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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2013, Vol. 09 ›› Issue (01) : 65 -69. doi: 10.3877/cma.j.issn.1673-5250.2013.01.015

所属专题： 文献；

论著

云南省丽江地区纳西族妇女宫颈感染高危型人乳头瘤病毒调查
亓晶1,*,*(), 李丽1, 郭燕1, 王耀华1, 张艳梅1, 和作珍1, 杨秋鸿1   
  1. 1. 674100　丽江，云南省丽江市人民医院妇产科
  • 收稿日期:2012-09-22 修回日期:2012-12-24 出版日期:2013-02-01
  • 通信作者: 亓晶

Study on High-Risk Human Papillomavirus Infection in Naxi Women of Lijiang, Yunnan Province

Jing QI1(), Li LI1, Yan GUO1, Yao-hua WANG1, Yan-mei ZHANG1, Zuo-zhen HE1, Qiu-hong YANG1   

  1. 1. Department of Obstetric and Gynecology, Lijiang City People' Hospital, Lijiang 674100, Yunnan Province, China
  • Received:2012-09-22 Revised:2012-12-24 Published:2013-02-01
  • Corresponding author: Jing QI
  • About author:
    Corresponding author: QI Jing, Email:
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亓晶, 李丽, 郭燕, 王耀华, 张艳梅, 和作珍, 杨秋鸿. 云南省丽江地区纳西族妇女宫颈感染高危型人乳头瘤病毒调查[J]. 中华妇幼临床医学杂志(电子版), 2013, 09(01): 65-69.

Jing QI, Li LI, Yan GUO, Yao-hua WANG, Yan-mei ZHANG, Zuo-zhen HE, Qiu-hong YANG. Study on High-Risk Human Papillomavirus Infection in Naxi Women of Lijiang, Yunnan Province[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2013, 09(01): 65-69.

目的

探讨云南省丽江地区纳西族妇女宫颈感染高危型人乳头瘤病毒(HR－HPV)的现状及高危因素。分析HR－HPV与宫颈浸润癌(SCC)及宫颈上皮内瘤变(CIN)发生发展的关系，为本地区宫颈癌的防治提供依据。

方法

选择2009年4月至2012年2月于本院妇科门诊就诊并接受妇科普查的6528例长期居住在丽江纳西族聚居地有性生活史的女性为研究对象。对其采用第二代杂交捕获(HC2)方法定量检测宫颈HR－HPV DNA载量。HR－HPV DNA载量判断标准：样本的相对光单位(RLU)与阳性对照临界值(CO)之比。根据RLU/CO值，将本组受试对象分为HR－HPV阴性组(RLU/CO<1.00)、低度载量组(RLU/CO为1.00～9.99)、中度载量组(RLU/CO为10.00～99.99)、高度载量组(RLU/CO≥100.00)。采用非条件多因素logistic回归法分析HR－HPV DNA载量与宫颈病变类型的关系(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，并与受试对象签署临床研究知情同意书)。

结果

本组6528例受试者的HR－HPV感染阳性率为12.55%(819/6528)。根据本组1680例宫颈疾病患者(纳西族妇女为1173例，非纳西族为507例)的组织病理学检查结果：慢性炎症组为500例，宫颈上皮内瘤变(cervical intra－epithelial neoplasia，CIN)Ⅰ组为607例，CINⅡ组为435例，CINⅢ组为112例，宫颈浸润癌(squamous cervical cancer，SCC)组为26例。其中，纳西族妇女分别占61.80%(309/500), 79.08%(480/607), 65.29%(284/435), 74.11%(83/112)与65.38%(17/26)。纳西族妇女与其他民族妇女的HR－HPV阳性率比较，差异无统计学意义(P>0.05)。不同年龄受试者的HR－HPV感染率比较，差异有统计学意义(χ2＝109.21，P<0.05)。首次性生活年龄越小，HR－HPV感染率越高(χ2＝14.79，P<0.05)；孕、产次增多及2个以上性伴侣者，HR－HPV感染率亦随之增加，且差异有统计学意义(χ2＝54.65，316.97；P<0.05)。文化程度与HR－HPV感染率无相关性(P>0.05)。随着宫颈病变程度增加，HR－HPVDNA高度载量所占比例增加，二者呈正相关关系(r＝0.425，P<0.05)，慢性炎症组、CINⅠ组～CINⅢ组及SCC组分别为1.00%(5/500)，3.62%(22/607)，9.89%(43/435)，49.11%(55/112)及65.38%(17/26)。

结论

受试者年轻、首次性生活年龄<18岁，孕、产次多及多个性伴侣是HR－HPV感染的高危因素。宫颈HR－HPV感染及其载量，是影响宫颈病变及发展的重要因素。

关键词: 高危型人乳头瘤病毒, 杂交捕获法, 病毒载量, 宫颈上皮内瘤变
Objective

To investigate the status and risk of high-risk human papillomavirus (HR-HPV)infection in Naxi women of Lijiang, Yunnan Province.To determine association between HR-HPV and the stage of squamous cervical cancer (SCC) and cervical intraepithelial neoplasia (CIN) lesion.To provide the basis for local cervical cancer control.

