实行Leep治疗，治疗后3个月再次行TCT检查并检测高危型HPV。阳性病例行组织学检查。结果：CIN1 HPV转阴率为74．2％（49／66），病变残留率为4、5％（3／66），病变残留与HPV持续阳性成正比；CIN2～3HPV转阴率为46．9％（15／32），病变残留率为34．4％（11／32）。病变残留与HPV持续阳性成正比；CIN1组治疗后HPV阴转率及病灶彻底切除率均高于CIN2～3组，统计学分析有显著意义。结论：高危型HPV感染率与CIN程度成正比，CIN2—3高于CIN1；Leep不仅可以有效治疗CIN1，而且可以有效降低HPV感染率；Leep治疗对部分CIN2～3尚不够充分，应加大宫颈组织的切除范围和深度；Leep治疗后残留病变与HPV持续阳性密切相关；TCT和HC-2检测不仅可以评价CIN疗效，而且可以作为CIN治疗后追踪随访的有效手段。     

宫颈细胞学阴性患者高危型HPV含量与CIN2及更高级别病变的相关性

[目的]探讨高危型人乳头状瘤病毒(HPV)检测对宫颈液基细胞学阴性妇女宫颈上皮内瘤变(CIN)的诊断价值。[方法]收集宫颈癌筛查中细胞学阴性而高危型HPV阳性的妇女498例,行阴道镜下宫颈活检。分析高危型HPV负荷量与CIN2+的相关性。[结果]在498例患者中,CIN2+病变者共65例,占13.1%。高危型HPV<10的257例中患CIN2+有13例,占5.1%。高危型HPV10~100和>100的病例中患CIN2+比例分别为18.2%(26/143)和26.5%(26/98)。各组之间的CIN2+比例差异有统计学意义(χ2=93.673,P=0.000)。在调整年龄因素后,高危型HPV 10~100患CIN2+的风险是<10者的2.356倍(95%CI:1.449~8.828),而>100者患CIN2+的风险是<10者的3.595倍(95%CI:2.214~13.533)。[结论]高危型HPV负荷量与CIN病变级别密切相关,高危型HPV负荷量越高,患CIN2+的危险度越高。     

宫颈上皮内瘤变患者高危型HPV基因分型的研究

[目的]研究青岛地区宫颈上皮内瘤变患者的高危型人乳头瘤病毒感染的基因分型情况。[方法]应用型特异聚合酶链反应检测宫颈上皮内瘤变患者高危型HPV的分型情况。[结果]各型HPV的感染率之间差异具有非常显著性（χ^2=42.632,P〈0.001）。四种高危型HPV感染率从高到低依次为：HPV16,HPV58,HPV18,HPV33。[结论]青岛地区主要高危型HPV在宫颈上皮内瘤变患者中感染的主要型别依次为HPV16,HPV58,HPV18,HPV33,为宫颈疾病的筛查和治疗提供依据,同时也指导本地区HPV疫苗的研究。     

高危型HPV亚型及亚型组合检测宫颈癌及高级别宫颈上皮内瘤变的比较研究

背景与目的：高危型人乳头状瘤病毒(high risk human papillomavirus,hrHPV)感染对于浸润性宫颈癌(invasive cervical carcinoma,ICC)及其癌前病变的致病性存在亚型及地区差异。本研究通过分析本地区30岁及以上女性宫颈病变患者中HPV亚型分布特点,进一步识别罹患包含ICC的高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia grade 2 or worse,CIN2+)风险更高的亚型,并比较这些高风险亚型及亚型组合检测CIN2+病变的有效性。方法：收集来自复旦大学附属肿瘤医院就诊患者具备组织学随访结果的宫颈标本,行PCR-反向点杂交法(PCR-reverse dot blot,PCR-RDB)HPV基因分型检测,利用Logistic回归模型分析hrHPV亚型与CIN2+病变的风险关系,并构建ROC曲线(receiver operating characteristiccurve,ROC curve)评价不同亚型及亚型组合检测CIN2+病变的准确性。结果：符合研究要求患者413例,含38例CIN1,184例CIN2/3,126例ICC和65例阴性对照人群。HPV16、58、33和18依次为致CIN2+最常见的4种HPV亚型,仅HPV16(P<0.000 1)、58(P=0.002)及33(P=0.015)为罹患CIN2+病变的高风险亚型。联合检测HPV16/18/33/58诊断CIN2+病变的ROC曲线下面积(the area under the ROC curve,AUC)显著高于HPV16/18亚型组合(P=0.006 6)。结论：HPV16/18/33/58亚型组合用于辅助本地区CIN2+病变的检测可能更为有效。     

