目的：研究医院机会性筛查人群高危型人乳头瘤病毒( high risk-human papillomavirus,HR-HPV)感染的流行病学特征,探讨HR-HPV感染与宫颈癌前病变的关系。方法收集2012年1月1日至2012年12月31日期间,就诊于首都医科大学附属北京朝阳医院妇科门诊,同时接受HR-HPV和宫颈薄层液基细胞学检查( thinprep cytologic test,TCT)符合纳入标准的2305例患者资料。采用二代杂交捕获法(hybird capture II,HC-II)进行HR-HPV检测。结果1)医院机会性筛查人群HR-HPV感染率为34.84%,年轻女性(20~24岁)感染率最高(50.0%),随着年龄的增加,感染率逐渐下降,45~49岁女性感染率最低(24.18%),≧55岁者感染率升高(47.02%),感染率呈双高现象。宫颈薄层液基细胞学异常率的年龄分布特点,与HR-HPV感染率的年龄分布特点一致。2) TCT结果为正常或者炎性反应、不典型鳞状上皮细胞( atypical squamous cells undetermined significance,ASCUS)、低度鳞状上皮内瘤样病变(low squamous intraepithelial lesion,LSIL)、高度鳞状上皮内瘤样病变(high squamous intraepithelial lesion,HSIL)、宫颈鳞状细胞癌(squamous of cervical carcinoma,SCC)中, HR-HPV的感染率分别是23.98%、66.47%、87.21%、98.04%、100%。宫颈组织活检病理为正常或炎性反应、宫颈上皮内瘤样病变1级( cervical intraepithelial lesions-Ⅰ,CIN-Ⅰ)、CIN-Ⅱ、CIN-Ⅲ、SCC患者HR-HPV的感染率分别为67.44%、86.96%、88.24%、94.57%、90.48%。3)在ASCUS患者中,宫颈高级别病变(≧CIN-Ⅱ)的发生率31.73%,HR-HPV阳性组宫颈高级别病变(≧CIN-Ⅱ)的检出率36.93%,HR-HPV阴性组宫颈高级别病变(≧CIN-Ⅱ)的检出率21.43%,两组间的差异具有统计学意义(X2=4.13,P=0.042)。4)在LSIL患者中,宫颈高级别病变的发生率34.40%,HR-HPV阳性组宫颈高级别病变的检出率37.37%,HR-HPV阴性组宫颈高级别病变的检出率14.29%,两组间的差异具有统计学意义(X2=5.76,P=0.016)。结论不同年龄,HR-HPV感染率及TCT异常率不同,<24岁和≧55岁为HR-HPV感染及异常宫颈薄层液基细胞学高峰年龄。 HR-HPV感染率和宫颈病变严重程度呈显著正相关。 HR-HPV检测不能作为ASCUS和LSIL患者分流管理的唯一手段,HR-HPV阴性的ASCUS和LSIL不能排除≧CIN-Ⅱ级病变,仍然需要做阴道镜检查。
目的：研究醫院機會性篩查人群高危型人乳頭瘤病毒( high risk-human papillomavirus,HR-HPV)感染的流行病學特徵,探討HR-HPV感染與宮頸癌前病變的關繫。方法收集2012年1月1日至2012年12月31日期間,就診于首都醫科大學附屬北京朝暘醫院婦科門診,同時接受HR-HPV和宮頸薄層液基細胞學檢查( thinprep cytologic test,TCT)符閤納入標準的2305例患者資料。採用二代雜交捕穫法(hybird capture II,HC-II)進行HR-HPV檢測。結果1)醫院機會性篩查人群HR-HPV感染率為34.84%,年輕女性(20~24歲)感染率最高(50.0%),隨著年齡的增加,感染率逐漸下降,45~49歲女性感染率最低(24.18%),≧55歲者感染率升高(47.02%),感染率呈雙高現象。宮頸薄層液基細胞學異常率的年齡分佈特點,與HR-HPV感染率的年齡分佈特點一緻。2) TCT結果為正常或者炎性反應、不典型鱗狀上皮細胞( atypical squamous cells undetermined significance,ASCUS)、低度鱗狀上皮內瘤樣病變(low squamous intraepithelial lesion,LSIL)、高度鱗狀上皮內瘤樣病變(high squamous intraepithelial lesion,HSIL)、宮頸鱗狀細胞癌(squamous of cervical carcinoma,SCC)中, HR-HPV的感染率分彆是23.98%、66.47%、87.21%、98.04%、100%。宮頸組織活檢病理為正常或炎性反應、宮頸上皮內瘤樣病變1級( cervical intraepithelial lesions-Ⅰ,CIN-Ⅰ)、CIN-Ⅱ、CIN-Ⅲ、SCC患者HR-HPV的感染率分彆為67.44%、86.96%、88.24%、94.57%、90.48%。3)在ASCUS患者中,宮頸高級彆病變(≧CIN-Ⅱ)的髮生率31.73%,HR-HPV暘性組宮頸高級彆病變(≧CIN-Ⅱ)的檢齣率36.93%,HR-HPV陰性組宮頸高級彆病變(≧CIN-Ⅱ)的檢齣率21.43%,兩組間的差異具有統計學意義(X2=4.13,P=0.042)。4)在LSIL患者中,宮頸高級彆病變的髮生率34.40%,HR-HPV暘性組宮頸高級彆病變的檢齣率37.37%,HR-HPV陰性組宮頸高級彆病變的檢齣率14.29%,兩組間的差異具有統計學意義(X2=5.76,P=0.016)。結論不同年齡,HR-HPV感染率及TCT異常率不同,<24歲和≧55歲為HR-HPV感染及異常宮頸薄層液基細胞學高峰年齡。 HR-HPV感染率和宮頸病變嚴重程度呈顯著正相關。 HR-HPV檢測不能作為ASCUS和LSIL患者分流管理的唯一手段,HR-HPV陰性的ASCUS和LSIL不能排除≧CIN-Ⅱ級病變,仍然需要做陰道鏡檢查。
