高危型人乳头状瘤病毒的感染状态及分型与宫颈病变发生的相关性研究

目的检测高危型人乳头状瘤病毒(HR-HPV)的感染状态与宫颈病变的发生及发展的相关性。方法对我院门诊2 876例妇女采用液基薄层细胞检测(TCT)、第二代杂交捕获法技术(HC2)-HPV-DNA检测及HPV分型检测,以TCT细胞学正常及高危型HPV阳性的妇女295人为目标人群,随访重复TCT细胞学和HPV基因分型,并对TCT细胞学异常的妇女进行阴道镜下宫颈组织活检。分析不同HPV感染型别、感染状态(持续性感染、间断性感染及感染清除)的TCT异常和宫颈病理异常的发生情况。结果目标群体随访1年,持续性HPV感染的女性与HPV感染清除或间断性感染的妇女相比宫颈病变的发生率无显著差异(P0.05);目标群体随访2年,持续性HPV感染女性比HPV感染清除或间断性感染妇女有更高的宫颈病变发生率(P0.01)。多重HPV感染并不比单一型别感染有更高的宫颈病变发生率(P0.05)。高危型HPV16和HPV18持续感染发生率高,且宫颈病变的发生率增加(P0.05)。结论持续性HPV感染2年以上,尤其HPV16及HPV18的持续性感染,发生宫颈病变的风险明显增加。高危HPV型别及感染状态的甄别更有临床指导意义。

Correlation between infective status of high risk human papillomavirus and cervical lesions

Objective：To explore the correlation of high-risk human papillomavirus（HPV）infection status and genotyping with occurrence of cervical lesions.Methods：A total of outpatient 2 876 women were detected by Thinprep cytology test（TCT）,HC2-HPV-DNA and HPV genotyping in Beijing Jishuitan Hospital.Among them,295 women with normal TCT and positive high-risk HPV were selected as target group.Repeated TCT and HPV-genotyping were done during 1-2 years of follow-up.Women with TCT cytological abnormality were performed with colposcopic biopsy and pathological diagnosis.Infection of high-risk HPV was classified to following categories：clearance of HPV infection,intermittent and persistent HPV infection,single or multiple HPV infection.Results：The morbidity of cervical lesions in the women with persistent HPV infection for more than two years was significantly higher than that in the women with HPV infection clearance or intermittent infection（P＜0.01）.The multiple HPV infection was less likely to increase the risk of cervical lesions compared with single HPV infection.Persistent infection of HR-HPV 16 or 18 increased the occurrence of cervical lesions（P＜0.05）.Conclusions：Persistent HR-HPV infection especially HR-HPV-16 and 18 for more than two years increases the risk of cervical lesions.HPV genotyping and the duration of infection possess clinical significance for occurrence of cervical lesions.