宫颈腺癌患者高危型人乳头瘤病毒感染情况分析

目的 分析宫颈腺癌患者高危型人乳头瘤病毒（HPV）的感染情况,为宫颈腺癌的病因学提供进一步依据.方法 回顾性分析江西省妇幼保健院2003年1月～2010年12月收治的258例宫颈腺癌患者的临床病理资料,同时与江西省都昌县妇幼保健院2009年1～12月收治的426例宫颈鳞癌患者的HPV感染情况进行对比.结果 258例宫颈腺癌患者总HPV感染率为58.5％（151/258）,腺癌（非特指）、黏液腺癌、子宫内膜样腺癌、透明细胞腺癌、浆液性腺癌的HPV感染率分别为52.6％（10/19）、62.6％（87/139）、52.1％（25/48）、52.2％ （24/46）及80.0％（4/5）,不同病理类型的宫颈腺癌HPV感染率差异无统计学意义（P=0.365）.139例黏液腺癌中宫颈管型114例、微小偏离型14例、肠型2例、绒毛型9例,其HPV感染率分别为63.2％（72/114）、35.7％（5/14）、100.0％（2/2）、88.9％（8/9）;宫颈腺癌Ⅰ、Ⅱ、Ⅲ期的HPV感染率分别为70.0％（77/110）、52.2％（47/90）、46.6％（27/58）,Ⅰ期分别和Ⅱ、Ⅲ期比较差异有统计学意义（P＜0.05）;在≤4 cm的宫颈腺癌中HPV检出率为69.1％（56/81）,而在＞4 cm的宫颈腺癌中HPV的检出率为53.7％（95/177）,两组比较差异有统计学意义（P=0.021）;≤45岁患者宫颈腺癌HPV感染率为68.6％ （94/137）,＞45岁患者宫颈腺癌HPV感染率为47.1％（57/121）,两组比较有差有统计学意义（P=0.01）.426例宫颈鳞癌的HPV感染率为91.1％（388/426）,与腺癌HPV感染率比较差异有高度统计学意义（P＜0.01）.结论 宫颈腺癌的发生与HPV感染相关,不同病理类型宫颈腺癌的HPV感染率相近;随临床期别上升、局部肿瘤＞4 cm和年龄＞45岁的宫颈腺癌患者的HPV感染率有降低的趋势;宫颈腺癌显著低于宫颈鳞癌的HPV感染率.

Analysis of high-risk human papilloma virus infection in patients with cervical adenocarcinoma

Objective To analyze the high-risk human papilloma virus infection in patients with cervical adenocarcinoma,to provide the basis of the etiology of the cervical adenocarcinoma.Methods 258 cases of cervical adenocarcinoma from January 2003 to December 2010 in Jiangxi Maternal and Child Health Hospital were selected,426 cases of cervical squamous carcinoma from January to December 2009 in Maternal and Child Health Hospital of Duchang County were chosen.Human papilloma virus infection was compared.Results The HPV infection rate of 258 patients with cervical adenocarcinoma was 58.5％（151/258）,the HPV infection rate of adenocarcinoma （un-specified）,mucinous adenocarcinoma,endometrioid adenocarcinoma,clear cell adenocarcinoma,serous adenocarcinoma were 52.6％ （10/19）,62.6％ 87/139）,52.1％ （25/48）,52.2％ （24/46）and 80.0％ （4/5） respectively; the differences of cervical adenocarcinoma HPV infection rate in different pathological type were not statistically significant （P =0.365）.There were 139 cases mucinous adenocarcinoma,in which 114 cases were endocervical subtype,14 cases were minimal deviation adnocarcinoma,2 cases were intestinal subtype,9 cases were villoglandular adenocarcinoma and the HPV infection rates were 63.2％ （72/114）,35.7％ （5/14）,100.0％ （2/2）,88.9％ （8/9） respectively; the HPV positive rates for stage Ⅰ,Ⅱ,Ⅲ were 70.0％ （77/110）,52.2％ （47/90）,46.6％ （27/58） respectively and the differences between stage Ⅰ and stage lⅡ and stage Ⅲ were statistically significant （P ＜ 0.05）.HPV relevance ratio of cervical adenocarcinoma with tumor size ≤4 cm was 69.1％ （56/81）,the HPV relevance ratio of cervical adenocarcinoma with tumor size ＞4 cm was 53.7％ （95/177）,the differences were statistically significant （P =0.021）; HPV infection rate of cervical adenocarcinoma in patients with ≤ 45 years old was 68.6％ （94/137）,HPV infection rate of cervical adenocarcinoma in patients with ＞45years old was 47.1％ （57/121）,the differences were statistically significant （P =0.01）; HPV infection rate of cervical squamous carcinoma was 91.1％ （388/426）,the difference was statistically significant with HPV infection rate of cervical adenocarcinoma （P ＜ 0.01）.Conclusion The occurrence of cervical adenocarcinoma has correlation with HPV infection,HPV infection rate of different pathological type of cervical adenocarcinoma is similar.The HPV infection rate has the depressed tendency with the raise of clinical period,tumor sides ＞4 cm,＞ 45 years old;the HPV infection rate of cervical adenocarcinoma is prominently lower than that of cervical squamous carcinoma.