中国女性人群宫颈人乳头瘤病毒感染及型别分布的多中心横断面研究

摘要

Objective To study the type-specific prevalence of human papillomavirus (HPV) infection among women in China and to provide evidence for primary prevention and screening of cervical cancer programs.Methods From May,2004 to April,2007,a population-based multicenter cross-sectional study was conducted by the Cancer Hospital,Chinese Academy of Medical Sciences.Women aged 17-59 years from 4 urban areas and 4 rural areas,were screened,under both liquid based cytological and HPV tests for cervical cancer.Specimens of cervical cell were used for genotyping with Linear Array or enzyme-linked immunesorbent assay.Women showed positive in primary screening were referred to exams for further colposcopy and/or histo-pathological detections.Results A total of 6 723 women were included in the data analysis.The overall prevalence of HPV infection was 15.5％.Two age-specific peaks of prevalence of HPV infection were detected among the different age groups.The first peak occurred in 17-24 year-old women in both rural areas and urban areas,while the second one occurred in 40-44 year-old women in urban areas and in 45-49 year-old women in rural areas.The prevalence of HPV infection increased with the severity of diagnosed cervical intraepithelial lesions by cytological or histo-pathological test (x2=62.857,22.113,P＜0.001).HPV16 (3.2％) was seen the most common high risk HPV type,followed by HPV58 (1.8％),HPV52 (1.5％),HPV18 (1.0％) and HPV33 (1.0％) respectively.Other common types would include HPV66 (0.64％),HPV42 (0.58％) and HPV53 (0.46％).The prevalence of HPV16 infection in rural women was significantly higher than that in urban women (x2=4.696,P＜0.05).Conclusion Prevalence of HPV infection in Chinese women seemed to be high and with two age-specific peaks.HPV16 appeared the most commonly seen type in women with cervical lesions.HPV58 and 18 were the predominant types.Type-specific distribution of HPV infection should be taken into consideration in the development of comprehensive cervical cancer prevention strategies in China.%目的 评价我国一般人群HPV型别的感染情况及分布特点,为宫颈癌一级预防及人群筛查提供参考.方法 2004年5月至2007年4月在城乡各4个地区对17～59岁妇女,采用液基细胞学、HPV检测筛查宫颈癌,并开展以人群为基础的多中心横断面调查.第二代杂交捕获HPV检测初筛阳性采用Linear Array技术和混合HPV寡聚探针酶联免疫技术进行分型检测.细胞学和/或HPV阳性者再转诊做阴道镜和组织活检.结果 6 723名研究对象HPV总感染率为15.5％.HPV感染率随年龄变化呈双峰状态,城市妇女感染高峰在17～ 24岁组及40～ 44岁组,农村妇女在17～24岁组和45 ～ 49岁;HPV感染率也随宫颈细胞学和组织学病变程度呈上升趋势(x2=62.857和x2=22.113,均P＜0.001).HPV16是最常见(3.2％)的高危型别,其次是HPV58(1.8％)、52(1.5％)、l8(1.0％)和33(1.0％).常见的其他型别包括HPV66 (0.64％)、42(0.58％)、53(0.46％).农村妇女HPV16感染率高于城市妇女(x2=4.696,P＜ 0.05).结论 我国女性人群HPV感染率较高,随年龄变化呈双峰型分布.HPV16为一般人群宫颈病变中最常见型别,HPV58和18是优势感染型别.在制订我国宫颈癌综合预防策略时应考虑HPV感染型别分布的特征.