河南省女性HPV流行病学调查及宫颈病变风险评估  

HPV epidemiological survey and risk assessment of cervical lesions in women in Henan province

作　　者：刘慧[1,2,3] 李洋 Liu Hui;Li Yang(Henan Provincial Peoples Hospital,Zhengzhou 450000;Zhengzhou University People's Hospital,Zhengzhou 450000;Henan University People's Hospital,Zhengzhou 450000)

机构地区：[1]河南省人民医院,郑州450000 [2]郑州大学人民医院,郑州450000 [3]河南大学人民医院,郑州450000

出　　处：《现代妇产科进展》2022年第9期641-647,共7页Progress in Obstetrics and Gynecology

摘　　要：目的:了解河南省女性人乳头瘤病毒(HPV)流行病学特征,评估不同高危型及疑似高危型HPV引起宫颈病变的风险程度,为制定适合我国国情的宫颈癌筛查和疫苗防治策略提供参考依据。方法:回顾分析2019年1月1日至2020年12月31日在河南省人民医院健康管理科行HPV基因分型检测及液基薄层细胞学(TCT)检测的体检者资料,将宫颈细胞学病变≥ASCUS界定为TCT阳性。采用卡方检验进行组间率的比较;采用归因分析比较不同HPV亚型对宫颈细胞学异常的致病贡献;采用相对危险度(RR)分析不同HPV亚型对宫颈细胞学及组织病理学异常的风险程度。结果:共纳入10430例体检者,平均年龄(47.44±11.66)岁,HPV阳性者1411例(13.53%),TCT阳性者191例(1.83%)。HPV年龄分布近似双峰分布,20~29岁女性HPV感染率最高(17.30%),其次是60~65岁女性(15.21%),年龄在65岁以上女性HPV感染率最低(11.63%),差异有统计学意义(P=0.041)。对高危及疑似高危型HPV的流行病学分析显示,河南省最流行的5种HPV依次是HPV52(2.18%)、HPV58(1.42%)、HPV16(1.36%)、HPV53(1.32%)、HPV39(1.25%)。归因分析显示,TCT阳性的致病HPV中归因比例最大是HPV52(5.62%),提示HPV52是宫颈细胞学异常最主要的致病亚型,其次为HPV16(3.14%)、HPV58(2.33%)、HPV56(1.63%)、HPV53(1.00%)。RR分析显示,相较于其他高危及疑似高危型HPV,HPV16[RR(95%CI)=1.792(1.098~2.923)]及HPV56[RR(95%CI)=3.800(2.190~0.593)]对TCT阳性有更高的致病风险,差异有统计学意义(P<0.05);与HPV16(RR=0.985)相比,HPV56(RR=1.58)、HPV58(RR=1.354)、HPV52(RR=1.324)导致宫颈病变的危险度呈上升趋势。结论:河南省最常见的五种HPV亚型是HPV52、HPV58、HPV16、HPV53、HPV39,其中HPV52是宫颈细胞学异常最主要的致病亚型。HPV56/58/52对宫颈病变的危险程度似乎高于HPV16。中国的宫颈癌筛查策略、阴道转诊及未来HPV疫苗的研制对HPV56/58/52感染应采取更加积极的行动。Objective:To understand the epidemiological characteristics of human papillomavirus(HPV)in women in Henan Province,and to evaluate the risk of cervical lesions caused by different high-risk and suspected high-risk HPV types,so as to provide reference for formulating cervical cancer screening and vaccine prevention strategies suitable for China’s national conditions.Methods:A retrospective analysis of the data of physical examiners who underwent HPV genotyping and thinprep cytologic test(TCT)testing in the Health Management Section of Henan Provincial People’s Hospital from January 1,2019 to December 31,2020,defined cervical cytology≥ASCUS as TCT positive.The chi-square test was used to compare rates between groups.Attribution analysis was used to compare the pathogenic contributions of different HPV subtypes to cervical cytology abnormalities.Relative risk(RR)analysis was used to analyze the risk of cervical cytology and histopathological abnormalities caused by different HPV subtypes.Results:A total of 10430 medical examiners were included in this study,with an average age of(47.44±11.66)years old.1411(13.53%)were HPV-positive,and 191(1.83%)were TCT-positive.The age distribution of HPV was approximately bimodal distribution.The HPV infection rate among women aged 20~29 was the highest(17.30%),followed by women aged 60~65(15.21%),and the HPV infection rate among women over 65 was the lowest(11.63%).The difference was statistically significant(P=0.041).Epidemiological analysis of high-risk and suspected high-risk HPV types showed that the five most prevalent HPV types in Henan province were HPV52(2.18%),HPV58(1.42%),HPV16(1.36%),HPV53(1.32%),and HPV39(1.25%).The attribution analysis showed that HPV52(5.62%)was the most attributable proportion of causative HPV leading to TCT positivity,suggesting that HPV52 was the most common pathogenic subtype of cervical cytology,followed by HPV16(3.14%),HPV58(2.33%),HPV56(1.63%),HPV53(1.00%).RR analysis showed that compared with other high-risk and suspected high-risk HP

关 键 词：宫颈癌筛查 人乳头瘤病毒 归因分析 相对危险度分析 疫苗 

分 类 号：R737.33[医药卫生—肿瘤]