MSM人群肛管HPV基因分型研究及相关因素分析

发布时间：2018-05-31 05:29

本文选题：男男性行为人群 + 人类乳头瘤病毒　；参考：《青岛大学》2017年硕士论文

【摘要】：目的本研究旨在通过探究MSM人群肛管HPV的感染情况及其基因亚型分布情况,分析MSM人群中肛管HPV感染的相关危险因素,以为临床早期防治MSM人群的HPV感染提供有力依据。方法2014年9月~2016年8月,选取在青大附院性健康中心检测(山东省VCT检测门诊、国家哨点检测单位)、青岛市MSM项目工作组招募及皮肤科门诊主动寻求治疗的现患肛门肛管尖锐湿疣(condyloma acuminatum,CA)的MSM作为研究对象。通过“一对一”匿名问卷访谈方式,获取研究人群的社会人口学及行为学特征等相关信息;采集研究对象静脉血,进行HIV血清学检测;同时采集肛管拭子标本,通过PCR技术对HPV基因亚型检测,包括18种高危型(HPV 16、18、31、33、35、39、45、51、52、53、56、58、59、66、68、73、82和83)和5种低危型(HPV6、11、42、43和81)共23种基因型。相关危险因素分析采取单因素分析及多因素Logistic回归分析。结果共收集病例167例,其中完成问卷调查、抽取静脉血及采集肛拭子者共计116例,为有效病例。结果发现:1.研究对象年龄为18至52岁之间,平均年龄为29.41±6.86岁。主要社会人口学特征分析显示,20~29岁年龄组、高中或中专文化、未婚及独居的MSM人群中,HPV感染相较高发;2.116例样本中检测出HPV 82例,阳性率70.69%,部分样本存在多重HPV感染。3.经典型CA患者占79.27%,以HPV16阳性检出率最高,占36.92%,多重感染中则以HPV6+HPV11的感染几率最高,占6.15%;扁平型CA患者占20.73%,以HPV16感染率最高,占23.53%,多重感染中主要以HPV6+HPV16的阳性感染率最高,占11.76%;4.高危型HPV亚型中,以HPV16感染阳性率最高,共计28例,占24.14%;低危型HPV亚型分布中,以HPV6的阳性率最高,共计21例,占18.10%;HPV高危组中合并HIV阳性比例59.62%(31例),明显高于HPV低危组中阳性比例30.00%(9例),组间比较差异显著(P0.05),具有统计学意义;5.HPV高危型感染患者同时合并HIV感染的几率明显高于HPV低危亚型感染的患者(P0.05),经Pearson检验分析,高危型HPV感染与HIV感染呈明显的正相关(r=0.4325,P0.05);6.多因素Logistic回归分析显示,近3个月发生过肛交的男性性伴数量≥10人及曾出现过性病相关症状者,与MSM人群肛门肛管CA患者HPV感染的发生存在明显的相关性(P0.05)。结论招募的研究对象中HPV感染率70.69%,其中HPV6和HPV16为常见的感染基因亚型,MSM人群肛门肛管HPV感染的危险因素可能与发生肛交的男性性伴数量以及性病相关症状的出现存在明显相关性,尽早开展有针对性干预对于早期防控MSM人群的HPV感染非常重要。
[Abstract]:Objective the purpose of this study was to analyze the risk factors of anal HPV infection in MSM population by investigating the situation of HPV infection and its gene subtype distribution in MSM population, so as to provide evidence for early prevention and treatment of HPV infection in MSM population. Methods from September 2014 to August 2016, the patients were selected to be tested in the sexual health center of Qingda affiliated Hospital (Shandong Province). MSM of condyloma acuminatum (condyloma acuminatum) of anus and anal canal, which was recruited by MSM project working group of Qingdao city and actively sought treatment in dermatological outpatient department, was used as the research object. Through the "one to one" anonymous questionnaire interview, to obtain the social demographic and behavioral characteristics of the study population and other relevant information; collect the blood of the study object vein, HIV serological test; collect anal swab samples, at the same time, The subtypes of HPV gene were detected by PCR technique. There were 23 genotypes including 18 high risk HPV16HPV16HPV16HPV16HPV16HPV16HPV16HPV161HPV16HPV161HPV161HPV161HPV161HPV161HPV161HPV161HPV161HPV161HPV161HPV161HPV31HPV31HPV31HPV31HPV31HPV31HPV31HPV31HPV31HPV31HPV31HPV31HHPV16HPV16HPV@@ The risk factors were analyzed by univariate analysis and multivariate Logistic regression analysis. Results A total of 167 cases were collected, among which 116 cases were collected venous blood and anal swab. It turned out that 1: 1. The subjects were 18 to 52 years old, with an average age of 29.41 卤6.86 years. The analysis of main social demographic characteristics showed that 82 cases of MSM infection were detected in 29 years old group, middle school or technical secondary school group, unmarried and single population, 82 cases of HPV infection were detected in 2.116 samples, the positive rate was 70.69%, and some samples had multiple HPV infection .3The positive rate was 70.69%, and the positive rate was 70.69%. Classical CA patients accounted for 79.27, with the highest positive rate of HPV16 (36.922um), the highest rate of HPV6 HPV11 infection among multiple infections (6.15%), flat CA patients (20.73%), HPV16 infection rate (23.53%), and HPV6 HPV16 infection rate was the highest in multiple infections. About 11.76%. Among the high risk subtypes of HPV, the positive rate of HPV16 infection was the highest (28 cases, 24.14%), and the distribution of HPV subtype of low risk type was the highest in HPV6 (21 cases). The positive rate of HIV in the high risk group of 18.10 HPVs was 59.62%, which was significantly higher than that in the low risk group of HPV (30.009 cases), and the difference between the two groups was significant (P 0.05). 5. The probability of HIV infection in the patients with HPV-high risk type infection at the same time was significantly higher than that in the patients with HPV-high risk group (P < 0.05). Patients with low risk subtype HPV infection were analyzed by Pearson test. There was a significant positive correlation between high risk HPV infection and HIV infection. Multivariate Logistic regression analysis showed that the number of male sexual partners who had anal sex in the past 3 months or more and those who had STD-related symptoms were significantly correlated with the incidence of HPV infection in MSM patients with anal and anal CA. Conclusion the infection rate of HPV is 70.69% in the study subjects. HPV6 and HPV16 are the common risk factors of HPV infection in anus and anus, which may be associated with the number of male sexual partners who have anal intercourse and the occurrence of STD-related symptoms. There is a clear correlation, Early targeted intervention is very important for early prevention and control of HPV infection in MSM population.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R752.53

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