汕头市妇女HPV-52感染与宫颈鳞状上皮病变的关系  

Risk analysis of HPV-52 infection and cervical squamous epithelial lesions in Shantou,China

作　　者：王媛媛[1] 陈依超 郑洁 彭燕燕[3] 王少洪[1] WANG Yuanyuan;CHEN Yichao;ZHENG Jie;PENG Yanyan;WANG Shaohong(Department of Pathology,Shantou Central Hospital,Shantou 515041;Department of Clinical Research Center,Shantou Central Hospital,Shantou 515041;Department of Laboratory Medicine,Shantou Central Hospital,Shantou 515041,Guangdong,China)

机构地区：[1]汕头市中心医院病理科,广东汕头515041 [2]汕头市中心医院临床医学研究中心,广东汕头515041 [3]汕头市中心医院检验科,广东汕头515041

出　　处：《癌变．畸变．突变》2020年第4期304-308,共5页Carcinogenesis,Teratogenesis & Mutagenesis

基　　金：2018年汕头市中心医院科研培育计划优先资助项目(2018第56号)。

摘　　要：目的:探讨汕头市妇女感染人乳头状瘤病毒(HPV)的主要亚型,及其在宫颈鳞状上皮病变中的致病特点及风险分析。方法:收集2015~2018年在汕头市中心医院同时进行HPV分型检测和薄层液基细胞学(LCT)检查的病例37700例,及其中3924例进行宫颈活检的病例。HPV分型检测采用医用核酸分子快速杂交基因分型试剂盒,包含15种高危HPV,即HPV-16、-18、-31、-33、-35、-39、-45、-5l、-52、-53、-56、-58、-59、-66和-68;6种低危型HPV,即HPV-6、-11、-42、-43、-44、CP8304。细胞学检查按照伯塞斯达系统(TBS)分级(2014版)标准进行分类,分为未见上皮内病变或恶性病变(NILM)、非典型鳞状细胞-意义不明确(ASC-US)、低级别鳞状上皮内病变(LSIL)、非典型鳞状细胞-不排除高级别鳞状上皮内病变(ASC-H)、高级别鳞状上皮内病变(HSIL)和鳞状细胞癌(SCC)。使用SPSS 19.0软件建立数据库,计数资料率的比较采用频数分布进行统计,风险评估采用卡方检验2×2列表。结果:37700位LCT检查病例中HPV-52总感染率为3.55%(1338/37700),HPV-52单一感染882例,HPV-52多重感染(指两种及以上HPV亚型感染)456例,其中包含两重感染313例,三重及以上感染143例,HPV-52多重感染最常见的3种亚型分别是HPV-58/52(12.46%,39/313)、HPV-53/52(11.18%,35/313)、HPV-16/52(11.18%,35/313)。HPV-52多重感染患者LCT筛查结果出现ASC-US及以上病变尤其是HSIL中,最多见型别为HPV-16/52。宫颈活检结果风险分析显示,与HPV-52单一感染比较,HPV-52/16多重感染患HSIL/SCC风险增加(P<0.01,OR=8.27),并且增加HSIL发展到SCC的发病风险(P=0.01,OR=12.65)。与包含HPV-52但不包含HPV-16的多重感染比较,HPV-52/16多重感染增加患HSIL或者SCC风险(P<0.01,OR=3.36),并且增加HSIL发展为SCC的风险(P=0.03,OR=1.29)。结论:HPV-52是汕头市妇女最常见的HPV感染宫颈亚型,但患者主要发生HSIL病变,当合并HPV-16感染时增加癌前病变及癌变风险。OBJECTIVE:To explore pathogenic characteristics and risk of human papillomavirus-52(HPV-52)infection in cervical squamous cell lesions in Shantou,China.METHODS:37700 cases of HPV typing and thin-layer liquid-based cytology(LCT),and 3924 cases of cervical biopsy were collected in the Shantou Central Hospital from 2015 to 2018.HPV was detected by using the medical nucleic acid molecule rapid hybridization genotype kit which contained 15 high-risk HPV(HPV-16,-18,-31,-33,-35,-39,-45,-51,-52,-53,-56,-58,-59,-66,and-68)and 6 low-risk HPV(HPV-6,-11,-42,-43,-44,CP8304).Cytology examination was classified according to the TBS(the Bethesda system)classification standard(2014 version),and was divided into negative for intraepithelial lesion or malignancy(NILM),atypical squamous cells of undetermined significance(ASC-US),low-grade squamous intraepithelial lesion(LSIL),atypical squamous cells without exclusion of HSIL(ASC-H),high grade squamous intraepithelial lesion(HSIL)and squamous cell carcinoma(SCC).The database was established by SPSS 19.0.The rate comparison of the counted data was performed by using frequency distribution.The risk assessment was performed by using a chi-square test 2×2 list.RESULTS:The total infection rate of HPV-52 in 37700 patients was 3.55%(1338/37700).There were 882 cases of HPV-52 single infection and 456 cases of HPV-52 multiple infection,including 313 cases of double infection and 143 cases of triple and above.The three most common genotype of HPV-52 multiple infection were HPV-58/52(12.46%,39/313),HPV-53/52(11.18%,35/313),HPV-16/52(11.18%,35/313).The most common genotype was HPV-16/52 in ASC-US and above lesions,especially in HSIL.Risk analysis of cervical biopsy showed that HPV-52/16 increased the risk of HSIL/SCC,compared with HPV-52 single infection(P<0.01,OR=8.27),and increased the risk from HSIL to SCC(P=0.01,OR=12.65).Multiple infections of HPV-52/16 increased the risk from HSIL to SCC,compared with multiple infections that included HPV-52 but not HPV-16(P<0.01,OR=3.36),and increased th

关 键 词：人乳头状瘤病毒 宫颈癌 多重感染 分型 

分 类 号：R737.33[医药卫生—肿瘤]