HPV在宫颈病变中的临床意义

生殖道人乳头瘤病毒(HPV)感染是一种广泛流行的性传播疾病.高危型HPV持续感染被认为是宫颈癌及其癌前病变发生的主要因素.多重HPV感染、HPV病毒负荷与宫颈癌及其癌前病变的病变程度及发展密切相关.目前,对于宫颈HPV感染检测有多种手段,其中PCR和捕获杂交技术(HCⅡ)在临床实验室应用较广泛.在宫颈癌的筛查中联合应用HPV检测和细胞学,可以提高敏感性、减少随诊频率,减少不必要的阴道镜检查.对于细胞学检查为不典型鳞状细胞(ASCUS)者,HPV检测可以帮助进一步区分高危人群.同时,HPV检测有可能作为一种有效的宫颈癌前病变及宫颈癌治疗后随访的预后指标.     

高危型HPV—DNA检测对ASCUS分流监测的临床价值

目的：评价高危型人类乳头瘤病毒（HPV）检测对未明确意义的不典型鳞状细胞（Atypicalsquamouscellsofundeterminedsignificance,ASCUS）分流监测的临床价值。方法：对376例初筛结果为ASCUS病例,3个月后进行宫颈液基细胞学复查和高危型HPV—DNA检测,并根据检查结果将病例分为4组：A组,细胞学＋／HPV＋;B组,细胞学-／HPV＋;C组,细胞学＋／HPV-;D组,细胞学-／HPV-。对A、B、C组病例进行了阴道镜检查及活检,比较3组问宫颈上皮内瘤变（cervicalintraepithelialneoplasma,CIN）发生率的差异。由于D组发展成为肿瘤的风险极低,不纳入比较。结果：A组（细胞学＋／HPV＋）患者CINⅡ／Ⅲ发生率为41．59％,B组（细胞学-／HPV＋）为23．75％,而C组（细胞学＋／HPV-）为3．70％。高危型HPV在ASCUS患者中感染率随年龄增长而降低,其中30岁以下年龄组高危型HPV—DNA阳性率为71．43％,而50岁以上年龄组仅为26．80％。结论：在二次筛查中增加高危型HPV-DNA检测较单纯重查宫颈液基细胞学检测可提高CINⅡ／Ⅲ检出率。ASCUS临床意义可随年龄增长而出现明显变化。高危型HPV-DNA检测可对ASCUS进行有效的分流监测。     

珠海地区妇女宫颈上皮内瘤变与高危型人乳头瘤病毒亚型关系的初步研究

目的探讨珠海地区妇女宫颈上皮内瘤变与高危型人乳头瘤病毒亚型的关系。方法采用杂交捕获二代（HC-Ⅱ）方法定量检测珠海地区宫颈疾病患者HPV-DNA的含量,全部269例患者阴道镜下多点取活组织病理检查,根据病理学诊断结果分组。结果珠海地区高危型HPV在慢性宫颈炎、C INⅠ、C INⅡ及C INⅢ的感染率分别为13.5%、48.2%、73.8%及93.7%,HPV16在四组中感染率依次为3.6%、13.4%、47.6%及65.6%,宫颈病变存在多重HPV感染。结论珠海地区宫颈上皮内瘤变患者感染HPV16、18、31、58及35型较多见,多重HPV感染可能促进宫颈上皮内瘤变的发生。     

