摘要：
目的 研究女性生殖道人乳头瘤病毒(human papilloma virus,HPV)感染与沙眼衣原体(Chlamydia trachomatis,CT)感染的关系,及其与宫颈癌前病变和宫颈癌发生的相关性.方法 以妇产科门诊患者540例为研究对象,所有患者均行HPV、CT和宫颈细胞学检查.对疑似宫颈病变的患者进一步行宫颈活检.根据HPV检测结果,将HPV检测阳性的患者140例设为观察组,HPV检测阴性的患者400例设为对照组,分析生殖道HPV感染与CT感染的相关性,以及其与宫颈病变发生的相关性.结果 观察组宫颈病变发生率(21.4％)显著高于对照组(1.3％,P＜0.000 1).按照HPV感染分型,进一步将观察组分为高危组(78例)、低危组(32例)和混合感染组(30例).高危组(25.6％)和混合感染组(26.7％)宫颈病变发生率均显著高于低危组(6.3％,P=0.009;P=0.019).同时,观察组CT感染率(27.1％)显著高于对照组(3.3％,P＜0.000 1).HPV感染患者中,高危组(33.3％)和混合感染组(36.7％)的CT感染率均显著高于低危组(3.1％,P=0.021;P=0.019).依据是否存在CT感染将观察组患者分为HPV单纯感染组和CT混合感染组.结果显示后者宫颈病变率(57.8％)显著高于前者(25.5％,P=0.046).且CT混合感染组,高危HPV和混合HPV感染患者宫颈病变的发生率分别为39.3％和50.0％,均明显高于HPV单纯感染组中高危HPV和混合HPV感染患者,其发生率分别为16.0％和15.4％,差异均具有统计学意义(P=0.026和P=0.017).Logistic回归分析显示高危型HPV感染(OR=2.180,P=0.018)、HPV和CT混合感染(OR=6.690,P=0.012)是宫颈病变发生的风险因素.结论 女性生殖道CT感染与HPV感染密切相关,HPV和CT混合感染是宫颈癌前病变和癌变的独立风险因素.通过早期筛查女性生殖道HPV感染和CT感染,及时有效地治疗微生物混合感染,对进一步降低宫颈癌前病变和宫颈癌的发病率,提高临床治疗效果具有重要意义.%Objective To study the relationship between female genital human papilloma virus (HPV) infection and Chlamydia trachomatis (CT) infection,and its correlation with cervical precancerous lesions and cervical cancer.Methods A total of 540 female outpatients were recruited.All the patients were given HPV,CT and cervical scraping examination.Cervical biopsy was conducted in patients with suspected cervical lesions.According to the results of HPV examination,140 patients with confirmed HPV infection were designated as the observation group,and 400 patients negative to HPV were designated as control group.The relationship between HPV infection and CT infection,and its correlation with cervical lesions was analyzed.Results The incidence of cervical lesions in the observation group (21.4％) was significantly higher than that in control group (1.3％,P＜0.000 1).According to type of HPV infection,patients in the observation group were divided into the high-risk group (78 cases),low risk group (32 cases) and mixed infection group (30 cases).The incidence of cervical lesions in the high-risk group (25.6％) and mixed infection group (26.7％) was significantly higher than that in the low-risk group (6.3％,P=0.009;P=0.019).The incidence of CT infection in the observation group (27.1％) was significantly higher than that in control group (3.3％,P＜0.000 1).The incidence of CT infection in the high-risk group (33.3％) and the mixed infection group (36.7％) was significantly higher than that in the low-risk group (3.1％,P=0.021;P=0.019).Based on the presence of CT infection,the patients in the observation group were divided into HPV infection group and CT mixed infection group.The incidene of cervical lesions in the latter (57.8％) was significantly higher than that in the former (25.5％,P=0.046).And in CT mixed infection group,the incidence of cervical lesions in patients with high risk of HPV infection and mixed HPV were 39.3％ and 50.0％,it was significantly higher than that of pure HPV and mixed infection in patients with high-risk HPV infection group,the incidence rate was 16.0％ and 15.4％,the differences were statistically significant (P=0.026,P=0.017).Logistic regression analysis showed that high-risk HPV infection (OR=2.180,P=0.018),mixed infection of HPV and CT (OR=6.690,P=0.012) were risk factors for cervical lesions.Conclusion CT infection in female genital tract is closely related to HPV infection.Mixed infection of HPV and CT is an independent risk factor of cervical precancerous lesion and cancer.It is of important significance to further reduce the incidence of cervical cancer and precancerous lesions through the early screening of female genital HPV infection and CT infection,timely and effective treatment of mixed microbial infections.
