南京地区妊娠期妇女高危型人乳头瘤病毒感染率及其对妊娠结局的影响

目的 调查南京地区孕妇高危型人乳头瘤病毒及亚型感染率,并探讨其对于妊娠结局的影响.方法 选取2014年2月至2016年5月南京中医药大学附属中西医结合医院(江苏省中医药研究院)产科门诊建卡孕妇1557例,同时分别以2016年1月至6月健康体检人群85例、妇科门诊就诊的各类炎症疾病患者2062例为对照,比较各组人群HR-HPV及亚型感染率,以早产、胎膜早破两种常见不良妊娠为结局,探讨孕期HR-HPV感染对于妊娠结局的影响,并进一步分析HR-HPV不同基因型感染之间孕妇妊娠结局的差异.结果 ①妊娠组、疾病组及健康体检组HR-HPV感染率分别为12.91％、16.39％和11.76％,妊娠组HR-HPV感染率显著低于疾病组(P＜0.05),与健康体检组之间无差异(P＞0.05).妊娠组16、18亚型及其它12种HR-HPV亚型感染率分别为2.63％、0.64％和10.66％,18亚型及其它12种HR-HPV亚型感染率均显著低于疾病组(P＜0.05),而16亚型无显著性差异(P＞0.05).②HR-HPV感染孕妇不良妊娠结局发生率显著高于无HR-HPV感染孕妇(P＜0.05).③二元Logistic回归分析显示,HR-HPV感染是早产、胎膜早破两种常见不良妊娠结局的危险因素(OR:3.323,95％ CI:2.192～5.036,P＜0.001),而年龄、孕产次对妊娠结局没有影响(P＞0.05).④单一HR-HPV 16或18亚型、其它12种高危亚型及两种或两种以上高危亚型感染之间孕妇不良妊娠结局发生率无显著性差异(P＞0.05).结果 孕期HR-HPV感染是早产、胎膜早破两种常见不良妊娠结局的危险因子,因此做好孕前及妊娠期HR-HPV筛查和积极干预,有利于优生优育.

HR-HPV Prevalence in Gravidas of Nanjing and Its Impact on Pregnancy Outcome

Objective To investigate the high-risk human papillomavirus (HR-HPV) and its subtype prevalence in gravidas of Nanjing,to discuss its impact on the pregnancy outcome.Methods A total of 1557 gravidas from February 2014 to May 2016 were collected,also included were 2062 inflammatory disease patients in gynecology clinic and 85 cases of physical examination population as the control groups from January to June of 2016.HR-HPV and its subtypes prevalence were compared among three groups.Premature rupture of membranes and premature delivery were used as to evaluate impacts of HR-HPV infection on pregnancy outcome.Different effects in HR-HPV subtypes wereanalyzed.Results HR-HPV prevalence in gravidas group,inflammatory disease group and the control group were 12.91％,16.39％ and 11.76％,respectively.The prevalence of HR-HPV in gravidas group was significantly lower than that of inflammatory disease group (P ＜ 0.05),but no difference with control group (P ＞ 0.05).Prevalence of HR-HPV 16,18 subtype and other 12 subtypes in gravidas were 2.63％,0.64％ and 10.66％,respectively.The gravidas group prevalence of HR-HPV 18 subtype and other 12 subtypes were significantly lower than that of inflammatory disease group (P ＜ 0.05),but no difference on 16 subtype(P ＞ 0.05).The adverse pregnancy outcomes of HR-HPV infected pregnant women were significantly higher than non-infected ones (P ＜ 0.05).Binary Logistic regression analysis showed that the HR-HPV infection during pregnancy was a risk factor for adverse pregnancy outcomes,such as premature rupture of membranes and premature delivery (OR:3.323,95％ CI:2.192-5.036,P ＜0.001).Age,pregnancy and delivery times showed no effect as pregnancy outcomes (P ＞ 0.05).The adverse pregnancy outcomes between single HR-HPV 16,18 subtype,other 12 subtypes and two or more than two subtypes infection had no difference(P ＞ 0.05).Conclusion HR-HPV infection in pregnancy is a risk factor for adverse pregnancy outcomes.Therefore,pre-pregnancy and during-pregnancy screening for HR-HPV and active intervention would promote good prenatal and postnatal care.