Differences in human papillomavirus type distribution in high‐grade cervical intraepithelial neoplasia and invasive cervical cancer in Europe

Knowledge of differences in human papillomavirus (HPV)‐type prevalence between high‐grade cervical intraepithelial neoplasia (HG‐CIN) and invasive cervical cancer (ICC) is crucial for understanding the natural history of HPV‐infected cervical lesions and the potential impact of HPV vaccination on cervical cancer prevention. More than 6,000 women diagnosed with HG‐CIN or ICC from 17 European countries were enrolled in two parallel cross‐sectional studies (108288/108290). Centralised histopathology review and standardised HPV‐DNA typing were applied to formalin‐fixed paraffin‐embedded cervical specimens dated 2001–2008. The pooled prevalence of individual HPV types was estimated using meta‐analytic methods. A total of 3,103 women were diagnosed with HG‐CIN and a total of 3,162 with ICC (median ages: 34 and 49 years, respectively), of which 98.5 and 91.8% were HPV‐positive, respectively. The most common HPV types in women with HG‐CIN were HPV16/33/31 (59.9/10.5/9.0%) and in ICC were HPV16/18/45 (63.3/15.2/5.3%). In squamous cell carcinomas, HPV16/18/33 were most frequent (66.2/10.8/5.3%), and in adenocarcinomas, HPV16/18/45 (54.2/40.4/8.3%). The prevalence of HPV16/18/45 was 1.1/3.5/2.5 times higher in ICC than in HG‐CIN. The difference in age at diagnosis between CIN3 and squamous cervical cancer for HPV18 (9 years) was significantly less compared to HPV31/33/‘other’ (23/20/17 years), and for HPV45 (1 year) than HPV16/31/33/‘other’ (15/23/20/17 years). In Europe, HPV16 predominates in both HG‐CIN and ICC, whereas HPV18/45 are associated with a low median age of ICC. HPV18/45 are more frequent in ICC than HG‐CIN and associated with a high median age of HG‐CIN, with a narrow age interval between HG‐CIN and ICC detection. These findings support the need for primary prevention of HPV16/18/45‐related cervical lesions.     

Long‐term risk of cervical cancer following conization of cervical intraepithelial neoplasia grade 3—A Danish nationwide cohort study

Using nationwide Danish registries we examined the long‐term risk of cervical cancer in women diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3) (including adenocarcinoma in situ (AIS)) on the cone compared to women with a normal cytology test. Initially, we identified women born 1918–1990, who were recorded as living in Denmark between January 1, 1978 and December 31, 2012. From the Pathology Data Bank information on CIN3 on the cone, margins status, histological type of CIN3 and cervical cytology results was extracted. Cox proportional hazard model was used to estimate the relative risk of subsequent cervical cancer. We included 59,464 women with CIN3 on the cone and 1,918,508 women with a normal cytology test. Overall, women diagnosed with CIN3 had a higher risk of subsequent cervical cancer compared to women with normal cytology (HR = 2.06; 95%CI: 1.81–2.35). Analyses according to time since conization showed elevated risks in all time periods, and 25 years or more after conization the relative risk was significantly increased (HR = 2.56; 95%CI: 1.37–4.77). Twenty years or more after conization, also women with negative margins had an increased relative risk (HR = 2.49; 95%CI: 1.12–5.57). In addition, the long‐term relative risk of cervical cancer varied with the different histological types of CIN3 and was highest for AIS (HR = 7.50; 95%CI: 1.87–30.01, 10–14 years after conization). In conclusion, women diagnosed with CIN3 on the cone have a long‐lasting increased risk of cervical cancer even when the margins on the cone are negative.     

