HPV单一与多重型别感染子宫颈病变风险比较

目的 对比HPV单一与多重型别感染者子宫颈病变风险,探索相应的管理模式.方法 回顾性总结2010年至2012年在北京大学第一医院妇产科同时行子宫颈细胞学与HPV检测且高危型HPV阳性妇女7 192例的临床资料,分析HPV高危型单一与多重型别感染者子宫颈癌前病变及浸润癌的相关性.结果 7 192例HPV高危型感染者中单一及多重型别感染率分别占75.88%及24.12%.在单一及多重型别感染者中,最常检出的型别均为16型,其次为58型、52型、53型.单一与多重型别感染者中细胞学高级别异常及以上占比分别7.81%及8.24%,两者无统计学差异(χ2=0.343,P=0.574),Logistic回归分析发现HPV16、31、33型别感染与细胞学高级别及以上异常具有相关性OR分别为3.700(95%CI:3.048~4.492)、2.038(95%CI:1.568~2.647)、1.563(95%CI:1.110~2.201)].单一与多重型别感染者中CIN2+检出率分别为22.29%及23.04%,CIN3+检出率分别为11.72%及8.73%,两组感染者CIN2+检出无统计学差异(χ2=0.226,P=0.653),CIN3+检出有统计学差异(χ2=0.622,P=0.011),在HPV16、HPV16/18单一与多重型别感染者CIN2+检出均无统计学差异(χ2值分别为2.215、2.680,均P>0.05),CIN3+检出均有统计学差异(χ2值分别为0.622、11.112,均P<0.05),在非HPV16/18型单一及多重型别感染者CIN2+、CIN3+检出均无统计学差异(χ2值分别为2.747、0.199,均P>0.05).Logistic回归分析发现HPV 16型、单一型感染、细胞学异常及高级别异常与子宫颈病变CIN2+具有相关性OR值分别为2.358(95%CI:1.934~2.874)、1.264(95%CI:1.020~1.566)、2.216(95%CI:1.779~2.761)、9.599(95%CI:7.728~112.575);HPV16、33型别感染、细胞学异常及高级别异常与CIN3+具有相关性OR值分别为4.192(95%CI:3.102~5.665)、1.806(95%CI:1.183~2.757)、2.919(95%CI:1.360~2.708)、10.357(95%CI:7.545~14.215).结论 HPV多重型感染虽可导致更多的细胞学异常,但尚未导致更多的高级别细胞学异常;HPV单一型别、HPV16型别、16/18型别感染者的CIN3+风险增高,临床上应重视对这一人群的管理.

Comparison of risk of cervical lesions in HPV single and multiple infections

Objective To compare the risk of cervical lesions in patients with single and multiple types of human papilloma virus (HPV) infections and to explore the corresponding management model.Methods Clinical data of 7 192 women accepting cervical cytology and HPV detection with positive in high risk HPV in Peking University First Hospital during 2010-2012 were summarized retrospectively.The correlation between cervical precancerous lesions and invasive carcinoma in HPV high-risk single and multiple severe infections was analyzed.Results Among 7 192 HPV high-risk patients, the rates of single and multiple infections were 75.88% and 24.12%, respectively.Among the single and multiple types of infection, the type detected most frequently was type 16, followed by type 58, type 52 and type 53.Among the patients with single or multiple infections, the rate of high-level abnormalities and worse results in cytology was 7.81% and 8.24%, respectively.There was no statistical difference between two groups (χ2=0.343, P=0.574).Logistic regression analysis showed that type 16, type 31 and type 33 of HPV infection were associated with high-level abnormalities and worse results in cytology OR value was 3.700 (95%CI: 3.048-4.492), 2.038 (95%CI: 1.568-2.647) and 1.563 (95%CI: 1.110-2.201).The detection rate of CIN2+ was 22.29% and 23.04%, respectively among the patients with single and multiple infections, while the detection rate of CIN3+ was 11.72% and 8.73% among them.There was no significant difference in CIN2+ detection between two groups (χ2=0.226, P=0.653), but statistical difference was showed in CIN3+ detection (χ2=0.622,P=0.011).In HPV16 and HPV16/18, there was no statistically significant difference in CIN2+ detection between patients with single and multiple infections (χ2 value was 2.215 and 2.680, respectively, both P>0.05), while statistical difference was showed in CIN3+ detection (χ2 value was 0.622 and 11.112, respectively, both P<0.05).There was no significant difference in CIN2 + and CIN3 + detection between single and multiple infected patients with non-type HPV16/18 1](χ2 value was 2.747 and 0.199, respectively, both P>0.05).Logistic regression analysis showed that HPV type 16, single infection, cytology abnormality and high-level cytology abnormality were correlated with CIN2+ OR value was 2.358 (95%CI:1.934-2.874), 1.264 (95%CI:1.020-1.566), 2.216 (95%CI:1.779-2.761), 9.599 (95%CI:7.728 to 112.575), respectively].Whereas HPV type 16 and type 33 infection, cytology abnormality and high-level cytology abnormality were associated with CIN3+ OR value was 4.192 (95%CI:3.102-5.665), 1.806 (95%CI:1.183-2.757), 2.919 (95%CI:1.360-2.708), 10.357 (95%CI:7.545-14.215), respectively].Conclusion Multiple infection of HPV might lead to more cytology abnormality but not led to more high-level cytology abnormality.Patients with single HPV infection, type 16 and type 16/18 HPV infection are at high risk of CIN3+, and the management on them should be paid more attention in clinics.