新疆维吾尔自治区哈萨克族女性HPV感染型别分布及危险因素分析  

Genotype distribution and behavioral risk factor analysis of human papillomavirus infection among Kazak women in Xinjiang Uygur Autonomous Region

作　　者：王岩 董璇[3] 赵雪莲 热米拉·热扎克 沈谷群 迪达尔·塔勒哈提[4] 刘丽萍 赵方辉 Wang Yan;Dong Xuan;Zhao Xuelian;Rezhake Remila;Shen Guqun;Talehati Didaer;Liu Liping;Zhao Fanghui(Departments of Cancer Epidemiology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Affiliated Tumor Hospital of Xinjiang Medical University,Urumqi 830011,China;Xinjiang Medical University,Urumqi 830011,China;Tuoli Women and Children’s Hospital,Tacheng 834700,China;Tuoli People’s Hospital,Tacheng 834700,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/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,北京100021 [2]新疆医科大学附属肿瘤医院,乌鲁木齐830011 [3]新疆医科大学,乌鲁木齐830011 [4]塔城托里县妇幼保健院,834700 [5]塔城托里县人民医院,834700

出　　处：《中华流行病学杂志》2020年第12期2112-2118,共7页Chinese Journal of Epidemiology

基　　金：美国中华医学基金会卫生政策与体系科学公开竞标项目(16-255)。

摘　　要：目的评价新疆维吾尔自治区哈萨克族女性高危型HPV(HR-HPV)感染率及型别分布,评估子宫颈病变分布及其与HPV感染的相关性,并对HPV感染的危险因素进行初步分析。方法2018年6月在新疆维吾尔自治区托里县开展以人群为基础的子宫颈癌筛查研究,共招募2000名25~64岁哈萨克族女性。每位女性采集3份子宫颈脱落细胞标本,分别行careHPV(不分型)、PCR HPV、p16INK4a及薄层液基细胞学检测,并对任一检测结果阳性者转诊阴道镜,阴道镜检查结果异常者在病变处取活检。病理结果作为最终诊断的金标准。结果HPV总的感染率为14.55%,其中HR-HPV感染率为12.90%,且在50~54岁年龄组最高;常见的5种HR-HPV基因型别为HPV16(2.80%)、HPV51(2.35%)、HPV52(1.70%)、HPV56(1.50%)和HPV39型(1.20%);HPV以单一感染者居多(71.48%);50~54岁年龄组多重感染率最高,多重感染者中以双重感染为主(69.88%),且HPV42和HPV56是最常见的合并感染型别;子宫颈上皮内瘤样病变1级中HPV16(31.82%)、HPV51(27.27%)和HPV18(13.64%)型感染率较高;子宫颈上皮内瘤样病变2级中HPV16型(57.14%)感染率较高;子宫颈上皮内瘤样病变3级及以上中HPV16(55.56%)和HPV18(33.33%)型感染率较高;多因素logistic回归结果显示,文化程度高、绝经及梅毒感染会增加HPV感染的可能性。结论哈萨克族女性HR-HPV以HPV16、51、52型别较为常见;HR-HPV感染与文化程度、绝经状况及梅毒感染有关,需针对高危因素制定相应措施,重视性病患者和>50岁女性的筛查工作,进行有效干预。Objective To investigate the prevalence and genotype distribution of high-risk human papillomavirus(HR-HPV)and the correlation between cervical lesions and analyze the risk factors for HR-HPV infection.Methods In June 2018,a population-based study for cervical cancer screening in Tuoli county of Xinjiang Uygur Autonomous Region was conducted.A total of 2000 Kazak women aged 25-64 years were included in the study.Three cervical exfoliated cells samples were collected from them for careHPV,PCR HPV,p16INK4a,and liquid-based cytology(LBC)tests.Women with any positive test were referred for colposcopy with biopsies taken at abnormal sites.Histo-pathological diagnoses were used as the gold standard.Results The overall prevalence of HPV was 14.55%,among which the infection rate of HR-HPV was 12.90%,which was even higher in the 50-54 years age group.The most prevalent genotypes of HR-HPV were HPV16(2.80%),HPV51(2.35%),HPV52(1.70%),HPV56(1.50%),and HPV39(1.20%).The most common HPV infection was a single infection(71.48%).In the age group of 50-54 years,the multiple infection rates were higher,with the majority of double infection(69.88%),and HPV42 and 56 were the most common co-infection types.HPV16(31.82%),HPV51(27.27%)and HPV18(13.64%)were higher in cervical intraepithelial neplasia grade 1,HPV16(57.14%)was higher in cervical intraepithelial neplasia grade 2,and HPV16(55.56%)and HPV18(33.33%)were higher in cervical intraepithelial neplasia grade 3 or worse.Results from the multivariate logistic regression analysis showed that higher education,menopause,and syphilis infection increased the HPV infection.Conclusions The most common prevalence genotypes of HR-HPV among Kazak women were HPV16,HPV51,and HPV52.The infection rate of HR-HPV among Kazak women was correlated with education level,menopausal status,and syphilis infection.Measures should be taken targeting high-risk factors.This result suggests that STD patients and women aged 50 and above should be encouraged for screening.

关 键 词：人乳头瘤病毒 基因型 危险因素 哈萨克族 

分 类 号：R737.33[医药卫生—肿瘤]