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1712例高危型HPV感染与宫颈病变相关性的临床资料分析
The relationship of HPV high-risk genotypes and cervical lesions in 1712 cases
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DOI:
作者:
楼微华,洪祖蓓,狄文
Lou Weihua,Hong Zubei,Di Wen
作者单位:
上海交通大学医学院附属仁济医院
Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine
关键词:
人乳头瘤病毒 高危亚型 宫颈病变 致病风险
Human papillomavirus, High risk genotype,Cervical lesions,Pathogenic risk
摘要:
目的:分析1712例HPV高危亚型在宫颈癌、癌前病变和正常人群中的分布差异,探讨HPV亚型检测对宫颈病变诊治的临床价值。方法:收集2007年7月至2012年8月间于上海交通大学医学院附属仁济医院妇科门诊行机会性宫颈癌筛查人群的宫颈脱落细胞标本,完成HPV分型检测和液基细胞学检查。对HPV高危亚型阳性或液基细胞学检查结果大于等于ASCUS者,进一步行阴道镜检查并取宫颈组织活检。结果:机会性宫颈癌筛查完成HPV分型检测10838例,高危亚型阳性1712例,占筛查总数的15.9%。最常见的6种高危亚型分别为16, 58, 52, 33,18,31。经病理确诊宫颈癌及宫颈上皮内瘤变患者348例,以病理诊断CIN II+作为临界终点,不同HPV高危亚型感染导致CIN II+的比例存在差异,p<0.05,差异有统计学意义。最易引起宫颈CINII+的HPV亚型是HPV16和HPV18。HPV16/18单一亚型感染者中,最终病理诊断为CIN的比例存在差异,HPV16单一亚型感染的致病风险远高于HPV18和其他亚型。HPV18多重感染者较HPV18单一感染者,发生高级别CIN及以上病变的风险显著提高。结论:本地区HPV高危亚型感染的常见亚型依次为16,58,52,33,18,31,不同HPV高危亚型的致病风险存在差异,利用HPV亚型检测进行宫颈癌筛查和随访可能更有临床指导意义。
【OBJECTIVE】 To analyze the distributional difference of HPV high-risk genotypes in different cervical cancer, cervical precancerous lesion and the normal population, explore the pathogenicity difference of several common HPV high-risk genotypes in cervical cancer and cervical intraepithelial neoplasia so as to study the value of HPV genotypes test in the diagnosis and treatment of cervical lesion.【METHODS】We collected the cervical exfoliative cells in the cervical cancer screening people at the Affiliated Renji Hospital of Shanghai Jiaotong University School of Medicine from 2007 July to 2012 August, they were all completed HPV typing and liquid based cytology. The HPV high-risk genotype positive or liquid based cytology results greater than or equal to ASCUS, into a colposcopy and cervical biopsy. 【RESULTS】In the screening of 10838 cases, positive high-risk genotypes appeared in 1712 cases, accounting for 15.9% . The six most common high-risk genotypes were 16 ( 6.48%, 702/10838 ), 58 ( 3.15%, 341/10838 ), 52 ( 2.39%, 259/10838 ), 33 ( 1.74%, 188/10838 ), 18 ( 1.45%, 157/10838 ), 31 ( 1.18%, 128/10838 ). Eventually there were 32 carcinoma cases,214 high-grade cervical intraepithelial neoplasia cases,102 low- grade cervical intraepithelial neoplasia cases and 1364 chronic cervicitis cases confirmed by pathology. According to the pathological diagnosis of CIN II+ as critical endpoint, we analyzed the relationship between HPV genotypes and cervical lesions, which found that different HPV high-risk genotype infection leads to different CIN II+ incidents, p<0.05. The most common genotype leading to CIN II+ is HPV16 and HPV18. In one type infection,HPV16 has a higher pathogenic risk than HPV18 and other genotypes.Multiple HPV18 infection has a higher pathogenics risk than single HPV18 infection(p<0.01).【CONCLUSIONS】The distribution difference of HPV genotype varies in regions, the most common HPV high-risk genotypes in Shanghai area were 16, 58, 52,33,18,31.Different HPV genotypes means different pathogenic risk. HPV genotype tests is recommended in cervical screening and follow up.
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