目的 探讨血清叶酸和红细胞叶酸水平与宫颈癌变的关系以及叶酸缺乏和HPV16型感染在宫颈癌变中的相互作用.方法 选取经病理学确诊的宫颈炎症(CI)患者80例、低度宫颈上皮内瘤样变(CINⅠ)患者55例、高度宫颈上皮内瘤样变(CINⅡ/Ⅲ)患者55例以及宫颈鳞状细胞癌(SCC)患者64例作为研究对象.采用PCR法检测HPV 16感染状况、微生物法测定血清叶酸及红细胞叶酸水平.结果 随着宫颈癌变的进展,HPV16感染率升高(趋势x2=34.96,P＜0.001),血清叶酸含量(趋势x2=42.17,P＜0.001)和红细胞叶酸含量(趋势x2=31.39,P＜0.001)均呈逐渐降低趋势,血清叶酸和红细胞叶酸含量呈正相关(r=0.405,P＜0.001).分组分析显示,血清叶酸和红细胞叶酸含量的OR和调整OR(aOR)值在CINⅡ/Ⅲ和SCC组均呈上升趋势,趋势检验有统计学意义(P＜0.001),但在CIN Ⅰ组未显示相同趋势.血清叶酸缺乏与HPV16感染在CINⅡ/Ⅲ及SCC组中存在正相加作用,而红细胞叶酸缺乏与HPV16感染在CIN各组和SCC组中均存在正相加作用.结论 叶酸缺乏可增加宫颈癌变的发生风险,在宫颈癌变的过程中与HPV16感染可能具有协同作用.%Objective To investigate the relationship between folate in serum,red blood cell (RBC),cervix cancerization,as well as the interaction between folate deficiency and HPV16 infection in cervix cancerization.Methods 254 samples were selected from the patients who were newly pathologically diagnosed of having cervix inflammation (CI),low-grade cervical intraepithelial neoplasia (CIN Ⅰ),high-grade cervical intraepithelial neoplasia (CIN Ⅱ/Ⅲ) and cervical squamous cell carcinoma (SCC).PCR and microbiological assay were adopted to detect HPV infection and folate concentration.Results Rates of HPV16 infection increased with the severity of cervix cancerization (tend:x2=34.96,P＜0.001),while decreased with concentrations of serum and RBC folate (tend:x2=42.17,P＜0.001; tend:x2=31.39,P＜0.001).There was a positive correlation between serum and RBC folate (r=0.405,P＜0.001).Data from grouping analysis showed that OR and aOR of serum and RBC folate appeared a rising trend,with statistical significance in CIN Ⅱ/Ⅲand SCC,but did not show the same trend in CIN Ⅰ.Results from interaction analysis showed that serum folate deficiency had an additive interaction with HPV16 infection in CIN Ⅱ/Ⅲ and SCC,while RBC folate having an additive interaction with HPV16 infection in the whole process of cervix cancerization.Conclusion Both serum and RBC folate deficiency could increase the risk of cervix cancerization,and folate deficiency might have a synergic action with HPV 16 in this procession.
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