HPV感染种系型别与宫颈癌变的相关性研究

摘要

目的 研究妇女下生殖道人乳头瘤病毒(HPV)感染的种系型别分布,探讨不同基因型HPV与子宫颈癌变的相关性.方法 对我院门诊476例宫颈HPV感染的患者以第二代杂交捕获(HC-Ⅱ)试验检测13种高危型HPV,同时采用核酸分子快速导流杂交基因分型技术(HybriMax)进行21种HPV-DNA亚型分析,分析HPV感染型别与宫颈癌变的相关性.结果 476例患者中,HybriMax法检测13种高危型HPV的阳性率为84.9％,HC-Ⅱ法为85.7％,两种方法的总符合率为95.8％,Kappa指数(KI)为0.83.HPV亚型感染频度由高到低依次为16、58、52、11、33、18、68、31、6、39、53、66、CP8304、51、56、45、59、44和42型,宫颈癌/HSIL组最常见的前6位型别由高到低为16( 16.4％)、58(11.3％)、52(8.0％)、33(3.8％)、18(3.4％)和31(2.5％),LSIL组为16(8.4％)、58(4.6％)、18(3.4％)、33(3.4％)、39(2.9％)和68(2.9％),正常组织/炎症组为16(5.5％)、11(5.0％)、58(4.2％)、6(2.9％)、31(2.1％)和10(2.1％).正常组织/炎症组、LSIL组、宫颈癌/HSIL组中两种以上HPV亚型感染者分别占22.7％、33.7％和55.3％,最后一组明显高于前两组,差异有统计学意义(P＜0.05).结论 哈尔滨地区妇女下生殖道感染HPV型别以16、58、52、11、33、18型较为多见,其中16、58、52、33和18型的致癌性较强.HPV-DNA分型检测在官颈癌变的临床诊断和预后判断方面具有重要意义.%Objective To investigate human papillomavirus(HPV) types distribution among infected women and to discuss the relevance between different DNA types of HPV and cervical cancerization. Methods In the cervical specimens collected from 476 patients with HPV infection, hybrid capture Ⅱ ( HC- Ⅱ ) technique was used to detect the 13 types of HR-HPV, meanwhile DNA flowthrough hybridization genotyping (HybriMax) technique was applied to determine the 21 HPV-DNA subtypes. The relevance between the infection of different HPV types and cervical cancerization was analyzed via the distribution of HPV subtypes. Results The positive rate of HybriMax technique detecting 13 types of HR-HPV was 84. 9% , while that of HC- II technique was 85. 7%. The coincidence of the two techniques was 95. 8% , and the kappa index was 0. 83. According to the infection rates in the 476 patients from high to low, the order of HPV subtypes was as follow; 16, 58, 52, 11, 33, 18, 68, 31, 6, 39, 53, 66, CP8304, 51, 56, 45, 59, 44 and 42. The infection rate in cervical cancer/HSIL group from high to low was 16(16.4%), 58(11.3%), 52(8.0%), 33(3.8%), 18(3.4%) and 31(2. 5%); in LSIL group was 16(8.4%), 58(4. 6% ) ,18(3.4% ), 33(3.4%), 39(2.9%) and 68(2. 9%); in normal tissue/cervicitis group was 16(5. 5%), 11(5. 0% ), 58(4. 2% ), 6(2.9% ), 31(2. 1% ) and 10(2.1%). The incidence of more than one type of HPV in normal tissue/cervicitis group, LSIL group and cervical cancer/HSIL group were 22. 7% , 33. 7% and 55. 3% respectively. The infection rate of cervical cancer/HSIL group was obviously higher than the other two with statistical significance (P<0.05). Conclusion The infection of HPV-16, 58, 52, 11, 33 and 18 is common subtypes in cervical infected diseases than other types. HPV-16, 58, 52, 33 and 18 contribute more to cervical cancer. The detection of HPV-DNA is of great importance in diagnosis and prognosis of cervical cancerization.