中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2009年
9期
923-927
,共5页
孙丽君%娄雪玲%王东红%杨誉佳
孫麗君%婁雪玲%王東紅%楊譽佳
손려군%루설령%왕동홍%양예가
人乳头瘤病毒%宫颈癌%疫苗
人乳頭瘤病毒%宮頸癌%疫苗
인유두류병독%궁경암%역묘
Human papillomavirus%Cervical cancer%Vaccine
目的 了解贵州省部分地区妇女宫颈人乳头瘤病毒(HPV)感染的分布情况及高危因素,为该地区宫颈癌防治及疫苗的投入使用提供一定的依据.方法 采用导流杂交技术对2339例有性生活妇女宫颈脱落细胞进行21种HPV基因型检测及宫颈液基细胞学检测,对其中部分HPV阳性携带者和(或)宫颈液基细胞检查阳性结果 者在阴道镜下取组织活检进行病理检查.分析HPV感染高危因素及各型宫颈病变中HPV亚型感染分布特点.结果 在被调查的2339例妇女中HPV感染总阳性率为30.31%(709/2339),共有20种HPV亚型被检测出来.HPV感染阳性排在前5位的亚型从高到低依次为HPV16、52、18、58、和11,感染率从高到低分别为9.87%(231/2339)、5.64%(132/2339)、4.95%(116/2339)、4.19%(98/2339)和2.99%(70/2339).HPV感染的高峰年龄为31～35岁,初次性生活越早,HPV感染率越高(经趋势X2检验,X2=15.933,P<0.05).病理学检查确诊了366例宫颈上皮内瘤变(CIN)患者及181例宫颈浸润癌患者,CIN患者HPV感染率依次为CIN Ⅰ 34.26%(74/216)、CIN Ⅱ77.78%(56/72)、CIN Ⅲ82.05%(64/78).181例宫颈浸润癌患者中,宫颈鳞癌的HPV感染率为84.52%(131/155),宫颈腺癌的HPV感染率为38.46%(10/26).HPV阳性宫颈鳞癌中16型占61.83%(81/131)、腺癌18型占60%(6/10),HPV16与宫颈鳞癌关系密切(X2=11.948,P<0.001,OR鳞癌/腺癌=5.946),HPV18亚型在宫颈鳞癌和腺癌中分布比较差异无统计学意义(P>0.05).结论 贵州省HPV亚型感染分布以16、52、18、58型为主.宫颈病变程度与HPV感染密切相关,HPV感染高发于中青年妇女,初次性生活年龄较早是HPV感染的高危因素,长期持续高危型HPV感染可能导致宫颈癌.高度鳞状上皮内病变及宫颈癌主要由高危型HPV感染所致.HPV16亚型与宫颈鳞癌关系密切,HPV18亚型在宫颈鳞癌与腺癌中的分布无明显差异.本地区可考虑应用HPV16/18二价疫苗降低宫颈癌的发病率.
目的 瞭解貴州省部分地區婦女宮頸人乳頭瘤病毒(HPV)感染的分佈情況及高危因素,為該地區宮頸癌防治及疫苗的投入使用提供一定的依據.方法 採用導流雜交技術對2339例有性生活婦女宮頸脫落細胞進行21種HPV基因型檢測及宮頸液基細胞學檢測,對其中部分HPV暘性攜帶者和(或)宮頸液基細胞檢查暘性結果 者在陰道鏡下取組織活檢進行病理檢查.分析HPV感染高危因素及各型宮頸病變中HPV亞型感染分佈特點.結果 在被調查的2339例婦女中HPV感染總暘性率為30.31%(709/2339),共有20種HPV亞型被檢測齣來.HPV感染暘性排在前5位的亞型從高到低依次為HPV16、52、18、58、和11,感染率從高到低分彆為9.87%(231/2339)、5.64%(132/2339)、4.95%(116/2339)、4.19%(98/2339)和2.99%(70/2339).HPV感染的高峰年齡為31～35歲,初次性生活越早,HPV感染率越高(經趨勢X2檢驗,X2=15.933,P<0.05).病理學檢查確診瞭366例宮頸上皮內瘤變(CIN)患者及181例宮頸浸潤癌患者,CIN患者HPV感染率依次為CIN Ⅰ 34.26%(74/216)、CIN Ⅱ77.78%(56/72)、CIN Ⅲ82.05%(64/78).181例宮頸浸潤癌患者中,宮頸鱗癌的HPV感染率為84.52%(131/155),宮頸腺癌的HPV感染率為38.46%(10/26).HPV暘性宮頸鱗癌中16型佔61.83%(81/131)、腺癌18型佔60%(6/10),HPV16與宮頸鱗癌關繫密切(X2=11.948,P<0.001,OR鱗癌/腺癌=5.946),HPV18亞型在宮頸鱗癌和腺癌中分佈比較差異無統計學意義(P>0.05).結論 貴州省HPV亞型感染分佈以16、52、18、58型為主.宮頸病變程度與HPV感染密切相關,HPV感染高髮于中青年婦女,初次性生活年齡較早是HPV感染的高危因素,長期持續高危型HPV感染可能導緻宮頸癌.高度鱗狀上皮內病變及宮頸癌主要由高危型HPV感染所緻.HPV16亞型與宮頸鱗癌關繫密切,HPV18亞型在宮頸鱗癌與腺癌中的分佈無明顯差異.本地區可攷慮應用HPV16/18二價疫苗降低宮頸癌的髮病率.
