人乳头瘤病毒多重感染与宫颈病变的相关性分析

金龙妹; 徐灵; 肖丽萍; 张晓华; 张琳琳; 杨慧宾; 张蕾; 曹晶; 徐军

doi:10.19428/j.cnki.sjpm.2018.18682

人乳头瘤病毒多重感染与宫颈病变的相关性分析

Correlation between multiple HPV infection and cervical lesions

摘要

摘要:
目的探讨人乳头瘤病毒(HPV)多重感染与宫颈病变的关系。
方法对2013年1月—2016年12月闵行区115 463例妇科普查妇女的宫颈细胞标本采用巴氏涂片法联合HPV基因分型检测法行宫颈癌筛查，宫颈病变根据组织病理学诊断，比较不同类型宫颈病变HPV多重感染的比例及基因型分布。
结果普查人群HPV感染率为11.18%，高危型HPV感染率10.93%，其中多重感染占21.02%，二重感染最常见，最多亚型是六重。604例宫颈病变者HPV感染率为94.21%，均为高危型，其中多重感染占23.73%，二重感染最常见，最多亚型是四重。多重HPV感染与单一HPV感染宫颈癌前病变/宫颈癌的发病率比较差异均无统计学意义(P＞0.05)。随着感染亚型的增加宫颈病变例数趋于减少，病变级别越高减少越明显，宫颈鳞癌组多重感染率仅为15.69%，与LSIL组及HSIL组比较HPV多重感染率差异有统计学意义(P＜0.05)。宫颈病变HPV单一感染亚型位于前5位的依次是HPV16、52、58、18、33型，HPV16型占38.71%。多重感染以合并HPV16型感染为主，占56.30%，宫颈鳞癌占比达100%。
结论HPV多重感染不增加宫颈病变的机会，宫颈病变的严重程度与HPV感染型别无相关性，而与感染HPV的基因型有关。HPV16型的致癌性最强，普查后需严密随访和管理HPV16型特别是包含有HPV16型的多重持续性感染者。

Abstract:
ObjectiveTo investigate the relationship between multiple infection of human papilloma virus (HPV) and cervical lesions.
MethodsThe cervical cell specimens of 115 463 women from January 2013 to December 2016 in Minhang District were examined by using the method of bar smear combined with HPV genotyping, and diagnosis of cervical lesions done according to histopathology.The proportion and genotype distribution of HPV multiple infection in different types of cervical lesions were compared.
ResultsThe HPV infection rate was 11.18% and the high risk HPV infection rate was 10.93%.The multiple infection rate was 21.02%, the double infection was the most common and the most subtype was six infection.The infection rate of HPV in 604 patients with cervical lesions was 94.21%, all of them were high risk type.The multiple infection rate was 23.73%, the double infection was the most common, and the most subtype was four infection.There was no significant difference in the incidence of cervical lesions/carcinogenesis between multiple HPV infection and single HPV infection(P > 0.05).With the increase of the infection subtype, the number of cases of cervical lesions tended to decrease, and the higher the level of the lesion was, the more obvious it was.The multiple HPV infection rate cervical squamous cell carcinoma group was only 15.69%.Compared with LSIL group and HSIL group, the multiple infection rate of HPV had statistical significance(P < 0.05).The HPV single infection subtype of cervical lesions located in the first five was HPV16, 52, 58, 18, 33 type, of which type HPV16 was 38.71%.Multiple infections were mainly combined with HPV16-type infection, accounting for 56.30%, and cervical squamous cell carcinoma accounting for 100%.
ConclusionMultiple HPV infection does not increase the chance of cervical lesions.The severity of cervical lesions is not related to the number of HPV infection types, but to the genotype of infected HPV.The carcino-genicity of type HPV16 is the strongest.After the census, close follow-up and management are required of type HPV16, especially those containing HPV16 type multiple persistent infection.

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