中国城市妇女人乳头状瘤病毒多重感染情况及其与子宫颈病变的关系

目的 调查中国城市女性子宫颈上皮内人乳头状瘤病毒(human papillomavirus,HPV)的多重感染状况及其与子宫颈病变之间的关系.方法 在中国南方和北方代表城市(广东省深圳市和辽宁省沈阳市)中,采用相同研究方案,经整群抽样,在每个城市中各选取1个社区,对2个社区中1712名(深圳市1027名;沈阳市685名)15-59岁女性进行横断而调查,并收集子宫颈上皮脱落细胞,对HPV进行检测和分型.结果 1712名受检者HPV多重感染率为4.73%(81/1712),HPV多重感染率在城市间的差异无统计学意义深圳为4.38%(45/1027),沈阳为5.26%(36/685),X~2=0.70,P=0.404].HPV多重感染者中,HPV16型感染占的比重最高为23.46%(19/81),其次为HPV58和52型,各占19.75%(各16例).子宫颈细胞学检查正常人群中,HPV多重感染率为3.42%(55/1606).而子宫颈低度病变和高度病变者中HPV多重感染率分别为17.39%(12/69)和37.84%(14/37),HPV多重感染率随病变程度加深而增加(Z=9.38,P<0.01).HPV多重感染导致高度病变风险比单一感染更大(多重感染:OR=96.61,95%CI值为32.07～291.06;单一感染:OR=34.60,95%CI值为12.59～95.02);对于导致低度病变风险而言,两者差别不大OR值(95%CI值)分别为15.00(6.89～32.65)、12.04(6.88～21.08)].多因素分析显示,多个性伴侣是HPV多重感染的主要危险因素(OR=2.04,95%CI值:1.19～3.49).结论 中国城市女性中,HPV多重感染导致宫颈高度病变的危险性要显著高于单一感染.HPV多重感染有可能作为子宫颈病变早诊早治和随访的有效指标之一.

Relationship between multiple infection of human papillomavirus and cervical neoplasia among Chinese women in urban areas

Objective To investigate the prevalence of multiple infections of human papillomavirus (HPV) and its relationship with cervical neoplasia among Chinese women in urban areas. MethodsA population-based cross-sectional study was performed among 1712 women (1027 in Shenzhen, Guangdong province and 685 in Shenyang, Liaoning province, respectively) aged 15 -59 years in China. One community was chosen by cluster sampling in each city. Exfoliated cervical cell was collected and HPV types were detected. ResultsThe total HPV prevalence of multiple infections was 4. 73% (81/1712). There was no significant difference of HPV infection between two cities (Shenzhen vs Shenyang:4. 38% (45/1027) vs 5.26 % (36/685) ; X~2 = 0. 70 ,P = 0. 404). Among all multiple infections, HPVI 6-related infection was the most common one, accounting for 23.46% (19/81), followed by HPV52 and 58 (19. 75% for each, 16/81). HPV prevalence of multiple infections were 3. 42% (55/1606), 17. 39% (12/69) and 37. 84% (14/37) among the women with normal corvix, low-grade lesion and high-grade lesion, respectively. The HPV prevalence of multiple infections increased with the severity of cervical neoplasia (Z = 9. 38, P =0. 01). The risk of high-grade lesion increased more dramatically among the women with multiple infections than single infections (adjusted OR = 96. 61,95% CI: 32. 07 - 291.06 vs adjusted OR = 34. 60,95% CI: 12. 59- 95.02 for multiple and single infections, respectively). However, the risk of low-grade lesion increased relatively similarly among the women with the multiple and single infections (OR = 15.00,95% CI: 6. 89 - 32.65 vs OR = 12. 04,95% CI: 6. 88 - 21.08 for multiple and single infections, respectively). Multiple-sexual-partner was the key risk factor for multiple infection of HPV (OR = 2. 04,95% CI: 1.19 -3. 49). Conclusion Multiple infections may play a higher role than single infection in the development of cervical neoplasia. Multiple HPV infections could be introduced into the strategy for cervical cancer prevention as a possible biomarker.