高危型HPV持续感染对宫颈癌前病变进展的影响

目的探讨高危型HPV持续感染对宫颈癌前病变进展的影响。方法选取2014年1月-2017年1月天津市第五中心医院和兰州市第一人民医院诊治的420例高危型人乳头状瘤病毒(HPV)感染者作为研究对象,随访2年并记录宫颈癌前病变进展情况。其中HPV分型采用荧光PCR法检测;宫颈细胞学采用液基薄层细胞(TCT)检测,可疑异常者转诊阴道镜检查和或组织病理学检查。结果 420例高危HPV者中,其中初感染者中比例较高的是16型(100/420,23. 81%)、52型(75/420,17. 86%)、18型(70/420,16. 67%)和58型(64/420,15. 24%);HPV16型、18型和58型在初感染、持续1年感染和持续2年感染上比较,差异均有统计学意义(均P<0. 05)。随访2年,420例高危HPV感染中,进展组和维持/逆转组分别为40例和380例,两组持续感染率比较,差异有统计学意义(P<0. 05)。进展组和维持/逆转组初次性行为年龄和性伴侣人数比较,差异均有统计学意义(均P<0. 05),但年龄、初潮年龄、各阴道炎发生率比较,差异均无统计学意义(均P>0. 05)。将初次性行为年龄、性伴侣人数、高危HPV持续感染情况纳入Logistic多因素回归模型分析,发现高危HPV持续感染及HPV16型持续感染是导致病理进展的独立危险因素(P<0. 05),其相对风险分别为2. 183倍和1. 687倍。结论高危HPV感染可导致宫颈癌前病变,尤以高危HPV持续感染及HPV16型持续感染风险最大,临床应予以密切关注。

The effect of persistent high-risk HPV infection on the progression of cervical precancerous lesions

Objective To investigate the effect of persistent high-risk HPV infection on the progression of cervical precancerous lesions. Methods 420 patients with high-risk human papillomavirus( HPV) infection who were treated in our hospital from January 2014 to January 2017 were selected as the study subjects. The patients were followed up for 2 years and the progress of cervical precancerous lesions was recorded. HPV typing was detected by fluorescent PCR,cervical cytology was detected by liquid-based thin layer cells( TCT),and those with suspected abnormalities were referred for colposcopy and histopathological examination. Results Among 420 high-risk HPV patients,16( 100/420,23. 81%),52( 75/420,17. 86%),18( 70/420,16. 67%) and 58( 64/420,15. 24%) were the most prevalent. There were significant differences among HPV 16,18 and 58 in initial infection,one-year infection and two-year infection.( P <0. 05). Following up for 2 years,of 420 cases of high-risk HPV infection,40 cases were in the progressive group and 380 cases in the maintenance/reversal group,respectively. There was significant difference in the persistent infection rate between the two groups( P< 0. 05).There was significant difference in the age of first sexual intercourse and the number of sexual partners between the progressive group and the maintenance/reversal group( P< 0. 05),but there was no significant difference in age,menarche age and the incidence of vaginitis( P>0. 05). The age of first sexual behavior,number of sexual partners and persistent infection of high-risk HPV were analyzed by logistic regression model. It was found that persistent infection of high-risk HPV and persistent infection of HPV16 were independent risk factors for pathological progress( P<0. 05),and their relative risks were 2. 183 times and 1. 687 times,respectively. Conclusion High-risk HPV infection can lead to cervical precancerous lesions,especially high-risk HPV persistent infection and HPV16 persistent infection,which should be paid close attention to clinically.