CAJ | 학술논문

目的：探讨医院机会性筛查人群初次高危型人乳头瘤( high risk human papillomavirus,HR-HPV)感染后病毒自然清除或持续感染的相关因素。方法随访2013年1月1日到2013年12月31日首都医科大学附属北京朝阳医院妇产科初次HR-HPV阳性患者969例。观察HR-HPV感染患者病毒自然清除特征及相关因素,分析年龄、病毒基因分型、多重感染以及初次感染病毒负荷量与病毒自然消除及持续性感染的关系。 SPSS 18.0统计软件进行统计学处理,Kaplan-Meier生存分析用于计算病毒清除时间。 COX比例风险回归用于病毒清除相关因素分析。结果969例HR-HPV 感染患者平均病毒清除时间为9.52(95% CI：9.09~9.95)个月,中位消退时间8(95% CI：7.65~8.36)个月。不同年龄组HR-HPV自然清除的时间不同(X2=7.93,P=0.047)。不同亚型HPV自然清除时间不同,清除时间最长的前5位分别是HPV56型、HPV33型、HPV58型、HPV52型、HPV18型。病毒清除时间最短的是依次HPV45型、HPV51型、HPV68型。多病毒联合感染同病毒持续感染相关,联合感染者病毒清除时间明显延长,持续感染时间延长(X2=18.67,P=0.000)。初次感染的病毒负荷量不同,病毒自然清除时间不同,差异有统计学意义(X2=18.68,P=0.000)。 COX比例风险回归分析显示：年龄(回归系数为-0.082,P=0.046)及多病毒联合感染(回归系数为-0.231,P=0.037)同病毒清除呈负相关,初次感染病毒负荷量分级(回归系数为-0.185,P=0.108)与病毒自然清除时间无相关。结论 HR-HPV基因型为HPV56型、HPV35型、HPV58型、HPV51型、HPV35型,≧50岁女性、多重感染以及初次高病毒负荷量患者,病毒自然清除时间长,更易发生持续性感染。
목적：탐토의원궤회성사사인군초차고위형인유두류( high risk human papillomavirus,HR-HPV)감염후병독자연청제혹지속감염적상관인소。방법수방2013년1월1일도2013년12월31일수도의과대학부속북경조양의원부산과초차HR-HPV양성환자969례。관찰HR-HPV감염환자병독자연청제특정급상관인소,분석년령、병독기인분형、다중감염이급초차감염병독부하량여병독자연소제급지속성감염적관계。 SPSS 18.0통계연건진행통계학처리,Kaplan-Meier생존분석용우계산병독청제시간。 COX비례풍험회귀용우병독청제상관인소분석。결과969례HR-HPV 감염환자평균병독청제시간위9.52(95% CI：9.09~9.95)개월,중위소퇴시간8(95% CI：7.65~8.36)개월。불동년령조HR-HPV자연청제적시간불동(X2=7.93,P=0.047)。불동아형HPV자연청제시간불동,청제시간최장적전5위분별시HPV56형、HPV33형、HPV58형、HPV52형、HPV18형。병독청제시간최단적시의차HPV45형、HPV51형、HPV68형。다병독연합감염동병독지속감염상관,연합감염자병독청제시간명현연장,지속감염시간연장(X2=18.67,P=0.000)。초차감염적병독부하량불동,병독자연청제시간불동,차이유통계학의의(X2=18.68,P=0.000)。 COX비례풍험회귀분석현시：년령(회귀계수위-0.082,P=0.046)급다병독연합감염(회귀계수위-0.231,P=0.037)동병독청제정부상관,초차감염병독부하량분급(회귀계수위-0.185,P=0.108)여병독자연청제시간무상관。결론 HR-HPV기인형위HPV56형、HPV35형、HPV58형、HPV51형、HPV35형,≧50세녀성、다중감염이급초차고병독부하량환자,병독자연청제시간장,경역발생지속성감염。
Objective To investigate the persistence and clearance data regarding the 13 types of high risk human papillomavirus( HR-HPV) in the population of primary infection. Methods A total of 969 cases of HR-HPV positive patients were followed up between January 1, 2013 and December 31, 2013. The epidemiological characteristics of HR-HPV persistent infection were analyzed. The age, viral genotyping, HR-HPV multiple genotypes and initial viral load were evaluated. Statistical analyses were performed using SPSS software for Windows (version 18. 0). The Kaplan-Meier survival function was used for calculating the time taken for the clearance of HR-HPV. The role of a group of independent variables concerning the time taken until clearance was evaluated using a Cox proportional-hazards regression model. P<0. 05 was considered statistically significant. Results The average time of viral clearance was 9. 52 months for all of 969 cases (9. 09-9. 95 months 95% CI) . Older women had longer clearance time than the younger women groups(X2=7. 63, P=0. 45). It was found that HPV-56, 35, 58, 52 and 18 had the lower probability of being cleared, when that HPV-45, 51 and 68 had the shorter time to be cleared. It was also found that multiple viral infection had the lower probability of being cleared than the single ones ( X2=18. 67, P=0. 000). Lower viral loads had better clearance compared to those having higher viral loads(X2=18. 68, P=0. 000)). It was shown that age (regression coefficient=-0.082, P=0. 046)and single or multiple HR-HPV infection (regression coefficient=-0.231, P=0. 037) were associated with time to clearance in the present sample, while the lower or higher viral loads (regression coefficient=-0. 185, P=0. 108) was not associated with time to clearance in the Cox proportional-hazards regression model. Conclusion HPV infection clearance in this study was related to factors such as age, infection type, viral load and the multiple or single viral infections.