Methods

From April 2009 to February 2012, a total of 6528 women who were resident in Lijiang City and had sexual experience, Outpatient gynecological census were recruited. Their HR-HPV DNA load was detected by hybrid capture 2 (HC2). HR-HVP infections of different cervical lesion stages were compared. HR-HPV DNA load was measured by the ratios of relative light units compared to cut off (RLU/CO). According to RLU/CO values, they were categorized into: Negative group (<1.00), low viral load group (1.00-9.99), medium viral load group (10.00-99.99), and high viral load group (>100.00). Association between HR-HPV and CINs were evaluated by unconditional multinomial logistic regression. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Lijiang City People' Hospital. Informed consent was obtained from all participants.

Results

Positive for HR-HPV was 12.55%(819/6528) among 6528 tested women. There had no significance difference between infection rates of HR-HPV and ages among 6528 women(χ2=109.21, P<0.05). The earlier of younger woman who had first sexual behaviors were, the higher her infection rates of HR-HPV were(χ2=14.79, P<0.05). Cervical lesions diagnosis which was confirmed by histopathological findings indicated that cervical lesions were diagnosed by biopsies as chronic inflammation of the cervix(n=500), CINⅠ(n=607), CINⅡ(n=435), CINⅢ(n=112)与SCC(n=26). Infection rates of HR-HPV were higher in women who had many times of gravidities and parities than those who had only one time. Infection rates of HR-HPV in women of sexual partners more than two were higher than those who had only one(χ2=54.65, 316.97; P<0.05). HR-HPV infection rates were disconnected with the educational levels of the tested women(P>0.05). HR-HPV infection rates had no significance difference between the other nationalities and local Naxi women(P>0.05). The percentage of high HR-HPV DNA load increased with the severity of cervical lesions[1.00%(5/500)in chronic inflammation of the cervix group, 3.62%(22/607)in CINⅠ group, 9.89%(43/435)in CINⅡgroup, 49.11%(55/112)in CINⅢ group, 65.38%(17/26)in SCC group], that is, cervical lesions had a positive correlation with the percentage of high HR-HPV DNA load(r=0.425, P<0.05).

Conclusions

Young age, first sexual behavior before 18 years old, many times of gravidities, parities and sexual partners more than two were high-risk factors of HR-HPV infection. Cervical lesions were highly influenced by HR-HPV infection and HR-HPV DNA load.

Key words: high-risk human papillomavirus, hybrid capture, viral load, cervical intraepithelial neoplasia
表1 HR－HPV感染率与年龄，首次性生活年龄，孕、产次，性伴侣数及文化程度的关系比较[n(%)]
Table 1 Comparison of HR－HPV infection rates and age, age of first sexual behavior, times of gravidity and parity, number of sexual partners and educational levels[n(%)]
调查指标 n HR－HPV感染率 χ2 P
年龄(岁) ? ? ? ?
? ≤24 228 77(33.77) 109.21 <0.001
? 25～39 3771 488(12.94) ? ?
? 40～55 2412 245(10.16) ? ?
? >55 117 9 (7.69) ? ?
首次性生活年龄(岁) ? ? ? ?
? ≤18 282 53(18.79) 14.79 <0.001
? 19～24 4321 555(12.84) ? ?
? ≥25 1925 211(10.96) ? ?
孕、产次(次) ? ? ? ?
? 0 654 55 (8.41) 54.65 <0.001
? 1 1817 198(10.90) ? ?
? 2 2299 261(11.35) ? ?
? ≥3 1758 305(17.35) ? ?
性伴侣(位) ? ? ? ?
? ≥2 133 84(63.16) 316.97 <0.001
? 1 6395 735(11.49) ? ?
文化程度 ? ? ? ?
? 高中及以上 2792 325(11.64) 3.65 0.056
? 初中及以下 3736 494(13.22) ? ?
合计 6528 819(12.55) ? ?
表2 宫颈疾病患者的宫颈疾病程度与HR－HPV感染率的关系比较[n(%)]
Table 2 Comparison of HR－HPV infection rates and the severity of cervical lesions[n(%)]
组别 n HR－HPV感染率
CINⅠ组 607 74(12.19)
CINⅡ组 435 81(18.62)
CINⅢ组 112 76(67.86)
SCC组 26 25(96.15)
慢性炎症组 500 37 (7.40)
总计 1680 293(17.44)
表3 HR－HPV DNA载量与子宫颈病变程度的非条件多因素logistic回归分析
Table 3 Unconditional multinomial logistic regression analysis of association between HR－HPV and CINs
组别 n 构成比(%) 病毒载量
阴性 低度 OR(95%CI) 中度 OR(95%CI) 高度 OR(95%CI)
CINⅠ组 607 36.13 533 34 1.55(0.88～　2.76) 18 1.20 (0.58～　2.48) 22 3.82　(1.44～　10.17)
CINⅡ组 435 25.89 354 17 1.17(0.60～　2.28) 21 2.11 (1.04～　4.28) 43 11.25 (4.41～　28.69)
CINⅢ组 112 6.67 36 5 3.39(1.19～　9.59) 16 15.83 (7.07～ 35.46) 55 141.47(53.29～　375.55)
SCC组 26 1.55 1 3 73.11(7.26～735.91) 5 178.08(19.41～163.13) 17 1574.20(174.27～142 20.15)
慢性炎症组 500 29.76 463 19 1 13 1 5 1
图1 不同程度宫颈疾病HR－HPV感染率比较
Figure 1 Comparison of HR－HPV infection rates of four groups according to the severity of cervical lesions
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