목적：연구의원궤회성사사인군고위형인유두류병독( high risk-human papillomavirus,HR-HPV)감염적류행병학특정,탐토HR-HPV감염여궁경암전병변적관계。방법수집2012년1월1일지2012년12월31일기간,취진우수도의과대학부속북경조양의원부과문진,동시접수HR-HPV화궁경박층액기세포학검사( thinprep cytologic test,TCT)부합납입표준적2305례환자자료。채용이대잡교포획법(hybird capture II,HC-II)진행HR-HPV검측。결과1)의원궤회성사사인군HR-HPV감염솔위34.84%,년경녀성(20~24세)감염솔최고(50.0%),수착년령적증가,감염솔축점하강,45~49세녀성감염솔최저(24.18%),≧55세자감염솔승고(47.02%),감염솔정쌍고현상。궁경박층액기세포학이상솔적년령분포특점,여HR-HPV감염솔적년령분포특점일치。2) TCT결과위정상혹자염성반응、불전형린상상피세포( atypical squamous cells undetermined significance,ASCUS)、저도린상상피내류양병변(low squamous intraepithelial lesion,LSIL)、고도린상상피내류양병변(high squamous intraepithelial lesion,HSIL)、궁경린상세포암(squamous of cervical carcinoma,SCC)중, HR-HPV적감염솔분별시23.98%、66.47%、87.21%、98.04%、100%。궁경조직활검병리위정상혹염성반응、궁경상피내류양병변1급( cervical intraepithelial lesions-Ⅰ,CIN-Ⅰ)、CIN-Ⅱ、CIN-Ⅲ、SCC환자HR-HPV적감염솔분별위67.44%、86.96%、88.24%、94.57%、90.48%。3)재ASCUS환자중,궁경고급별병변(≧CIN-Ⅱ)적발생솔31.73%,HR-HPV양성조궁경고급별병변(≧CIN-Ⅱ)적검출솔36.93%,HR-HPV음성조궁경고급별병변(≧CIN-Ⅱ)적검출솔21.43%,량조간적차이구유통계학의의(X2=4.13,P=0.042)。4)재LSIL환자중,궁경고급별병변적발생솔34.40%,HR-HPV양성조궁경고급별병변적검출솔37.37%,HR-HPV음성조궁경고급별병변적검출솔14.29%,량조간적차이구유통계학의의(X2=5.76,P=0.016)。결론불동년령,HR-HPV감염솔급TCT이상솔불동,<24세화≧55세위HR-HPV감염급이상궁경박층액기세포학고봉년령。 HR-HPV감염솔화궁경병변엄중정도정현저정상관。 HR-HPV검측불능작위ASCUS화LSIL환자분류관리적유일수단,HR-HPV음성적ASCUS화LSIL불능배제≧CIN-Ⅱ급병변,잉연수요주음도경검사。
Objective To study epidemiological characteristics of population who underwent opportunistic screening for high risk-human papillomavirus( HR-HPV) infection, and to explore the relationship between HR-HPV infection and cervical precancerous lesions.Methods Data from 2 305 patients, according the inclusion criteria, who underwent HR-HPV DNAs and cervical cytology tests at the outpatient department of OB & GYN, Beijing Chaoyang Hospital from January 1, 2012 to December 31, 2012, were collected. HR-HPV DNAs were detected by hybrid capture-Ⅱ( HC-Ⅱ) method, cervical exfoliated cells were collected and inspected. SPSS 18. 