高危型人乳头瘤病毒感染变化与宫颈癌及癌前病变发病风险的15年前瞻队列随访研究  

Prevalence of human papiilomavirus infection and risk of cervical cancer or precancerous lesions in 15 years follow up： a prospective cohort study

作　　者：张倩[1] 胡尚英[1] 冯瑞梅[1] 董丽[1] 陈凤[1] 张询[2] 潘秦镜[3] 马缓飞 史少东 赵方辉[1] 乔友林[1] Zbang Q Hu SY Feng RM Dong L Chen F Zhao FH Qiao YL Zhang X Pan QJ Ma IF Shi SD(Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China Department of Cytopatho/ogy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Belting 100021, China Xiangyuan Women and Children＇s Hospital, Changzhi 046200, China)

机构地区：[1]国家癌症中心中国医学科学院北京协和医学院肿瘤医院流行病学研究室,100021 [2]国家癌症中心中国医学科学院北京协和医学院肿瘤医院病理科,100021 [3]国家癌症中心中国医学科学院北京协和医学院肿瘤医院细胞学室,100021 [4]山西襄垣县妇幼保健院,长治046200

出　　处：《中华肿瘤杂志》2016年第10期792-797,共6页Chinese Journal of Oncology

基　　金：基金项目：国家自然科学基金优秀青年科学基金（81322040）;北京希望马拉松专项基金课题（LC2011Y43）;中央高校基本科研业务费

摘　　要：目的评估筛查队列人群15年间的高危型人乳头瘤病毒（HR-HPV）感染变化与宫颈癌及癌前病变的发病风险。方法1999年建立的1997例35～45岁的山西省宫颈癌筛查队列（SPOCCS-I）人群分别在2005年、2010年和2014年进行细胞学和HR-HPV检测筛查随访，以新发中度及以上宫颈上皮内瘤样病变（CIN2＋）作为病变结局终点，计算HPV感染率和CIN2＋发病率的变化以及CIN2＋的发病风险。结果HPV的感染率为15．7％～22．3％．CIN2＋的检出率为1．1％～4．3％。在15年随访时间内，基线HR—HPV阳性组CIN2＋的累积发病风险明显高于基线HR-HPV阴性组（P〈0．01）。4次HPV阳性者CIN2＋的发病风险高达40．0％，4次HPV阴性者CIN2＋的发病风险仅为0．6％（RR调整=55．0，95％CI为11．3～268．4）。结论随访15年间，山西襄垣县农村妇女的HR—HPV的感染率和CIN2＋的发病率一直保持较高水平．HR-HPV阳性者的15年发病风险一直高于HR-HPV阴性者，HR-HPV阴性者6年内进展为CIN2＋的风险较低，且HPV阳性次数越多．新发CIN2＋的发病风险越高。提示HPV感染及宫颈癌高发区的HPV筛查间隔可以延长至5～6年。Objective To evaluate the 15 years changing trends of prevalence of high risk HPV （HR-HPV） infec, tion and the risks of cervical cancer and precancerous lesions （CIN2＋） among a Chinese rural population. Methods The screening cohort with 1997 women aged 35 to 45 years old was built in 1999 in Xiangyuan County, Shanxi province （SPOCCS-I） and followed up by cytology and HR-HPV testing in the years of 2005, 2010, and 2014. The changes of HR-HPV prevalence and the risks of cervical precancerous lesions with CIN2＋ as the endpoints were analyzed during the past 15 years. Results The detection rates of HPV infection and CIN2＋ were 15.7%-22.3% and 1.1%-4.3% for the baseline visit and the other 3 follow-ups, respectively. The cumulative risk of CIN2＋ in HR-HPV positive women at baselinewas significantly higher than HR-HPV negative women （P〈0.01） during the 15-year follow-up. The risk of CIN2＋ in the four-times HPV positive group was 40. 0%, while the group with four-times negative HPV results was 0.6% （Adjusted RR = 55.0, 95% CI： 11.3 to 268.4）. Conclusions The prevalence of HR- HPV infection and CIN2＋ lesions were high in Xiangyuan county during the 15 years. HR-HPV positivity elevated the risk of CIN2＋ compared to women whose HR-HPV test was negative. The risks of CIN2＋ incidence in 6 years were low among women with negative HR-HPV test. The risk of CIN2＋ increased with the numbers of HPV infection events. The screening interval could he extended to 5-6 years.

关 键 词：人乳头瘤病毒 宫颈肿瘤 队列研究 发病风险 

分 类 号：R737.33[医药卫生—肿瘤]