Clearance of human papillomavirus infection after successful conization in patients with cervical intraepithelial neoplasia

The natural history of high‐risk human papillomavirus (HRHPV) infection after successful treatment of cervical intraepithelial neoplasia (CIN) is not well known. This study was performed to evaluate the rate and pattern of HRHPV infection clearance after successful conization for CIN and to analyze factors associated with such clearance. A total of 287 patients who underwent loop electrosurgical excision procedures (LEEP) owing to HRHPV‐associated CIN were included. All patients had negative resection margins on LEEP specimens and underwent HPV testing with the hybrid capture II system at 3‐, 6‐, 9‐, 12‐, 18‐ and 24‐month follow‐up visits after LEEP. Persistent HPV infections were detected in 45.6%, 14.3%, 6.3%, 2.2%, 1.5% and 1.1% of patients at 3, 6, 9, 12, 18 and 24 months after LEEP, respectively. Clearance rates did not differ by age, parity or severity of cervical lesion. However, clearance rates were significantly slower in patients with HPV DNA loads >500 RLU/PC before LEEP (p = 0.040). During 2 years of follow‐up after LEEP, 24 patients had recurrent disease revealed by biopsy. The odds ratios for recurrent disease in patients with persistent HRHPV infection increased gradually from 5.17 at the 3‐month follow‐up visit to 12.54, 15.69 and 25.90 at 6‐, 9‐, 12‐ and 24‐month follow‐up visits, respectively. We conclude that HRHPV infection cleared gradually in most patients within 6 months of treatment. Clearance rates were significantly slower in patients with HPV DNA loads >500 RLU/PC. Persistent HPV infection was a significant positive predictor of recurrence.     

Cumulative risk of cervical intraepithelial neoplasia for women with normal cytology but positive for human papillomavirus: Systematic review and meta-analysis

Most women positive for human papillomavirus (HPV) are cytology normal. The optimal screen-management of these women is unclear given their risk of developing precancer. We performed a systematic review and meta-analysis of progression rates to precancer and cancer for HPV-positive, cytology normal women. We searched MEDLINE, EMBASE and Scopus for prospective studies measuring the cumulative incidence of precancer and cervical cancer in HPV-positive, cytology/histology normal women. Record screening was performed independently by two reviewers. We modeled the cumulative incidence over time using a multilevel random-effects meta-regression model. We used the model to predict HPV type-specific risks of precancer and cancer over follow-up. Data from 162 unique records were used in our analysis. The average incidence rate of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) in high-risk HPV positive but cytology/histology normal women was 1.0 per 100 women-years (95% CI: 1.0-1.1). This corresponds to an average cumulative risk at 1, 3 and 5 years of 2.1% (95% prediction interval 0.0-9.5), 4.3% (95% prediction interval 0.0-11.5) and 6.4% (95% prediction interval 0.0-13.5). HPV type was a strong predictor of the risk of oncogenic progression. There was substantial heterogeneity in the background precancer risk across studies (P-value < .0001). Our HPV type-specific progression risk estimates can help inform risk-based cervical cancer screening guidelines for HPV-positive women. However, precancer and cervical cancer risks are highly variable and may not be generalizable between populations.     

Genome-wide DNA methylation profiling identifies two novel genes in cervical neoplasia

DNA methylation analysis may improve risk stratification in cervical screening. We used a pan-epigenomic approach to identify new methylation markers along the continuum of cervical intraepithelial neoplasia (CIN) to cervical cancer. Physician-collected samples (54 normal, 50 CIN1, 40 CIN2 and 42 CIN3) were randomly selected from women at a single-center colposcopy clinic. Extracted DNA was subjected to Illumina Infinium EPIC array analysis, and methylation was assessed blinded to histopathological and clinical data. CpG sites whose state of methylation correlated with lesion grade were assessed (Spearman correlation), and a weighted methylation score was calculated comparing normal to CIN3. Validation of the top selected genes was performed in an independent cohort (100 normal, 50 CIN1, 50 CIN2, 50 CIN3 and 8 cervical cancers) of new patients, referred for colposcopic examination at three hospitals, using targeted DNA methylation Illumina amplicon sequencing. The relationship between a combined weighted marker score and progression from normal through precancerous lesions and cervical cancer was compared using one-way ANOVA. Our analyses revealed 7,715 CpGs whose methylation level correlated with progression (from normal to CIN1, CIN2 and CIN3), with a significant trend of increased methylation with lesion grade. We shortlisted a bigenic (hyaluronan synthase 1, HAS1 and ATPase phospholipid transporting 10A, ATP10A corresponding to cg03419058 and cg13944175 sites) marker set; r = 0.55, p < 0.0001. Validation of the four most discriminating genes (CA10, DPP10, FMN2 and HAS1) showed a significant correlation between methylation levels and disease progression (p-value < 2.2 × 10⁻¹⁶, adjusted R² = 0.952). Translational research of the identified genes to future clinical applications is warranted.     

