中山市163 431名妇女高危型HPV感染现状、年龄特征及病理分析  

Analysis of the prevalence,age characteristics and pathological analysis of high-risk HPV infection in 163431 women in Zhongshan City

作　　者：罗小婉[1] 罗燕艳[1] 陈昂[1] 符丽华[1] 林钰叶[1] LUO Xiao-wan;LUO Yan-yan;CHEN Ang;FU Li-hua;LIN Yu-ye(Department of Gynecology,Boai hospital of Zhongshan city,Zhongshan 528403,Guangdong,China;不详)

机构地区：[1]中山市博爱医院妇科,广东中山528403

出　　处：《广东医学》2022年第7期913-919,共7页Guangdong Medical Journal

基　　金：中山市社会公益科技研究项目(重大项目)(2019B1011)。

摘　　要：目的通过对参加中山市政府开展的宫颈癌筛查项目的163431名中山户籍女性的高危型HPV E6/E7 mRNA检测结果进行分析,了解该地区35~65岁妇女高危型HPV E6/E7 mRNA的感染现状、年龄特征及宫颈病变、宫颈癌的检出率,为该地区宫颈癌的防治提供参考。方法采集2018年9月至2020年12月参加中山市政府开展的宫颈癌筛查对象的宫颈分泌物,采用Aptima HPV E6/E7 mRNA PANTHER系统自动检测平台进行14种高危型HPV亚型的检测,并对参加随访的阳性病例进行液基细胞学、阴道镜检查及病理活检,以病理结果作为诊断宫颈病变及宫颈癌的金标准。结果筛查对象共计163431人,阳性人数8407人,阳性率5.14%(8407/163431),其中HPV 16、HPV 18/45、其他型别阳性率分别为0.61%(1000/163431)、0.28%(465/163431)、4.25%(6942/163431)。以5岁为一年龄组,35~65岁女性HPV E6/E7 mRNA总阳性率和其他型别阳性率均呈U型分布。其中60~65岁组的阳性率最高,与其他各组间差异有统计学意义(P<0.05)。对3568例病理活检结果分析发现,以HPV E6/E7 mRNA作为初筛,HSIL及以上的检出率为16.96%(605/3568),其中LSIL、HSIL、原位腺癌、宫颈癌检出率分别为26.82%(957/3568)、15.58%(556/3568)、0.25%(9/3568)、1.12%(40/3568)。将宫颈癌细分为宫颈鳞癌、宫颈腺癌,其检出率分别为0.90%(32/3568)、0.22%(8/3568)。进一步分析发现2223例液基细胞学正常而HPV E6/E7 mRNA其他型别阳性者中,HSIL及宫颈鳞癌的检出率分别为8.32%(185/2223)、0.18%(4/2223)。HSIL在60~65岁间的检出率高达10.93%,与60~65岁组HPV E6/E7 mRNA阳性率最高相符合。宫颈鳞癌在50~59岁中检出4例,检出率0.18%(4/2223)。结论HPV E6/E7 mRNA对宫颈病变及宫颈癌的检出率高,是一种适宜的宫颈癌初筛策略,同时需要对50岁以上的阳性人群重点随访,从而减少HSIL及以上病例的漏诊,降低宫颈癌的发生率。Objective By analyzing the test results of high-risk type HPV E6/E7 mRNA in 163431 women with household registration in Zhongshan who participated in the cervical cancer screening project carried out by the Zhongshan Municipal Government,the infection status and age of high-risk type HPV E6/E7 mRNA in women aged 35-65 years in this area were analyzed.The characteristics and detection rate of cervical lesions and cervical cancer provide reference for the prevention and treatment of cervical cancer in this region.Methods The cervical secretions of the subjects who participated in the cervical cancer screening carried out by the Zhongshan Municipal Government from September 2018 to December 2020 were collected,and the Aptima HPV E6/E7 mRNA PANTHER system automatic detection platform was used to detect 14 high-risk HPV subtypes.Liquid-based cytology,colposcopy and pathological biopsy were performed on the positive cases who participated in the follow-up,and the pathological results were used as the gold standard for the diagnosis of cervical lesions and cervical cancer.Results A total of 163431 females were screened,8407 were positive,and the positive rate was 5.14%(8407/163431).Among them,the positive rates of HPV 16,HPV 18/45 and other types were 0.61%(1000/163431)and 0.28%(465/163431)and 4.25%(6942/163431),respectively.Taking 5 years old as an age group,the total positive rate of HPV E6/E7 mRNA and the positive rate of other types of HPV in women aged 35-65 showed a U-shaped distribution.Among them,the 60-65-year-old group had the highest positive rate,and the difference was statistically significant with other groups(P<0.05).Analysis of 3568 cases of pathological biopsy results showed that with HPV E6/E7 mRNA as the primary screening,the detection rate of HSIL and above was 16.96%(605/3568),including LSIL,HSIL,adenocarcinoma in situ,and cervical cancer;with the detection rates of 26.82%(957/3568),15.58%(556/3568),0.25%(9/3568)and 1.12%(40/3568),respectively.The cervical cancer was subdivided into cervical squamou

关 键 词：高危型人乳头瘤病毒 E6/E7 MRNA检测 宫颈癌筛查 年龄 

分 类 号：R711.74[医药卫生—妇产科学] R737.33[医药卫生—临床医学]