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宫颈癌是影响全球女性生命安全的主要恶性肿瘤。我国子宫颈癌发病率较高,每年约有132 300例新病例,每100 000名妇女中约有27例发病[1]。流行病学研究证实持续性人乳头瘤病毒(human papillomavirus,HPV)感染是宫颈癌发生和进展的关键因素[2]。HPV感染情况复杂,容易受到病人种族、地区、病情严重程度、合并疾病影响,此外,HPV感染类型多,目前发现的HPV类型超过200多种,包括高风险和低风险HPV,多数病人存在多重感染[3]。宫颈高级别病变为癌前病变,如果在疾病早期或者病变未发生前筛查出宫颈癌高危人群,可早期发现宫颈癌并进行针对性治疗。临床工作中发现不同基因型HPV感染病人宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)发生风险及病情严重程度不一。探索宫颈高级别病变HPV基因型分布情况将进一步帮助临床发现高危宫颈癌人群及了解宫颈癌发生机制,因此本研究观察宫颈高级别病变病人HPV不同亚型分布情况。
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110例病人中,HPV阳性91例,阳性率为82.7%,阴性19例,阴性率为17.3%。
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2.2.1 HPV总感染情况在91例HPV阳性病人中,HPV感染例次为131例次,HPV基因型构成比位于前5位的分别为HPV16(28.2%)、HPV58(13.0%)、HPV52(11.4%)、HPV18(11.4%)、HPV33(10.7%)(见表 1)。
HPV感染基因型 感染例次 构成比/% HPV6 3 2.3 HPV11 2 1.5 HPV16 37 28.2 HPV18 15 11.4 HPV26 3 2.3 HPV31 2 1.5 HPV33 14 10.7 HPV39 2 1.5 HPV45 3 2.3 HPV51 2 1.5 HPV52 15 11.4 HPV53 9 6.9 HPV56 3 2.3 HPV58 17 13.0 HPV66 2 1.5 HPV68 2 1.5 合计 131 100.0 表 1 各HPV亚型感染情况
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HPV单一感染62例,多重感染29例,在宫颈高级别病变病人中,HPV单一感染构成比(68.1%)高于多重感染构成比(31.9%)。单一感染以HPV16、HPV18感染多见,多重感染以HPV58、HPV33、HPV16和HPV52感染多见(见表 2)。
HPV感染基因型 单一感染 多重感染 HPV6 1(1.6) 2(2.9) HPV11 0(0.0) 2(2.9) HPV16 27(43.5) 10(14.5) HPV18 11(17.7) 4(5.8) HPV26 1(1.6) 2(2.9) HPV31 1(1.6) 1(1.4) HPV33 4(6.5) 10(14.5) HPV39 0(0.0) 2(2.9) HPV45 2(3.2) 1(1.4) HPV51 1(1.6) 1(1.4) HPV52 5(8.1) 10(14.5) HPV53 2(3.2) 7(10.1) HPV56 0(0.0) 3(4.3) HPV58 6(9.7) 11(17.7) HPV66 1(1.6) 1(1.4) HPV68 0(0.0) 2(2.9) 合计 62(100.0) 69(100.0) 表 2 HPV感染类型分布[n;百分率(%)]
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在CINⅡ级及CINⅢ级病人中,HPV16单一感染均最高。CINⅡ级单一感染20例,多重感染20例,CINⅢ级病人单一感染33例,多重感染25例,CINⅢ级单一感染率高于CINⅡ级(χ2=6.38,P < 0.05)(见表 3)。
HPV感染基因型 CINⅡ级(51例) CIN Ⅲ级(40例) 单一感染 多重感染 总感染 单一感染 多重感染 总感染 HPV16 8(15.6) 4(7.8) 12(23.5) 19(47.5) 6(15.0) 25(62.5) HPV18 5(9.8) 2(3.9) 7(13.7) 6(15.0) 2(5.0) 8(20.0) HPV33 2(3.9) 4(7.8) 6(11.8) 2(5.0) 6(15.0) 8(20.0) HPV52 2(3.9) 5(9.8) 7(13.7) 3(7.5) 5(12.5) 8(20.0) HPV58 3(5.9) 5(9.8) 8(15.7) 3(7.5) 6(15.0) 9(22.5) 表 3 CINⅡ级及Ⅲ级中常见HPV分布情况[n;百分率(%)]
宫颈高级别病变病人HPV不同亚型分布情况
Distribution of different subtypes of HPV in patients with high-grade cervical lesions
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摘要:
