人乳头瘤病毒感染亚型在不同宫颈上皮内瘤变分期中分布特点及其感染危险因素分析

摘要

目的 分析山东省枣庄地区人乳头瘤病毒( HPV)感染亚型在不同宫颈上皮内瘤变(CIN)分期中的分布特点及其感染的危险因素,为建立该地区HPV数据库及HPV疫苗的地区性研发提供临床依据.方法 选取2016年1月至2018年6月济宁医学院附属医院滕州市中心人民医院妇科门诊收治的488例CIN患者,年龄(41. 87 ± 3. 56)岁,年龄范围为24~57岁.通过经阴道镜及薄层液基细胞学检测将宫颈上皮内瘤变进行分期,采用聚合酶链式反应( PCR)-膜杂交法检测研究组样本中HPV亚型.采用自制调查问卷收集患者信息,采用logistic回归分析方法分析宫颈上皮内瘤变患者HPV感染的高危因素.结果 488例患者总HPV感染率为85. 0% (415/488).其中CINⅢ期患者高危型的感染率[92. 8% (142/153)]、HPV感染率[96. 7% (148/153)]显著高于CINⅠ期[64. 0% (114/178)、71. 9% (128/178)]与CINⅡ期[79. 6% (125/157)、88. 5% (139/157)],差异有统计学意义(P<0. 05),CINⅡ期高危型感染率、HPV感染率显著高于CINⅠ期,差异有统计学意义(P<0. 05). CINⅠ期患者低危型感染率[7. 9% (14/178)]与CINⅡ期患者低危型感染率[8. 9% (14/157)]显著高于CINⅢ期[3. 9% (6/153)],差异有统计学意义(P<0. 05). CINⅢ期的HPV 16、HPV 52、HPV 59感染率显著高于CINⅠ和CINⅡ期(P<0. 05).在低危型中感染最多的是HPV 6,不同CIN分期中HPV 6分布比较,差异无统计学意义( P>0. 05).低学历、吸烟、不了解HPV相关知识、初次性生活较早、不使用避孕措施是CIN患者感染HPV的高危因素.结论 CINⅢ期患者有更大的HPV感染率,并且低学历、吸烟、不了解HPV相关知识、初次性生活较早、不使用避孕措施均为CIN患者感染HPV的高危因素.%Objective The distribution characteristics and risk factors of human papillomavirus (HPV)infection subtypes in different cervical intraepithelial neoplasia(CIN) stages were analyzed to pro-vide clinical basis for the establishment of HPV database and regional research and development of HPV vaccine in this region. Methods From January 2016 to June 2018,488 CIN patients admitted were select-ed,aged(41. 87 ± 3. 56),ranging from 24 to 57 years old. Cervical intraepithelial neoplasia was divided into stages by colposcopy and thin layer liquid-based cytology(TCT),and the HPV subtypes in the samples of the study group were detected by polymerase chain reaction( PCR)-membrane hybridization method. The self-made questionnaire was used to collect patient information,and the risk factors of HPV infection in pa-tients with cervical intraepithelial neoplasia were analyzed by logistic regression analysis. Results The total infection rate of HPV in 488 patients was 85. 0% . The CIN Ⅲ period in patients with high-risk type of in-fection rate[92. 8% (142/153)]and HPV infection rate[96. 7% (148/153)]was significantly higher than that of CINⅠ period[64. 0% (114/178)、71. 9% (128/178)] and CIN Ⅱ period[79. 6% (125/157)、88. 5% (139/157)],and the difference was statistically significant(P<0. 05). CIN Ⅱ period at high risk of infection and HPV infection rate was significantly higher than that of CINⅠ period(P<0. 05). CINⅠperiod in patients with low latent infection rate[7. 9% (14/178)]and CIN Ⅱ period in patients with type low latent infection rate [8. 9% ( 14/157 )] was significantly higher than that of CIN Ⅲ period [ 3. 9% (6/153)],(P<0. 05). CIN Ⅲ period of HPV16,HPV52,HPV59 infection rate was significantly higher than that of CIN Ⅰ and CIN Ⅱ period( P <0. 05) . In the low-risk type,HPV 6 was the most infected type. There was no statistically significant difference in the distribution of HPV 6 in different CIN stages (P>0. 05). Low education,smoking,not knowing HPV related knowledge,early first sexual life,not using contraception are risk factors for HPV infection in CIN patients. Conclusion CIN Ⅲ period patients have greater HPV infection rate,and low degree,smoking,don′t understand HPV related knowledge,early first sexual life,do not use contraception are risk factors of HPV infection in CIN patients.