CAJ | 학술논문

目的探讨人乳头状瘤病毒(HPV)感染与妇科其他常见病原微生物感染的关系.方法收集2007年6月至2008年12月在浙江省温岭市第一人民医院妇科门诊就医的857例妇女的宫颈和阴道拭子标本,采用PCR技术检查HPV DNA及其基因分型,采用链替代扩增方法检测沙眼衣原体,其他妇科病原微生物的检测按照常规方法进行,统计分析结果资料.结果本研究收集的857例妇女中检测出HPV阳性266例,阳性率为31.0%(266/857).在266例HPV阳性妇女中,除4例为混合基因型,其余262例共检测出35种HPV的不同亚型,各亚型按所出现频率>5%排列,分另是HPVl6(14.5%,38/262)、HPV58(9.2%,24/262)、HPV53(8.0%,21/262)、HPV42(6.1%,16/262);HPV高危型和可能高危型占58.8%(154/262),HPV低危型占27.9%(73/262),HPV未知危险型占13.4%(35/262).宫颈脱落细胞检测结果显示,63.2%(168/266)的HPV阳性妇女未见异常细胞,3.8%(10/266)是高度鳞状上皮内病变(HSIL),29.7%(79/266)是低度鳞状上皮内病变(LSIL),3.0%(8/266)是未明确诊断意义的不典型鳞状上皮细胞(ASCUS).在所有研究对象中未检测出淋病奈瑟菌,人型支原体在所有研究对象中仅检测出2例.logistic回归分析显示,HPV感染与沙眼衣原体和解脲支原体[>10000颜色变化单位(CCU)/ml]感染具有显著相关性(P均<0.01),而细菌性阴道病、无乳链球菌、假丝酵母菌、阴道毛滴虫和解脲支原体(≤l0000 CCU/ml)与HPV感染无相关性(P均>0.05);但患细菌性阴道病妇女的HPV阳性率为42.6%.沙眼衣原体是HPV感染的高危因素(OR=2.82,95%CI为1.74～4.57).结论细菌性阴道病与HPV感染虽不具有相关性,但其在HPV阳性妇女中普遍存在.HPV感染与沙眼衣原体和解脲支原体感染具有相关性;沙眼衣原体感染会增加HPV感染的机会.
목적 탐토인유두상류병독(HPV)감염여부과기타상견병원미생물감염적관계.방법 수집2007년6월지2008년12월재절강성온령시제일인민의원부과문진취의적857례부녀적궁경화음도식자표본,채용PCR기술검사HPV DNA급기기인분형,채용련체대확증방법검측사안의원체,기타부과병원미생물적검측안조상규방법진행,통계분석결과자료.결과 본연구수집적857례부녀중검측출HPV양성266례,양성솔위31.0%(266/857).재266례HPV양성부녀중,제4례위혼합기인형,기여262례공검측출35충HPV적불동아형,각아형안소출현빈솔>5%배렬,분령시HPVl6(14.5%,38/262)、HPV58(9.2%,24/262)、HPV53(8.0%,21/262)、HPV42(6.1%,16/262);HPV고위형화가능고위형점58.8%(154/262),HPV저위형점27.9%(73/262),HPV미지위험형점13.4%(35/262).궁경탈락세포검측결과현시,63.2%(168/266)적HPV양성부녀미견이상세포,3.8%(10/266)시고도린상상피내병변(HSIL),29.7%(79/266)시저도린상상피내병변(LSIL),3.0%(8/266)시미명학진단의의적불전형린상상피세포(ASCUS).재소유연구대상중미검측출임병내슬균,인형지원체재소유연구대상중부검측출2례.logistic회귀분석현시,HPV감염여사안의원체화해뇨지원체[>10000안색변화단위(CCU)/ml]감염구유현저상관성(P균<0.01),이세균성음도병、무유련구균、가사효모균、음도모적충화해뇨지원체(≤l0000 CCU/ml)여HPV감염무상관성(P균>0.05);단환세균성음도병부녀적HPV양성솔위42.6%.사안의원체시HPV감염적고위인소(OR=2.82,95%CI위1.74～4.57).결론 세균성음도병여HPV감염수불구유상관성,단기재HPV양성부녀중보편존재.HPV감염여사안의원체화해뇨지원체감염구유상관성;사안의원체감염회증가HPV감염적궤회.
Objective To Investigate correlation between screening assay of human papillomavirus (HPV) and microbial pathogens in gynecology. Methods Cervical samples were collected to search for HPV, bacteria and yeast infections in gynecologic outpatients. HPV typing was carried out by PCR and sequencing on cervical brush specimens. Chlamydia trachomatis was identified by strand displacement amplification (SDA) and the other microorganisms were detected by conventional methods. All data were analyzed to investigate the correlation among them. Results In this cross-sectional study, among 857 enrolled outpatients, there were 266 cases with positive HPV DNA, and the rate of infection was 31.0%(266/857). HPV genotype showed that thirty-five different HPV types were identified, of which HPV16 was the most prevalent ( 14.5%, 38/262), followed by HPV58 (9.2%, 24/262), HPV53 (8.0%, 21/262)and HPV42 (6.1%, 16/262); while other genotypes were present in less than 5% of HPV positive women.According to the reclassification, the aggregated percentage (high-risk and probably high-risk) of detected HPV was 58.8% ( 154/262), 27.9% (73/262) for low-risk and 13.4% (35/262) for unknown-risk HPV types. Among HPV positive women, cervical brush specimens results showed that more than 60% cases with normal cytology, 3.8% (10/266) with high-grade squamous intraepithelial lesions (HSIL), 29. 7% (79/266) with low-grade squamous intraepithelial lesions (LSIL) and 3.0% (8/266) with atypical squamous cells of undetermined significance (ASCUS), respectively. Statistical analyses revealed there was a significant association between the infected HPV and Chlamydia trachomatis or Ureaplasma urealyticum ( >10000 CCU/ml; all P <0.01), while no correlation was found between HPV infection and bacterial vaginosis, streptococcus agalactiae, candida, Trichomonas vaginalis or Ureaplasma urealyticum ( ≤ 10000CCU/ml; all P > 0.05 ). Among the cases with bacterial vaginosis, the positive rate of HPV infected was42.6%. Chlamydia trachomatis was one of the high-risk factors for the infection of HPV ( OR = 2.82, 95%CI: 1.74 -4.57). Mycoplasma hominis was isolated only in 2 cases, no patient was infected with Neisseria gonorrhocae. Conclusions Although bacterial vaginosis was not significantly associated with HPV, it was more common among the HPV positive women. There is the significant association between HPV and Chlamydia trachomatis or Ureaplasma urealyticum which may be increase the infection of HPV. These data suggest that it may be important to screen for the simultaneous presence of different microorganisms which may have synergistic pathological effects.