子宫颈脱落细胞人类端粒酶RNA亚单位基因的表达对子宫颈上皮内病变的意义

目的分析人类端粒酶RNA亚单位（hTERC）基因在子宫颈脱落细胞中的表达情况及其与子宫颈上皮内病变的关系。方法采用荧光原位杂交方法,检测100例子宫颈脱落细胞涂片中hTERC基因的表达情况,其中24例为未见上皮内病变或恶性细胞（NILM）;76例为细胞学异常样本,并用二代杂交捕获法（HC2）检测其高危型人乳头瘤状病毒（HR—HPv）。结果hTERC基因在NILM、未明确意义的非典型鳞状上皮细胞（ASCUS）、非典型鳞状上皮细胞不除外高度鳞状上皮内病变（ASC—H）、低度鳞状上皮内病变（LSIL）、高度鳞状上皮内病变（HSIL）及鳞状细胞癌（SCC）中的阳性表达率分别为0、32．25％、75．00％、35．71％、81．81％和100．00％。正常对照组显著低于阳性病变各组（P〈0．05）;HSIL组显著高于ASCUS组、LSIL组（X^2=6．1736,X^2=5．0004,P〈0．05）。HPV阳性率在细胞学分组中的表达情况分别为ASCUS54．80％、ASC—H75．00％、LSIL60．70％、HSIL90．90％和SCC100．00％。HSIL以上组HR—HPV阳性率明显高于ASCUS组（X^2=4．1767,P〈0．05）。结论hTERC基因的扩增在子宫颈癌发生、发展中起重要作用。hTERC基因检测可作为预测子宫颈病变进展的生物学标志物。     

Prevalence of types 16 and 33 is increased in high-risk human papillomavirus positive women with cervical intraepithelial neoplasia grade 2 or worse

High-risk human papillomavirus (hrHPV) types are causally related to cervical cancer and its high-grade precursor lesions. The risk posed by the different hrHPV types for the development of cervical intraepithelial neoplasia grade 2 or worse (> or =CIN2) needs to be established. Here, we present the hrHPV type-distribution in relation to cytology and histology for women participating in a cervical screening program. From 44,102 women who participated in a population-based cervical screening program in the Netherlands, 2,154 hrHPV GP5+/6+ PCR positive women were recruited to determine the distribution of 14 hrHPV types by reverse line blotting of GP5+/6+ PCR products. For each HPV type, associations with cytology and histologically confirmed > or =CIN2 were measured by odds ratios. HPV types 16 and 33 were more prevalent in women, amongst those containing a single hrHPV type, with moderate dyskaryosis or worse (>BMD) than in women with normal cytology, but only in case of underlying > or =CIN2 (OR 4.10, 95%CI 2.98-5.64 and OR 2.68, 95%CI 1.39-5.15, respectively). Similar results were obtained for women with double infections (OR 3.29, 95% CI 1.61-6.75 and OR 4.37, 95% CI 1.17-16.34). Coexisting types did not influence the prevalence of > or =CIN2 in HPV 16 or 33 positive women. The increased prevalence of type 16 and 33 in hrHPV positive women with > or =CIN2, compared to women with normal cytology, suggests that infection with these types confers an increased risk for development of > or =CIN2. Distinguishing these types may therefore have implications for future cervical screening strategies.     

