人乳头状瘤病毒感染致宫颈癌及癌前病变风险研究

目的 探讨感染人乳头状瘤病毒（human papilloma virus,HPV）后患宫颈癌及癌前病变风险.方法 采用HPV-DNA核酸扩增及导流杂交技术,对7 234例来我院就诊的宫颈异常患者,进行HPV21种亚型的基因检测和宫颈液基薄层细胞学（TCT）检测,对细胞学检测结果为非典型鳞状细胞（ASCUS）以上和/或HPV-DNA检测阳性的患者,行活组织病理检查,对HPV感染后患宫颈癌及癌前病变风险进行分析.结果 HPV总感染率为27.37%,检出率前四位依次是HPV 16型6.97%（504/7 234）、52型5.68%（411/7 234）、58型5.27%（381/7 234）和33型3.33%（241/7 234）,其中高危型病毒（HR-HPV）感染占78.16%（2147/2747）.宫颈癌患者HPV的检出率为73.33%（33/45）.单型HPV感染后患轻度鳞状上皮内瘤变（LSIL）及高度鳞状上皮内瘤变（HSIL）和宫颈癌的风险分别是HPV阴性者的4.055倍（95% CI 2.528～6.505）和5.103倍（95% CI 3.838～6.786）,多型混合HPV感染后患宫颈LSIL及HSIL和宫颈癌的风险分别是HPV阴性者的7.313倍（95% CI 4.314～12.397）和7.550倍（95%CI 5.395～10.564）.结论 单型HPV感染致宫颈HSIL或宫颈癌的风险是HPV阴性者的5.1倍,多型混合HPV感染致宫颈HSIL或宫颈癌的风险是HPV阴性者的7.6倍.

Risk of cervical cancer and precancerous lesions in patients infected with human papilloma virus

Objective TO evaluate the risk of cervical cancer and precancerous lesions in patients infected with human papilloma virus （HPV）. Methods HPV21 subtypes were detected using HPV-DNA nucleic acid amplification and hybridization diversion in 7234 patients with cervical abnormalities who underwent thin-prep cytology test （TCT）. Tissue biopsies were performed in patients with positive HPV-DNA or with atypical squamous cells of undetermined significance （ASCUS）; and the correlation of HPV infection with precancerous lesions or cervical cancer was analyzed. Results The total HPV infection rate was 27.37% （1780/7234）, with HPV16 ranked the first （6.97%, 504/7234）, followed by HPV52 （5.68%, 411/7234）, HPV58 （5.27%, 381/7234）and HPV33 （3.33%, 241/7234）. The HR-HPV infection accounted for 78.16% of total infection. The rate of HPV infection in patients with cervical cancer was 73.77% （33/45）. The risks of low-grade squamous intraepithelial lesion （LSIL）, high-grade squamous intraepithelial lesion （HSIL） and cervical cancer in single-type HPV infected patients were 4.055 （95% CI 2.528 -6.505） and 5.103 （95% CI 3.838 -6.786） times higher than that in HPV-negative patients; and the risks in mixed-type HPV infected patients were 7.313 （95% CI 4.314-12.397） and 7.550 （95% CI 5.395-10.564） times higher than that in HPV-negative patients, Conclusion Both single-type and mixed-type HPV infections increase the risk of cervical HSlL or cervical cancer, and the latter is more prominent.