不同女性人群生殖道人乳头瘤病毒感染状况分析

目的:调查不同女性人群生殖道人乳头瘤病毒(HPV)感染状况,为制定不同人群宫颈癌筛查策略提供理论依据。方法:选择2010年1月至2015年12月在重庆市妇幼保健院妇产科门诊体检和就诊的3376例妇女,分为5组:普通人群组770例,妇科疾病患者组1069例,宫颈上皮内瘤变(CIN)患者组560例,不孕症患者组648例,产褥期妇女组329例。采用HPV基因分型技术进行HPV检查,分析HPV DNA亚型感染状况。结果:(1)共检出HPV 22个型别,最常见类型依次为6型(14.81%,500/3376),16型(14.16%,478/3376),52型(12.59%,425/3376),58型(11.91%,402/3376),43型(6.66%,225/3376),未检测出HPV 44型。(2)不同人群HPV总阳性率及高危型阳性率不同,由高到低依次为CIN患者组[89.46%(501/560),85.89%(481/560)],不孕症患者组[66.67%(432/648),58.80%(381/648)],妇科疾病患者组[62.77%(671/1069),55.57%(594/1069)],普通人群组[24.03%(185/770),19.22%(148/770)],产褥期妇女组[13.07%(43/329),10.03%(33/329)]。(3)不同人群中HPV DNA亚型分布有差异,CIN患者组及不孕症患者组以高危型HPV感染为主,感染HPV型别构成比相似,最常见类型均为HPV16、58、52型,且HPV多重感染百分率高于其他组(P0.01),但妇科疾病患者组总体高危型HPV感染率及多重感染率明显高于普通人群及产褥期妇女组。(4)CIN患者组中随CIN病变级别增高,HPV总阳性率及高危型HPV阳性率皆增高,差异有统计学意义(χ~2总=57.49,P0.01;χ~2高危型=58.40,P0.01)。三重及以上HPV感染在高级别病变(CINⅡ、Ⅲ)中更常见(χ~2=8.96,P0.05),在CINⅡ、CINⅢ组中HPV16型检出率高于CINⅠ组,差异有统计学意义(χ~2=33.24,P0.01)。结论:不孕症患者及妇科疾病患者是高危型HPV感染及CIN的高危人群,重视机会性筛查是提高CIN检出率的有效手段。不同女性人群HPV感染状态不同,应针对不同女性人群制定特异筛查模式。

Investigation and Analysis on HPV Infection Status of Different Female Groups

Objective:To investigate HPV(human papillomavirus) infection status of different female groups for providing theoretical basis of developing screening programs in them.Methods:The infection status of HPV in 3376 women of gynecology department were examined with gene chip technique in Chongqing Obstetrics and Gynecology Hospital from Jan 2010 to Dec 2015.All the women were divided into 5 groups:Ordinary groups(770 cases),gynecological patients groups (1069 cases),CI N groups (560 cases),infertility g rou ps (648 cases),puerperium groups(329 cases).The infection status of various subtypes of HPV was compared and analyzed.Results:①Out of the 22 subtypes of HPV,HPV6 (14.81％,500/3376)was most conmen of all types,followed by subtypes HPV16 (14.16％,478/3376),HPV52 (12.59％,425/3376),HPV58 (11.91％,402/3376),HPV43 (6.66％,225/3376),and there were no HPV44.②The HPV positive rate and the HR-HPV(high risk HPV)positive rate were all different in the 5 groups which were CIN groups(89.46％,501/560;85.89％,481/560),infertility groups (66.67％,432/648;58.80％,381/648),gynecological patients groups (62.77％,671/1069;55.57％,594/1069),ordinary groups (24.03％,185/770;19.22％,148/770,puerperium groups (13.07％,43/329;10.03％,33/329)by descending order.③)Subtype of HPV DNA was different in different groups of people,subtypes of HR-HPV were found out more in CIN groups and infertility groups,and the subtypes of HPV were similar in them while the most frequent subtypes were HPV16/58/52,and the rate of multi-infection of HPV in CIN groups and infertility groups was higher than that of the other groups(P ＜ 0.01).But,the rate of HR-HPV infection and multi-infection in gynecological department was obviously higher than that of puerperium groups and normal people.④The positive rate of HPV/HR-HPV in CIN were increasing with the increase of clinical stage （x2HPV =57.49,P＜0.01;x2hr-hpv =58.40,P＜0.01).There were more HPV mixed infection cases in CIN Ⅱ/Ⅲ with three types and above than that in CIN Ⅰ (x2 =8.96,P ＜ 0.05).The positive rate of HPV16 in CIN Ⅱ / Ⅲ was higher than that in CIN Ⅰ[(x2 =33.24,P ＜0.01).Conclusions:Woman who is infertile or with gynecological disease has high risk of HPV infecting and CIN.Pay attention to opportunistic screening is an effective measures for improving the CIN detection rate,the HPV infection status of different female groups is different obviously.Specific screening programs should be developed for different female groups in the future.