0 software was used for statistical analysis. Results 1) The infection rate of HR-HPV of the screening crowd was 34. 84%, of which the young women(20-24 years old) is the highest(50. 0%). With aging, the rate decreased gradually, the lowest rate of women aged 45-49 years (24. 18%). It increased again after the age of 55 years(47. 02%), showing second peak of infection. The age distribution of positive rate of cervical cytology tests also had two peaks, consistent with characteristics of age distribution of HR-HPV infection rate. 2) HR-HPV infection rates were respectively 23. 98%, 66. 47%, 87. 21%, 98. 04% and 100% in normal or inflammation, atypical squamous cells undetermined significance( ASCUS) , low squamous intraepithelial lesion( LSIL) , high squamous intraepithelial lesion( HSIL) , squamous of cervical carcinoma( SCC) , thin preparation test( TCT) results, respectively. HR-HPV infection rates of subjects with normal cervical biopsy or inflammation, cervical intraepithelial lesions(CIN)-Ⅰ, CIN-Ⅱ, CIN-Ⅲ, ASCUS, LSIL, HSIL and SCC were 67. 44%, 86. 96%, 88. 24%, 94. 57%, 90. 48%, respectively. With the increasing level of cervical cytology lesions and cervical histological lesions, the rate of HR-HPV infection significantly increased. 3) In ASCUS patients, the incidence of high-grade cervical lesions was 31. 73%, which in HR-HPV positive group was 36. 93% and in negative group was 21. 43%. The difference was statistically significant between the two groups(X2=4. 13, P=0. 042). 4) In LSIL patients, the incidence of high-grade cervical lesions was 34. 40%, which in HR-HPV positive group was 37. 37% and in negative group was 14. 29%. The difference was statistically significant between the two groups( X2=5. 76, P=0. 016). Conclusion The infection rate of HR-HPV and the abnormal rate of cervical cytology are different with different age. Younger than 24 years and ≧55 years were peak of both of HR-HPV infection and abnormal cytology. HR-HPV infection and cervical lesion severity was positively correlated. Patients for ASCUS and LSIL of cervical cytology, if HR-HPV positive, will increase the probability of CIN-Ⅱ and above lesions, but negative patients cannot be excluded from high-grade cervical lesions, the colpscopic examination is necessary.
