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中华妇幼临床医学杂志(电子版) ›› 2023, Vol. 19 ›› Issue (06) : 683 -688. doi: 10.3877/cma.j.issn.1673-5250.2023.06.009

论著

宫颈上皮内瘤变Ⅲ患者血清性激素水平及其与高危型人乳头瘤病毒感染的关系
蒋冉1, 邹彩艳2,†(), 桑谊荃2   
  1. 1. 徐州市中心医院检验科，徐州　221000
    2. 徐州市中心医院内分泌科，徐州　221000
  • 收稿日期:2022-11-16 修回日期:2023-11-06 出版日期:2023-12-01
  • 通信作者: 邹彩艳

Serum sex hormone levels in patients with cervical intraepithelial neoplasia grade Ⅲ and its relationship with high-risk human papillomavirus infection

Ran Jiang1, Caiyan Zou2,†(), Yiquan Sang2   

  1. 1. Department of Clinical Laboratory, Xuzhou Central Hospital, Xuzhou 221000, Jiangsu Province, China
    2. Department of Endocrinology, Xuzhou Central Hospital, Xuzhou 221000, Jiangsu Province, China
  • Received:2022-11-16 Revised:2023-11-06 Published:2023-12-01
  • Corresponding author: Caiyan Zou
  • Supported by:
    Health Plan Scientific Research Project of Xuzhou(XWRCHT20220006)
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引用本文：

蒋冉, 邹彩艳, 桑谊荃. 宫颈上皮内瘤变Ⅲ患者血清性激素水平及其与高危型人乳头瘤病毒感染的关系[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(06): 683-688.

Ran Jiang, Caiyan Zou, Yiquan Sang. Serum sex hormone levels in patients with cervical intraepithelial neoplasia grade Ⅲ and its relationship with high-risk human papillomavirus infection[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(06): 683-688.

目的

探讨宫颈上皮内瘤变(CIN)Ⅲ患者血清性激素水平及其与高危型人乳头瘤病毒(HR-HPV)感染的关系。

方法

选择2019年12月至2022年2月徐州市中心医院诊治的105例CIN Ⅲ患者为研究对象，纳入观察组。选择同期在同一医院体检的107例健康受试者作为对照，纳入对照组。根据人乳头瘤病毒(HPV)检测结果，将观察组患者进一步分为HR-HPV亚组(n＝70，各型HR-HPV感染者)及非HR-HPV亚组(n＝35，各型低危型HPV或无HPV感染者)。对2组受试者或者2个亚组患者血清性激素水平，采用独立样本t检验进行统计学比较；对不同型别HR-HPV单一感染患者的血清性激素水平，采用单因素方差分析及LSD-t检验，分别进行总体及两两比较。对2组受试者HR-HPV不同型别单一、双重及总感染率，采用χ2检验进行比较。本研究遵循的程序符合徐州市中心医院医学伦理委员会要求(审批文号：201906)，所有受试者对研究知情同意，并签署临床研究知情同意书。

结果

①观察组患者血清卵泡刺激素(FSH)、促黄体激素(LH)水平，均低于对照组受试者，血清催乳素、雌二醇及孕酮水平，则均高于对照组，并且差异均有统计学意义(P<0.05)。②观察组患者HPV16、HPV18、HPV52单一感染率，HPV16＋HPV18双重感染率，以及HR-HPV总感染率，均高于对照组受试者，并且差异均有统计学意义(P<0.05)。③HR-HPV亚组患者血清FSH、LH水平分别为(1.8±0.4) mIU/mL、(1.6±0.1) mIU/mL，均低于非HR-HPV亚组的(2.4±0.5) mIU/mL、(1.9±0.3) mIU/mL；血清雌二醇浓度为(302.5±32.3) pmoL/L，则高于非HR-HPV亚组的(268.2±23.1) pmoL/L，并且差异均有统计学意义(t＝7.44、5.55、6.54，均为P<0.001)。④HPV16型感染患者血清雌二醇水平，分别高于HPV18、HPV52及HPV58型感染患者，并且差异均有统计学意义(P<0.05)；而这4个亚型HR-HPV单一感染患者血清FSH、催乳素、LH及孕酮水平比较，差异则均无统计学意义(P>0.05)。

结论

CIN Ⅲ患者血清性激素水平异常，与HR-HPV感染相关。临床可通过检测CIN Ⅲ患者血清性激素水平，监测HR-HPV感染情况，为临床制定宫颈癌防治方案提供参考。

关键词: 宫颈上皮内瘤样病变, 性腺甾类激素, 人乳头瘤病毒, 卵泡刺激素, 促黄体激素, 催乳素, 雌二醇, 孕酮, 女性
Objective

To explore serum sex hormone levels in patients with cervical intraepithelial neoplasia (CIN) grade Ⅲ and its relationship with high-risk human papillomavirus (HR-HPV) infection.