目的探讨宫颈高级别病变病人人乳头瘤病毒(HPV)不同亚型分布情况。 方法选取110例宫颈高级别病变的病人,均行液基细胞学检查(TCT)、HPV分型检查及阴道镜活检,观察病人不同类型HPV基因型分布情况。 结果110例病人中HPV阳性91例,阳性率为82.7%。91例HPV阳性病人中,HPV基因型感染率位于前5位的分别为HPV16(28.2%)、HPV58(13.0%)、HPV52(11.4%)、HPV18(11.4%)、HPV33(10.7%)。HPV单一感染62例,多重感染29例。单一感染以HPV16、HPV18感染多见,多重感染以HPV58、HPV33、HPV16和HPV52感染多见。在CINⅡ级及CINⅢ级病人中,HPV16单一感染均最高。CINⅢ级单一感染率高于CINⅡ级(P < 0.001)。 结论随宫颈高级别病变加重,HPV16感染率增加,HPV16、HPV58、HPV18、HPV33、HPV52在宫颈高级别病变中感染率高,其检测有助于宫颈高级别病变的识别。 Abstract:ObjectiveTo investigate the distribution of different subtypes of human papillomavirus(HPV) in patients with high-grade cervical lesions. MethodsA total of 110 patients with high-grade cervical lesions were examined using thiprep cytology test, HPV typing and colposcopy biopsy.The distribution of different HPV genotypes in patients were observed. ResultsAmong 110 patients, the positive HPV in 91 cases were found, and the positive rate of which was 82.7%.Among the 91 HPV-positive patients, the top 5 genotype of HPV were HPV16(28.2%), HPV58(13.0%), HPV52(11.4%), HPV18(11.4%) and HPV33(10.7%), respectively.There were 62 cases of single HPV infection and 29 cases of multiple HPV infection.HPV16 and HPV18 were more common in single infection, and HPV58, HPV33, HPV16 and HPV52 were more common in multiple infection.In CIN Ⅱ and CIN Ⅲ level patients, the single infection of HPV16 was the highest.The single infection rate of CIN Ⅲ level was higher than that of CIN Ⅱ level(P < 0.05). ConclusionWith the aggravation of high-grade cervical lesions, the infection rate of HPV16 increases, the infection rates of HPV16, HPV58, HPV18, HPV33 and HPV52 in high-grade cervical lesions are high, and the detection of which is helpful for the recognition of high-grade cervical lesions. -
Key words:
- high-grade cervical lesion /
- human papillomavirus /
- infection rate
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表 1 各HPV亚型感染情况
HPV感染基因型 感染例次 构成比/% HPV6 3 2.3 HPV11 2 1.5 HPV16 37 28.2 HPV18 15 11.4 HPV26 3 2.3 HPV31 2 1.5 HPV33 14 10.7 HPV39 2 1.5 HPV45 3 2.3 HPV51 2 1.5 HPV52 15 11.4 HPV53 9 6.9 HPV56 3 2.3 HPV58 17 13.0 HPV66 2 1.5 HPV68 2 1.5 合计 131 100.0 表 2 HPV感染类型分布[n;百分率(%)]
HPV感染基因型 单一感染 多重感染 HPV6 1(1.6) 2(2.9) HPV11 0(0.0) 2(2.9) HPV16 27(43.5) 10(14.5) HPV18 11(17.7) 4(5.8) HPV26 1(1.6) 2(2.9) HPV31 1(1.6) 1(1.4) HPV33 4(6.5) 10(14.5) HPV39 0(0.0) 2(2.9) HPV45 2(3.2) 1(1.4) HPV51 1(1.6) 1(1.4) HPV52 5(8.1) 10(14.5) HPV53 2(3.2) 7(10.1) HPV56 0(0.0) 3(4.3) HPV58 6(9.7) 11(17.7) HPV66 1(1.6) 1(1.4) HPV68 0(0.0) 2(2.9) 合计 62(100.0) 69(100.0) 表 3 CINⅡ级及Ⅲ级中常见HPV分布情况[n;百分率(%)]
HPV感染基因型 CINⅡ级(51例) CIN Ⅲ级(40例) 单一感染 多重感染 总感染 单一感染 多重感染 总感染 HPV16 8(15.6) 4(7.8) 12(23.5) 19(47.5) 6(15.0) 25(62.5) HPV18 5(9.8) 2(3.9) 7(13.7) 6(15.0) 2(5.0) 8(20.0) HPV33 2(3.9) 4(7.8) 6(11.8) 2(5.0) 6(15.0) 8(20.0) HPV52 2(3.9) 5(9.8) 7(13.7) 3(7.5) 5(12.5) 8(20.0) HPV58 3(5.9) 5(9.8) 8(15.7) 3(7.5) 6(15.0) 9(22.5) -
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