| 摘要: |
| 目的 了解上海地区妇科就诊人群人乳头瘤病毒（human papilloma virus，HPV）分型感染情况，分析HPV分型检测对宫颈疾病的诊断价值，为临床医师合理应用筛查手段提供依据。方法 分析2016年在上海交通大学医学院附属同仁医院妇科因各类原因就诊、自愿接受HPV分型检测病例的检测结果，统计分析HPV不同型别感染情况；其中504例因有临床症状或HPV阳性完成了液基薄层细胞学检查（TCT）和阴道镜下组织病理学检查，以病理诊断为宫颈病变诊断的"金标准"分析高危型HPV感染与宫颈病变的关系。结果 HPV分型检测的病例中，HPV总感染率为23.66%（2 998/12 670），其中84.09%（2 521/2 998）感染高危型HPV；高危型HPV总体感染率为19.90%（2 521/12 670），低危型HPV总体感染率为3.76%（477/12 670）。HPV感染者中，单一亚型感染率为71.21%（2 135/2 998），双重感染率为16.94%（508/2 998），其余为2种以上型别感染。低危型HPV感染在各年龄段差异无统计学意义；高危型HPV感染呈低年龄段人群感染率较高的现象（P<0.01）。高危型HPV感染中，感染率最高的5种亚型依次为HPV52、16、53、58、51型，低危型感染中前3位感染型别为HPV81、43、42型。随宫颈病变级别的升级，高危型HPV感染率呈升高趋势。HPV分型检测筛查宫颈疾病较TCT更灵敏，阴性预测值更高，其阴性结果对于排除宫颈癌意义较大。宫颈癌病例HPV感染为16、18和52型。结论 HPV分型检测准确性高并能明确基因类型，联合TCT和组织学检查更能有效地筛查宫颈病变细胞，为临床防治宫颈癌提供更可靠的科学依据。HPV分型检测筛查宫颈病变敏感度和阴性预测值高。初次宫颈癌筛查时，HPV分型检测可以替代TCT单独检测或联合TCT。 |
| 关键词: 人乳头瘤病毒 基因分型 液基薄层细胞学检查 宫颈癌 上海 |
| DOI：10.16781/j.0258-879x.2017.12.1526 |
| 投稿时间：2017-09-24修订日期：2017-11-01 |
| 基金项目: |
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| Investigation of human papilloma virus infection and virus genotyping in patients with cervical lesions in Shanghai |
| XIA Yan1,JIN Zhi-jun2*,NI Yun-xiang1,GONG Hui1,YANG Jing1,WEI Xue-min1 |
(1. Department of Obstetrics and Gynecology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, China;
2. Department of Obstetrics and Gynecology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To understand the genotypic infection status of human papilloma virus (HPV) in patients with gynecological diseases in Shanghai, and to analyze the diagnostic value of HPV genotyping in cervical disease, so as to provide reference for rational application of screening methods. Methods We analyzed the examination results of 12 670 patients with various gynecological diseases who voluntarily received the HPV genotyping test in Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine in 2016, and statistically analyzed the infection status of different genotypes of HPV. Among them, 504 cases with clinical symptoms or HPV infection received ThinPrep cytologic test (TCT) and colposcopy histopathological examination. The relationship between high-risk HPV infection and cervical lesion was analyzed according to the pathological diagnosis of cervical lesions. Results The overall HPV infection rate was 23.66% (2 998/12 670), of which 84.09% (2 521/2 998) were infected with high-risk type HPV; the overall infection rate of high-risk HPV was 19.90% (2 521/12 670), and the overall infection rate of low-risk HPV was 3.76% (477/12 670). Among the patients infected with HPV, the rate of single type infection was 71.21% (2 135/2 998), the rate of double infection was 16.94% (508/2 998), and the remaining were infected with more than two types. There were no significant differences in low-risk HPV infections between different age groups, while the patients in low-age group had high infection rate of high-risk HPV (P<0.01). In the high-risk HPV infection, the five subtypes of the highest infection rate were HPV52, HPV16, HPV53, HPV58, and HPV51. In the low-risk HPV infection, the top three infection types were HPV81, HPV43, and HPV42. With the escalation of cervical lesions level, the infection rate of high-risk HPV was increased. HPV genotyping was more sensitive than TCT in screening cervical disease, and its negative predictive value was higher, which had great significance for ruling out cervical cancer. HPV infections in cervical cancer cases were HPV16, HPV18 and HPV52. Conclusion HPV genotyping has high accuracy and clear genotype, and is more effective in screening cervical lesions when combined with TCT and histology, contributing to the prevention and treatment of cervical cancer. HPV genotyping has high sensitive and negative predictive value in screening cervical lesions, indicating that it can replace TCT or combine with TCT in initial cervical cancer screening. |
| Key words: human papilloma virus genotyping ThinPrep cytologic test uterine cervical carcinoma Shanghai |