Methods

A total of 105 CIN grade Ⅲ patients treated at Xuzhou Central Hospital from December 2019 to February 2022 were selected as research objects and included in the observation group, as well as 107 healthy individuals who underwent physical examinations at the same hospital during the same period were included in the control group. According to human papillomavirus (HPV) detection results, the patients in observation group were divided into HR-HPV subgroup (n=70, various types of HR-HPV infection) and non-HR-HPV subgroup (n=35, no/various types of low-risk HPV infection). Serum sex hormone levels of two groups of subjects or two subgroups of patients were compared by independent sample t test. The serum sex hormone levels among patients with different types of HR-HPV single infection were overall and pairwise compared by one-way ANOVA and least significant difference (LSD)-t test, respectively. The single, double, and total infection rates of different types of HR-HPV between two groups of subjects were compared by chi-square test. The procedures followed in this study was approved by the Medical Ethics Committee of Xuzhou Central Hospital (Approval No. 201906), and all participants have informed consent to the study and signed the informed consent forms.

Results

① The serum levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in observation group were lower than those in control group, while the serum levels of prolactin, estradiol and progesterone were higher than those in control group, and the differences were statistically significant (P<0.05). ② The single infection rates of HPV16, HPV18 and HPV52, the double infection rate of HPV16+ HPV18, and the total infection rate of HR-HPV in observation group were all higher than those in control group, and the differences were statistically significant (P<0.05). ③ The serum levels of FSH and LH in HR-HPV subgroup were (1.8±0.4) mIU/mL and (1.6±0.1) mIU/mL, respectively, which were lower than those of (2.4±0.5) mIU/mL and (1.9±0.3) mIU/mL respectively in non-HR-HPV subgroup; while the serum estradiol concentration was (302.5±32.3) pmoL/L, which was higher than that of (268.2±23.1) pmoL/L in non-HR-HPV subgroup, and the differences were statistically significant (t=7.44, 5.55, 6.54, all with P<0.001). ④ The serum estradiol levels in patients with HPV16 infection were higher than those with HPV18, HPV52 and HPV58 infection, respectively, and the differences were statistically significant (P<0.05). However, there were no significant differences in serum FSH, prolactin, LH and progesterone levels among patients with single infection of these 4 types of HR-HPV (P>0.05).

Conclusions

Abnormal serum sex hormone levels in CIN grade Ⅲ patients are associated with HR-HPV infection. Clinically, we can monitor the HR-HPV infection by detecting the serum sex hormone levels of CIN grade Ⅲ patients, so as to provide reference for formulate the prevention and treatment plan for cervical cancer.

Key words: Cervical intraepithelial neoplasia, Gonadal steroid hormones, Human papillomavirus viruses, Follicle stimulating hormone, Luteinizing hormone, Prolactin, Estradiol, Progesterone, Femininity
表1 观察组与对照组受试者血清性激素水平比较(±s)
组别 例数 FSH(mIU/mL) 催乳素(mIU/L) LH(mIU/mL) 雌二醇(pmoL/L) 孕酮(nmoL/L)
观察组 105 1.9±0.5 303.2±68.4 1.7±0.5 293.6±26.4 3.3±1.2
对照组 107 4.7±1.2 204.2±51.6 6.5±2.1 176.2±25.5 1.4±0.3
t值   21.94 12.44 23.84 32.81 13.14
P值   <0.001 <0.001 <0.001 <0.001 <0.001
表2 观察组和对照组受试者HR-HPV不同亚型单一、双重及总感染率比较[例数(%)]
组别 例数 单一感染 双重感染 总感染率
HPV16 HPV18 HPV52 HPV58 HPV16＋HPV18 HPV16＋HPV52
观察组 105 28(26.7) 20(19.1) 11(10.5) 1(1.0) 6(5.7) 4(3.8) 70(66.7)
对照组 107 4(3.7) 2(1.9) 1(0.9) 0(0) 0(0) 0(0) 7(6.5)
χ2值   — — — — — — 92.38
P值   <0.001 <0.001 0.011 0.971 0.048 0.149 <0.001
表3 HR-HPV亚组和非HR-HPV亚组CIN Ⅲ患者血清性激素水平比较(±s)
组别 例数 FSH(mIU/mL) 催乳素(mIU/L) LH(mIU/mL) 雌二醇(pmoL/L) 孕酮(nmoL/L)
HR-HPV亚组 70 1.8±0.4 323.3±64.5 1.6±0.1 302.5±32.3 3.2±0.2
非HR-HPV亚组 35 2.4±0.5 293.9±52.5 1.9±0.3 268.2±23.1 3.0±0.4
t值   7.44 1.03 5.55 6.54 1.44
P值   <0.001 0.312 <0.001 <0.001 0.125
表4 不同亚型HR-HPV单一感染CIN Ⅲ患者血清性激素水平比较(±s)
HR-HPV亚型 例数 FSH(mIU/mL) 催乳素(mIU/L) LH(mIU/mL) 雌二醇(pmoL/L) 孕酮(nmoL/L)
HPV16 28 1.9±0.4 381.7±79.4 1.7±0.5 365.1±31.6 4.3±1.5
HPV18 20 2.0±0.6 374.7±85.7 2.0±0.5 341.6±25.3 4.8±1.4
HPV52 11 2.2±0.7 352.4±77.5 2.1±0.6 358.2±30.5 4.1±0.8
HPV58 1 2.8±0 343.3±0 2.3±0 334.3±0 4.2±0
F值   1.42 0.68 2.21 2.81 1.49
P值   0.246 0.775 0.068 0.023 0.437
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