목적 료해귀주성부분지구부녀궁경인유두류병독(HPV)감염적분포정황급고위인소,위해지구궁경암방치급역묘적투입사용제공일정적의거.방법 채용도류잡교기술대2339례유성생활부녀궁경탈락세포진행21충HPV기인형검측급궁경액기세포학검측,대기중부분HPV양성휴대자화(혹)궁경액기세포검사양성결과 자재음도경하취조직활검진행병리검사.분석HPV감염고위인소급각형궁경병변중HPV아형감염분포특점.결과 재피조사적2339례부녀중HPV감염총양성솔위30.31%(709/2339),공유20충HPV아형피검측출래.HPV감염양성배재전5위적아형종고도저의차위HPV16、52、18、58、화11,감염솔종고도저분별위9.87%(231/2339)、5.64%(132/2339)、4.95%(116/2339)、4.19%(98/2339)화2.99%(70/2339).HPV감염적고봉년령위31～35세,초차성생활월조,HPV감염솔월고(경추세X2검험,X2=15.933,P<0.05).병이학검사학진료366례궁경상피내류변(CIN)환자급181례궁경침윤암환자,CIN환자HPV감염솔의차위CIN Ⅰ 34.26%(74/216)、CIN Ⅱ77.78%(56/72)、CIN Ⅲ82.05%(64/78).181례궁경침윤암환자중,궁경린암적HPV감염솔위84.52%(131/155),궁경선암적HPV감염솔위38.46%(10/26).HPV양성궁경린암중16형점61.83%(81/131)、선암18형점60%(6/10),HPV16여궁경린암관계밀절(X2=11.948,P<0.001,OR린암/선암=5.946),HPV18아형재궁경린암화선암중분포비교차이무통계학의의(P>0.05).결론 귀주성HPV아형감염분포이16、52、18、58형위주.궁경병변정도여HPV감염밀절상관,HPV감염고발우중청년부녀,초차성생활년령교조시HPV감염적고위인소,장기지속고위형HPV감염가능도치궁경암.고도린상상피내병변급궁경암주요유고위형HPV감염소치.HPV16아형여궁경린암관계밀절,HPV18아형재궁경린암여선암중적분포무명현차이.본지구가고필응용HPV16/18이개역묘강저궁경암적발병솔.
Objective To investigate the distribution of different Human papilloma virus(HPV) subtype infection of women cervixes in parts of Guizhou Province and the high risk factors of HPV infection,in order to offer some evidences for the use of vaccine of cervix eaneers in the region, and offer a group of reliable data for the screen-ing statistics of cervix eaneer in the world. Methods A total of 2339 women having sexual life were checked for 21 HPV genotypes by DNA flow-through hybridization technique and liquid-hased pap test(LPT) in their exfoliated cer-vical cells. Cervix tissues were taken in some HPV positive women and (or) LPT positive women among them for bi-opsy by the vaginoscope. The high risk factors of HPV infection and the distribution feature of HPV subtype infection in the different cervix diseases were anlayzed. Results The total positive rate of HPV infection was 30.31% (709/ 2339 ) in the 2339 women. There were 20 HPV subtypes to be detected. HPV subtype infection from high to low were HPVI6,52,18,58 and 11. The rates of HPV subtype infection were 9.87% (231/2339) ,5.64% ( 132/2339), 4.95% (116/2339 ) ,4.19% (98/2339)and 2.99 % (70/2339). The peak age of HPV infection ranged from 31 to 35 years old. The earlier the first sexual life,the higher HPV infeetion (tendeney X2 test,P <0.05). 366 CIN pa-tients and 181 patients of invasive cervix carcinoma( ICC)were diagnosed through pathology examination. The rate of HPV infection were 34.26% (74/216)in CIN Ⅰ ,77.78% (56/72)in CIN Ⅱ ,82.05% (64/78)in CIN Ⅲ. Among the 181 ICC,the rate of HPV infection was 84.52% (131/155)in squamous carcinoma of the cervix (SCC) and 38.46% (10/26) in adenocareinoma of uterine cervix (AUC). The infeetion rate of HPV16 was 61.83% ( 81/131 ) in the SCC of HPV positive. The infection rate of HPV18 was 60% (6/10)of the AUC of HPV positive. HPV16 was related closely with SCC ( X2 = 11. 948 ,P < 0.001 , ORSCC/AUC = 5. 946). There was no significant difference be-tween HPV 18 in SCC and AUC( P > 0.05). Conclusions The major HPV subtypes are 16,52,18,58 in Guizhou province. There is a close correlation between HPV infection and cervix diseases. HPV infection often occurs in young and middle-aged women. The first sexual life is a high factor of HPV infection. High risk HPV infecting would cause cervix cancer. CIN and cervix cancers are caused by high risk HPV infection. HPV16 is related closely with SCC. There is no significant difference between HPV18 in SCC and AUC. HPV16/18 vaccine could be considered to re-duce the incidence of cervical carcinoma in Guizhou province.
