性传播疾病10联检联合人乳头瘤病毒分型检测临床应用研究  

Clinical application research in the ten examinations combined with HPV typing detection in women with sexually transmitted disease

作　　者：马莉[1] 卞美璐[1] 李茜[1] 张庆霞[1] 阳艳军[1] 陈曦 袁记方 贺桂芳[1] 陈庆云[1] 刘红刚[3] MA Li;BIAN Mei-lu;LI Qian;ZHANG Qing-xia;YANG Yan-jun;CHEN Xi;YUAN Ji-fang;HE Gui-fang;CHEN Qing-yun;LIU Hong-gang(Department of Obstetrcis and Gynecology,China-Japan Friendship Hospital,Beijing 100029,China;不详)

机构地区：[1]中日友好医院妇产科,北京100029 [2]广东省人乳头瘤病毒(HPV)相关疾病分子诊断工程技术研究开发中心,广东广州510555 [3]首都医科大学附属北京同仁医院病理科,北京100730

出　　处：《中国实用妇科与产科杂志》2021年第7期771-775,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划“生殖健康及重大出生缺陷防控研究”重点专项“免疫对配子发生和胚胎发育的影响”(2018YFC1003900)

摘　　要：目的评估生殖道感染专病门诊性传播疾病(sexually transmitted disease,STD)的感染状况及其与高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)及以上病变的关系。方法对2019年10月至2020年1月在中日友好医院妇科生殖道感染专病门诊就诊的494例机会性筛查女性子宫颈脱落细胞行STD10联检联合人乳头瘤病毒(human papillomavirus,HPV)37分型检测,采用SPSS 22.0软件对数据进行统计学分析。结果494例机会性筛查女性人群中,STD10联检的总感染率为48.4%,且随着年龄段的增加,感染率呈下降趋势(χ^(2)=14.236,P=0.012)。在≤低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)人群中,STD的感染率明显高于≥HSIL人群;在腺细胞相关病变人群中STD的感染率最高(Fisher确切概率法,P<0.001)。沙眼衣原体感染是HPV感染(χ^(2)=10.925,P=0.001)和高危型HPV感染(χ^(2)=11.802,P=0.001)的危险因素;HPV37种亚型的总感染率为63.4%,在55~64岁年龄组女性的感染率最高,为75.8%。子宫颈上皮病变的病程越重,HPV感染率越高,在鳞状细胞癌(squamous cell carcinoma,SCC)和腺细胞癌(adenocarcinoma,AC)人群中,HPV的感染率为100%(Fisher确切概率法,P=0.002)。以组织病理学诊断≥HSIL作为子宫颈病变阳性的标准,高危型HPV感染会增加子宫颈病变的发生风险(χ^(2)=3.935,P=0.049)。结论成年女性罹患STD的风险高,沙眼衣原体感染可能会增加HPV尤其是高危型HPV感染的发病风险,进而增加HSIL发病的概率。因此,应该将STD的筛查纳入妇产科常规检查。Objective To evaluate the infection status of the sexually transmitted disease(STD)and its relationship with ≥high-grade squamous intraepithelial lesion(HSIL).Methods A total of 494 women receiving opportunistic screening in China-Japan Friendship Hospital from Oct.2019 to Jan.2020 were included.STD ten examinations combined with HPV typing detection of the exfoliated cervical cells were carried out.SPSS 22.0 software was used to analyze the statistical significance of the data.Results The total infection rate of STD was 48.4%by STD ten examinations,and with the increase of age the infection rate was droping(χ^(2)=14.236,P=0.012).The infection rate of STD in ≤ low grade squamous intraepithelial lesion(LSIL)was higher than that in ≥ HSIL.The infection rate of STD in glandular cell-related lesions was the highest(Fisher’s exact probability=36.199,P<0.001).The infection of Chlamydia trachomatis was the risk factor of HPV infection(χ^(2)=10.925,P=0.001)and high-risk type HPV infection(χ^(2)=11.802,P=0.001).The total infection rate of HPV 37 types was 63.4%,which was highest in females aged 55~64 years(75.8%).With the progression of lesions,HPV infection rate increased,reaching 100% in squamous cell carcinoma(SCC)and adenocarcinoma(AC)(Fisher exact probability=16.495,P=0.002).The histopathological diagnosis≥HSIL was taken as the criterion for positive cervical lesions,high-risk-type HPV infection increased the risk of the occurrence of cervical lesions(χ^(2)=3.935,P=0.049).Conclusions The adult women are at higher risk of STD.The infection with Chlamydia trachomatis increases the risk of HPV infection,especially the high-risk HPV,which increases the probability of the occurrence of HSIL.Therefore,STD screening should be included in the gynecological routine.

关 键 词：性传播疾病 人乳头瘤病毒 高级别鳞状上皮内病变 筛查 

分 类 号：K711.3[历史地理—历史学]