中国医学科学院学报
中國醫學科學院學報
중국의학과학원학보
ACTA ACADEMIAE MEDICINAE SINICAE
2010年
1期
90-95
,共6页
吴瑞芳%刘植华%周庆芝%乌兰娜%王倩%李晴%李霓%刘志红%石菊芳%李瑞珍%张长淮%周艳秋%刘彬%翁雷明%乔友林
吳瑞芳%劉植華%週慶芝%烏蘭娜%王倩%李晴%李霓%劉誌紅%石菊芳%李瑞珍%張長淮%週豔鞦%劉彬%翁雷明%喬友林
오서방%류식화%주경지%오란나%왕천%리청%리예%류지홍%석국방%리서진%장장회%주염추%류빈%옹뢰명%교우림
子宫颈上皮内瘤样病变%人乳头瘤病毒%危险因素%筛查
子宮頸上皮內瘤樣病變%人乳頭瘤病毒%危險因素%篩查
자궁경상피내류양병변%인유두류병독%위험인소%사사
cervical intraepithelial neoplasia%human papillomavirus%risk factors%screening
目的 了解深圳市女性生殖道高危型人乳头瘤病毒(HPV)感染现状及子宫颈上皮内瘤样病变(CIN)的现患率,对子宫颈癌常用筛查方法进行评价.方法 2004年11至12月,在深圳市南山区沙河街道办事处辖区内对15～59岁有性生活女性进行以人群为基础的流行病学调查.对所有接受筛查的妇女均行子宫颈醋酸肉眼观察(VIA)、电子阴道镜检查、液基细胞薄层涂片技术子宫颈脱落细胞学检查(LCT)及第二代杂交捕获技术(HC-Ⅱ)检测子宫颈分泌物中高危型HPV.对HPV阳性且LCT≥未明确诊断意义的不典型鳞状上皮细胞(ASCUS)和/或LCT≥低度鳞状上皮内瘤样病变(LSIL)的妇女行阴道镜下活组织病理学检查,以病理结果作为诊断CIN的金标准.结果 共有1137名妇女参加本次调查,该人群高危型HPV-DNA检出率为14.0%;15～24岁、25～29岁、30～34岁、35～39岁、40～44岁、45～49岁和50～59岁组HPV检出率分别为15.5%、17.7%、12.6%、8.8%、10.2%、15.3%和21.0%,各组间差异有统计学意义(P<0.05).25～29岁组与50～59岁组HPV感染率明显高于其他各年龄组(P<0.05);25～29岁组与50～59岁组间HPV感染率比较差异无统计学意义(P>0.05);35～39岁组HPV感染率最低,但除25～29岁组与50～59岁组以外的其他各年龄组组间比较,差异无统计学意义(P>0.05).年龄别HPV感染率曲线呈‘Ⅴ'字型的双峰相.妇女CIN现患率为4.4%,CIN Ⅰ、CINⅡ和CIN Ⅲ现患率分别为3.2%、1.0%和0.3%,CIN Ⅰ现患率明显高于CIN Ⅱ和CINⅢ(P<0.05).HPV感染率随子宫颈病变级别升高呈趋势性增加,无CIN病变的子宫颈HPV感染率为8.3%,CINⅡ以上病变HPV感染率达到100.0%.本调查人群未发现子宫颈癌病例.VIA、电子阴道镜、LCT和HC-Ⅱ高危型HPV检测检出高度鳞状上皮内瘤样病变(HSIL)的敏感性分别为35.7%、50.0%、92.9%和100%;4种检测方法检出HSIL的特异性依次为96.0%、87.2%、88.4%和86.9%;各种方法均有满意的阴性预测值.结论 高危型HPV感染是CIN的主要因为,深圳妇女子宫颈病变多处于发病早期阶段,防癌的重点在于预防HPV感染和治疗CIN.
目的 瞭解深圳市女性生殖道高危型人乳頭瘤病毒(HPV)感染現狀及子宮頸上皮內瘤樣病變(CIN)的現患率,對子宮頸癌常用篩查方法進行評價.方法 2004年11至12月,在深圳市南山區沙河街道辦事處轄區內對15～59歲有性生活女性進行以人群為基礎的流行病學調查.對所有接受篩查的婦女均行子宮頸醋痠肉眼觀察(VIA)、電子陰道鏡檢查、液基細胞薄層塗片技術子宮頸脫落細胞學檢查(LCT)及第二代雜交捕穫技術(HC-Ⅱ)檢測子宮頸分泌物中高危型HPV.對HPV暘性且LCT≥未明確診斷意義的不典型鱗狀上皮細胞(ASCUS)和/或LCT≥低度鱗狀上皮內瘤樣病變(LSIL)的婦女行陰道鏡下活組織病理學檢查,以病理結果作為診斷CIN的金標準.結果 共有1137名婦女參加本次調查,該人群高危型HPV-DNA檢齣率為14.0%;15～24歲、25～29歲、30～34歲、35～39歲、40～44歲、45～49歲和50～59歲組HPV檢齣率分彆為15.5%、17.7%、12.6%、8.8%、10.2%、15.3%和21.0%,各組間差異有統計學意義(P<0.05).25～29歲組與50～59歲組HPV感染率明顯高于其他各年齡組(P<0.05);25～29歲組與50～59歲組間HPV感染率比較差異無統計學意義(P>0.05);35～39歲組HPV感染率最低,但除25～29歲組與50～59歲組以外的其他各年齡組組間比較,差異無統計學意義(P>0.05).年齡彆HPV感染率麯線呈‘Ⅴ'字型的雙峰相.婦女CIN現患率為4.4%,CIN Ⅰ、CINⅡ和CIN Ⅲ現患率分彆為3.2%、1.0%和0.3%,CIN Ⅰ現患率明顯高于CIN Ⅱ和CINⅢ(P<0.05).HPV感染率隨子宮頸病變級彆升高呈趨勢性增加,無CIN病變的子宮頸HPV感染率為8.3%,CINⅡ以上病變HPV感染率達到100.0%.本調查人群未髮現子宮頸癌病例.VIA、電子陰道鏡、LCT和HC-Ⅱ高危型HPV檢測檢齣高度鱗狀上皮內瘤樣病變(HSIL)的敏感性分彆為35.7%、50.0%、92.9%和100%;4種檢測方法檢齣HSIL的特異性依次為96.0%、87.2%、88.4%和86.9%;各種方法均有滿意的陰性預測值.結論 高危型HPV感染是CIN的主要因為,深圳婦女子宮頸病變多處于髮病早期階段,防癌的重點在于預防HPV感染和治療CIN.
