深圳市成年女性生殖道高危型人乳头瘤病毒感染与宫颈癌患病调查

摘要

Objective To investigate the prevalence of high risk human papillomavirus (HPV) genital infection and cervical cancer in adult women from Shenzhen.Methods Cluster sampling was used to investigate the prevalence of HPV infection and cervical cancer from women aged 20-59 years old living in Luohu,Futian,Nanshan,Longgang and Baoan districts in Shenzhen from April 2006 to April 2010.All women were detected for liquid-based cytology test (LCT) or Thinprep cytologic test (TCT)and high-risk HPV-DNA test with hybrid capture Ⅱ (HC-Ⅱ ).All women with ≥ASC-US by cytology and/or a positive HC- Ⅱ test were asked to return for colposcopy and four-quadrant biopsy.Endocervical curettage was performed.Pathological finding were used as the gold standard of the diagnosis of cervical intraepithelial neoplasia.Results 10 210 women were involved in the study and 10 017 of them having completed data.The overall positive rate of high-risk HPV-DNA was 16.29％.HPV positive rates in 20-,30-,35-,40-,45-,50-59 age groups were 17.37％,15.59％,16.33％,14.74％,17.16％ and 17.98％,respectively.The curve of HPV infection rates in different age groups appeared a ‘W' shape.HPV infection rates in the 25-years-olds and 50-59 year-olds groups were significantly higher than the other age groups (x2=4.50,P=0.03 ).The overall prevalence rate of cervical intraepithelial lesions (CIN) was 7.52％,of which the prevalence rates of low-grade cervical intraepithelial lesions (CIN Ⅰ) was 5.32％ high-grade cervical intraepithelial lesions (CIN Ⅱ/Ⅲ ) was 2.21％,cervical cancer was 0.12％.The prevalence of CIN Ⅰ was significantly higher than the CIN Ⅱ/Ⅲ (x2=134.15,P＜0.001 ).The prevalence of cervical cancer in 45- age group was 0.12％,the highest.HPV infection rates increased with the grades of cervical lesions including women without CIN as 44.31％,in CIN Ⅰ as 70.73％,in CIN Ⅱ as 86.73％,and in CIN Ⅲ as 96.75％ and in cancer as 100.00％.The HPV infection rates were different in districts (x2=17.81,P=0.03 ),with Futian and Luohu higher than those of Nanshan,Longgang and Baoan district.The prevalence rate of CIN in Baoan was lower than other districts.The CIN prevalence rates were not significantly different among the other districts of Shenzhen (x2=4.84,P=0.18).Conclusion The prevalence of cervical cancer was low in adult women living in Shenzhen,with cervical lesions still in the early stage.Prevention of HPV infection and treatment of CIN were the key points for the prevention of cervical cancer.%目的 了解深圳市成年女性生殖道高危型人乳头瘤病毒(HPV)感染与宫颈癌患病情况.方法 2006年4月至2010年4月采取整群抽样方法,对深圳市罗湖、福田、南山、龙岗和保安区20 ～ 59岁有性生活史的女性开展宫颈癌筛查.受筛查妇女均行宫颈脱落细胞液基细胞学检查(LCT)或者新柏氏液基细胞学检查(TCT)和第二代杂交捕获技术(HC-Ⅱ).对HPV阳性,且细胞学≥未明确诊断意义的不典型鳞状上皮细胞( ASC-US)和/或LCT/TCT≥低度鳞状上皮内瘤样病变(LSIL)的妇女均行阴道镜下活组织病理检查,以确定有无宫颈上皮内瘤样病变(CIN)或宫颈癌.结果 共筛查10 210名妇女,其中10 017人检验结果完整,高危型HPV-DNA的总检出率为16.29％,其中20～、30～、35～、40～、45～和50～59岁组的检出率分别为17.37％、15.59％、16.33％、14.74％、17.16％和17.98％.年龄别HPV感染率曲线呈“W”形.25～和50 ～ 59岁组HPV感染率明显高于其他各年龄组( x2=4.50,P=0.03)；CIN Ⅰ、CINⅡ/Ⅲ、宫颈癌的现患率分别为5.32％、2.21％和0.12％,CIN Ⅰ明显高于CINⅡ/Ⅲ(x2=134.15,P＜0.001),45～岁组宫颈癌现患率最高,为0.12％.深圳市各区HPV感染差异有统计学意义(x2=17.81,P=0.03),其中福田区和罗湖区HPV感染率高于南山、宝安和龙岗区；宝安区CIN现患率最低,其他各区CIN现患率间的差异无统计学意义(x2=4.84,P=0.18).结论 深圳市成年女性宫颈癌患病率较低,宫颈病变多处于发病早期,重点应预防HPV感染和治疗CIN.