HPV拓展分型检测在宫颈癌筛查中的临床意义  

Study on HPV extended typing test in cervical cancer screening

作　　者：肖静 李莉[1] 邹锋 陈宇[1] XIAO Jing;LI Li;ZOU Feng;CHEN Yu(Department of gynecology and obstetrics,Department of anesthesiology,201306,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital)

机构地区：[1]上海交通大学附属第六人民医院妇产科,201306 [2]上海交通大学附属第六人民医院麻醉科

出　　处：《中国生育健康杂志》2023年第3期243-247,共5页Chinese Journal of Reproductive Health

基　　金：上海市第六人民医院院级科研基金(项目编号:DY2020020)。

摘　　要：目的探讨除HPV16/18外的HPV拓展分型检测对宫颈高级别上皮内病变和宫颈癌的筛查意义。方法回顾性研究分析,选取2018年1月—2020年12月在上海市第六人民医院(临港院区)就诊的1200名HPV分型检测阳性的女性,并对同期因各种指征转诊阴道镜且行活组织病理检查的868例妇女,按照是否发生宫颈高级别上皮内病变和宫颈癌分为观察组和对照组,对不同年龄段、以及各亚型HPV感染的结果进行统计学分析,并计算TCT和高危亚型HPV及各亚型组合对宫颈高级别上皮内病变和宫颈癌的预测效能。结果(1)1200名HPV感染的女性中,感染率前三位的亚型依次为HPV52、HPV16、HPV58,60岁以上女性多重感染率更高(χ^(2)=5.56,P=0.022);(2)HPV16、HPV31、HPV33亚型感染与HSIL和宫颈癌的发生有关,Logistic回归分析显示这三种亚型感染均是独立危险因素;(3)60岁及以上的患者HSIL和宫颈癌的检出率最高,差异有统计学意义(χ^(2)=8.322,P=0.004);(4)预测HSIL和宫颈癌的因子中,HPV16/31/33对HSIL和宫颈癌的预测约登指数最高。结论本地区除HPV16/18亚型,对其他高危亚型如HPV31、HPV33、HPV52、HPV58等亚型的拓展分型检测有助于避免HSIL和宫颈癌的漏诊;各年龄段的妇女对大多数高危亚型HPV的易感性无明显差异,应加强本地区60岁以上妇女的宫颈癌筛查及随访,提倡个体化筛查和随访方案。Objective To investigate the significance of HPV extended typing except HPV16/18 in high-grade intraepithelial lesions of HSIL and cervical cancer screening.Methods A total of 1200 women with HPV infection who attended Lingang campus of Shanghai sixth people′s hospital from Jan.2018 to Dec.2020 were selected for retrospective analysis.At the meantime,a total of 868 women including some of them and other women who underwent colposcope and histopathology examination were divided into two groups according to the occurrence of HSIL or cervical cancer.The results of HPV infection in different age groups and subtypes were statistically analyzed.The efficacy of TCT,high-risk HPV subtypes and their combinations in predicting HSIL and cervical cancer was calculated.Results 1.The top three subtypes were HPV52,HPV16 and HPV58,respectively,among the 1200 women infected with HPV.And the multiple infection rate was higher in women over 60 years old(χ^(2)=5.56,P=0.022).2.HPV16,HPV31 and HPV33 were associated with the occurrence of HSIL and cervical cancer,and Logistic regression analysis showed that the infection of these three subtypes were independent risk factors.3.The highest rates of HSIL and cervical cancer were found in patients aged 60 years and older(χ^(2)=8.322,P=0.004).Conclusion 1.In addition to HPV16/18 subtype,expanded typing of other high-risk subtypes such as HPV31,HPV33,HPV52 and HPV58 in this region is helpful to avoid missed diagnosis of HSIL and cervical cancer;2.There is no significant difference in the susceptibility of women of all ages to most high-risk subtypes of HPV,so cervical cancer screening and follow-up for women over 60 years old in this region should be strengthened,and individualized screening and follow-up programs should be advocated.

关 键 词：HPV分型检测 宫颈癌筛查 LOGISTIC回归分析 

分 类 号：R71[医药卫生—妇产科学] R17[医药卫生—临床医学]