목적 료해심수시녀성생식도고위형인유두류병독(HPV)감염현상급자궁경상피내류양병변(CIN)적현환솔,대자궁경암상용사사방법진행평개.방법 2004년11지12월,재심수시남산구사하가도판사처할구내대15～59세유성생활녀성진행이인군위기출적류행병학조사.대소유접수사사적부녀균행자궁경작산육안관찰(VIA)、전자음도경검사、액기세포박층도편기술자궁경탈락세포학검사(LCT)급제이대잡교포획기술(HC-Ⅱ)검측자궁경분비물중고위형HPV.대HPV양성차LCT≥미명학진단의의적불전형린상상피세포(ASCUS)화/혹LCT≥저도린상상피내류양병변(LSIL)적부녀행음도경하활조직병이학검사,이병리결과작위진단CIN적금표준.결과 공유1137명부녀삼가본차조사,해인군고위형HPV-DNA검출솔위14.0%;15～24세、25～29세、30～34세、35～39세、40～44세、45～49세화50～59세조HPV검출솔분별위15.5%、17.7%、12.6%、8.8%、10.2%、15.3%화21.0%,각조간차이유통계학의의(P<0.05).25～29세조여50～59세조HPV감염솔명현고우기타각년령조(P<0.05);25～29세조여50～59세조간HPV감염솔비교차이무통계학의의(P>0.05);35～39세조HPV감염솔최저,단제25～29세조여50～59세조이외적기타각년령조조간비교,차이무통계학의의(P>0.05).년령별HPV감염솔곡선정‘Ⅴ'자형적쌍봉상.부녀CIN현환솔위4.4%,CIN Ⅰ、CINⅡ화CIN Ⅲ현환솔분별위3.2%、1.0%화0.3%,CIN Ⅰ현환솔명현고우CIN Ⅱ화CINⅢ(P<0.05).HPV감염솔수자궁경병변급별승고정추세성증가,무CIN병변적자궁경HPV감염솔위8.3%,CINⅡ이상병변HPV감염솔체도100.0%.본조사인군미발현자궁경암병례.VIA、전자음도경、LCT화HC-Ⅱ고위형HPV검측검출고도린상상피내류양병변(HSIL)적민감성분별위35.7%、50.0%、92.9%화100%;4충검측방법검출HSIL적특이성의차위96.0%、87.2%、88.4%화86.9%;각충방법균유만의적음성예측치.결론 고위형HPV감염시CIN적주요인위,심수부녀자궁경병변다처우발병조기계단,방암적중점재우예방HPV감염화치료CIN.
Objective To investigate the prevalence of high-risk human papillomavirus(HPV)and incidence of cervical intraepithelial neoplasia(CIN)in female populations in Shenzhen,Guangdong Province,China.Methods Totally 1137 women aged 15-59 from Shahe Community,Nanshan District,Shenzhen were investigated for cervical cancer during an population-based epidemiological screening from November 2004 to December 2004.Visual inspection with acetic acid(VIA),colposcopy,liquid-based cytology test(LCT),and hybrid capture 2(HC-Ⅱ)were performed to detect the high-risk HPV types in cervical secretions.Biopsy under colposcope was performed in women who were HPV-positive with LCT ≥ atypical squamous cells of undetetemined sign(ASCUS)or HPV-negative with LCT ≥ low grade squamous intraepithelial lesion(LSIL),with the pathological results as the golden standards.Results The detection rate of high-risk HPV-DNA was 14.0%.HPV detection rates in 15-24,25-29,30-34,35-39,40-44,45-49,and 50-59 age groups were15.5%,17.7%,12.6%,8.8%,10.2%,15.3%,and 21.0%,respectively(P<0.05).HPV detection rates in 25-29 years group and 50-59 years group were significantly higher than those in other groups(P <0.05)and 35-39 group had the lowest detection rate.The curve of HPV infection rates in all groups was 'Ⅴ'type.The overall incidence of CIN was 4.4%.The incidences of CIN Ⅰ,CIN Ⅱ,and CIN Ⅲ were 3.2%,1.0%,and 0.3%,respectively,in which the incidence of CIN Ⅰ was significantly higher than those of CINⅡ and Ⅲ.HPV detection rates increased with cervical lesion grades,which in ≥ CIN Ⅱ groups and normal group were 100.0% and 8.3%,respectively.No cervical cancer was identified in this research.The sensitivities of VIA,colposcopy,LCT,and HC-Ⅱ for high-risk HPV screening were 35.7%,50.0%,92.9%,and100%,respectively,in detecting high-grade squamous intraepithelial lesion(HSIL),the specificities of these four methods were 96.0%,87.2%,88.4%,and 86.9%,respectively.Satisfactory negative predictive values were obtained for all methods.Conclusions HPV infection is the main risk factor for CIN.Cervical cancer among female populations in Shenzhen is still in early stages.Prevention of HPV infection and treatment of CIN are key for the prevention of cervical cancer.
