人乳头状瘤病毒DNA载量与子宫颈病变的关系

目的 研究妇女生殖道感染高危型人乳头状瘤病毒(HR-HPV)的载量与子宫颈上皮内瘤变(CIN)的关系。方法 收集参加横断面普查研究的1997名35～45岁已婚妇女的子宫颈脱落细胞,采用第二代杂交捕获试验(HC2)进行HPV DNA检测,病毒载量由样本的相对光单位(RLU)与标准阳性对照(PC)之比(RLU/PC)来衡量,按照log_(10)RLU/PC分为阴性(<0)、低度载量(0～1.12)、中度载量(1.13～2.23)和高度载量(2.24～3.37)。子宫颈病变按照病理诊断分为正常、CIN1、CIN2～3和子宫颈癌(SCC)。采用非条件多项式logistic回归分析病毒载量与子宫颈病变级别的关系。结果 100％(12/12)的SCC、97.3％(72/74)的CIN2-3、58.3％(74/127)的CIN1、11.5％(205/1784)的正常对象HR-HPV DNA检测阳性,各组阳性对象的中位log_(10)RLU/PC分别为2.60、2.32、2.18和1.18。从低度病毒载量与CIN1的危险比值比(OR)为3.8(1.9～7.3)至高度病毒载量与CIN2～3的OR值为865.9(200.1～3738.0),显示出感染病毒载量与子宫颈病变程度呈正相关(P<0.001)。结论 子宫颈HR-HPV病毒载量是影响SCC及癌前病变的重要危险因素。

Association between high-risk human papiliomavirus DNA load and cervical intraepithelial lesion

Objective To determine the association between viral load of high risk type human papillomavirus(HR-HPV) and stage of cervical intraepithelial neoplasia(CIN)lesion. Methods Cervical exfoliated cells were collected from 1997 women aged 35-45 in a cross-sectional screening study. HPV DNA was detected by hybrid capture 2(HC2) system, and viral load was measured by the ratios of relative light units compared to standard positive control(RLU/PC). Log_(10) RLU/PC were categorized into four groups: negative(<0), low viral load (0-1.12), medium viral load (1.13-2.23), and high viral load (2.24-3.37). Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2-3, and squamous cervical cancer(SCC). Association between HR-HPV and CINs were evaluated by unconditional multinomial logistic regression. Results 100%(12/12) SCC, 97.3%(72/74) of CIN 2-3, 58.3%(74/127) of CIN 1, and 11.5%(205/1784) of normal women were positive for HPV DNA. The median log_(10) RLUs for the positive women with SCC, CIN 2-3, CIN 1 and in normal women were 2.60, 2.32, 2.18 and 1.18 respectively. The odds ratio(OR)between low viral load of HPV DNA and CIN 1 was 3.8(1.9-7.3) while between high viral load and CIN 2-3 was OR=865.9(200.1-3738.0)which showed that higher viral load could increase the risk of cervical lesions(P<0. 001). Conclusion Both cervical cancer and CINs were highly influenced by HR-HPV viral load.