Persistence of HPV infection and risk of high-grade cervical intraepithelial neoplasia in a cohort of Colombian women

Little is known about the dynamics of human papillomavirus (HPV) infection and subsequent development of high-grade cervical intraepithelial neoplasia (CIN2/3), particularly in women >30 years of age. This information is needed to assess the impact of HPV vaccines and consider new screening strategies. A cohort of 1728 women 15–85 years old with normal cytology at baseline was followed every 6 months for an average of 9 years. Women with squamous intraepithelial lesions were referred for biopsy and treatment. The Kaplan–Meier method was used to estimate the median duration of infection and Cox regression analysis was undertaken to assess determinants of clearance and risk of CIN2/3 associated with HPV persistence. No difference in the likelihood of clearance was observed by HPV type or woman''s age, with the exception of lower clearance for HPV16 infection in women under 30 years of age. Viral load was inversely associated with clearance. In conclusion, viral load is the main determinant of persistence, and persistence of HPV16 infections carry a higher risk of CIN2/3.     

深圳华侨城不同职业女性生殖道HPV感染与CIN现患率调查

背景与目的:目前全世界公认HPV感染是子宫颈癌的病因。本研究旨在了解深圳市不同职业女性人群的生殖道高危型人乳头瘤病毒(human papillomavirus,HPV)感染现状及子宫颈上皮内瘤样病变(cervical intra-epithelial neoplasia,CIN)的现患率,探讨职业因素在子宫颈癌发病中的作用。方法:2004年11月至12月,在深圳市华侨城对15～59岁1137名有性生活女性居民及辖区工厂和服务业从业妇女进行以人群为基础的流行病学调查。对所有接受筛查的妇女均行电子阴道镜检查、液基细胞薄层涂片技术(liquid-based cytology test,LCT)子宫颈脱落细胞学检查及第二代杂交捕获技术(hybrid captureⅡ,HC-Ⅱ)宫颈脱落细胞中高危型HPV检测。对HPV阳性并且LCT≥未明确诊断意义的不典型鳞状上皮细胞(atypical squamous cells of undetetemined sign,ASCUS)和/或LCT≥低度鳞状上皮内瘤样病变(low grade squamous intraepithelial lesion,LSIL)的妇女行阴道镜下活组织病理学检查,以病理结果作为诊断子宫颈上皮内瘤样病变的金标准。资料采用VFP软件录入和整理,利用χ2检验和非条件Lo-gistic回归分析危险因素和CIN的关系。结果:该人群高危HPV-DNA总检出率为14.0%,社区居民、工厂工人、服务业妇女三种人群的HPV检出率分别为14.1%、9.2%、18.9%,工厂工人HPV感染率明显低于服务业妇女和社区居民(P<0.01和P<0.05)。社区居民和工厂工人各年龄组间HPV感染率差异无显著性(P>0.05),服务业妇女15～24岁和25～29岁HPV感染率分别为23.0%和28.2%,较30～34岁和35岁以上组HPV感染率明显增高(P<0.01)。本组妇女CIN现患率为4.4%,CINⅠ现患率明显高于CINⅡ和CINⅢ(P<0.05)。社区居民、工厂工人和服务业妇女CIN现患率分别为3.8%、2.8%和7.4%,服务业妇女CIN现患率明显高于社区居民和工厂工人CIN(P<0.05)。随病变级别升高HPV感染率呈趋势性增加,CINⅡ以上HPV感染率为100%。工人CINⅠ和慢性宫颈炎的HPV感染率为40.0%和47.8%,而服务业CINⅠ的感染率是85.7%,慢性宫颈炎亦有66.7%HPV阳性。单因素和多因素非条件Logistic回归分析,HPV感染是CIN的唯一高危因素(χ2=133.751,P=0.000,OR=43.431);妇女职业、性伙伴≥3个和最经常性伙伴维持时间在1年以内等者是HPV感染的显著危险因素。结论:高危型HPV感染是本组CIN的主要原因,服务业30岁以下妇女HPV感染和CIN现患率均较高,应做重点监测。