新疆巴楚县维吾尔族妇女HPV感染、高级别宫颈病变及宫颈癌与行为因素、微量元素和维生素的关系研究

发布时间：2018-02-16 07:10

本文关键词： 宫颈病变微量元素维生素诊断价值相关性　出处：《新疆医科大学》2016年博士论文　论文类型：学位论文

【摘要】：目的:研究新疆巴楚县维吾尔族妇女HPV感染、宫颈高级别病变及宫颈癌(CINⅡ+)的行为危险因素及其与血清微量元素、维生素的关系;分析血清微量元素和维生素水平预测HPV感染、CINⅡ+的价值;探讨巴楚县土壤和饮用水中微量元素水平与当地维吾尔族妇女HPV感染率、CINⅡ+之间的相关性。从而为新疆维吾尔族宫颈癌的干预提供依据。方法:1.自2014年3月1日至6月15日,通过整群抽样的方法,在巴楚县的9个乡镇进行维吾尔族妇女的宫颈癌筛查,共筛查5045名妇女。选择细胞学ASC-US及以上、care HPV检测阳性或VIA/VILI阳性者646例进入研究队列。此外,选择2011年3月1日至2014年6月15日期间,在新疆肿瘤医院妇科住院确诊的来自巴楚县的宫颈疾病患者187例进入研究队列。检出CINⅡ+者作为病例组,慢性宫颈炎及CINⅠ级者作为对照组;HPV感染者作为阳性组,未感染者作为阴性组。研究对象均进行宫颈癌相关行为危险因素问卷调查,并检测血清微量元素、维生素的含量。2.在每个乡镇,随机选取农田土地42处,按同种土壤取5个点取样;并于一年内的2、5、8和12月定点采集每个乡镇的饮用水30份,每份至少1L。测定土壤和饮用水中As、Cd、Co、Ni、Cu、Zn、Mn、Se和Fe的含量水平。3.采用卡方检验对病例组和对照组、阳性组和阴性组进行单因素分析,将P0.1的因素纳入多因素Logistic回归分析;采用诊断试验评价与接收者工作特征曲线分析微量元素和维生素水平预测HPV感染、CINⅡ+的诊断价值;采用偏相关分析,研究土壤和饮用水中微量元素水平与维吾尔族妇女CINⅡ+检出率和HPV感染率之间的相关性。结果:1.多因素分析显示,结婚年龄≤15岁、结婚次数3次、同房次数≥3次/周、在家分娩、经期用卫生纸、厕所用土块、个人护理得分低、洗澡频率低、未避孕和配偶吸烟是新疆巴楚县维吾尔族妇女HPV感染的高危行为因素,而家庭收入5000元和5000~1万元、结婚次数3次、在家分娩、宫颈癌家族史、个人护理得分低、经期用卫生纸和配偶吸烟是其宫颈高级病变及宫颈癌的高危行为因素。2.血清中As≥0.02 mg/Kg和维生素D3≥49.6434ng/L是HPV感染的危险因素,而Ni≥0.1232 mg/Kg、Se≥0.02 mg/Kg和叶酸≥17.6705 ug/L是其保护因素;血清中Fe≥6.9153 mmol/L和As≥0.02 mg/Kg是宫颈高级病变及宫颈癌的危险因素,而Ni≥0.0965mg/Kg、Se≥0.02 mg/Kg和维生素C≥0.6857ug/L则是其保护因素。3.As、Ni、Se及维生素D3和叶酸预测HPV感染的诊断价值均较低,ROC曲线下面积小于0.7。4.单用Se、Se和As联合、Se和Ni联合可以用于预测宫颈高级病变及宫颈癌,诊断价值可达中等(ROC曲线下面积0.7以上),其灵敏度和阴性预测价值较高、假阴性率较低,但特异度、正确率和阳性预测价值较低,假阳性率较高。5.巴楚县土壤和饮用水中微量元素的含量未超过国家土壤环境和生活饮用水的标准;CINⅡ+级宫颈病变的检出率与土壤中As和Cu呈正相关、与Se呈负相关,与饮用水中As呈正相关、与Zn呈负相关;HPV感染率与土壤中As呈正相关、与Se呈负相关,与饮用水中Cu呈正相关、与Se呈负相关。结论:行为因素在新疆巴楚县维吾尔族妇女HPV感染和宫颈病变的发生过程中具有重要作用,应该针对性地对行为危险因素进行干预,提倡晚婚、配偶戒烟、入厕用卫生纸、加强个人护理及经期卫生等;血清中微量元素和维生素的含量与巴楚县维吾尔族妇女HPV感染、CINⅡ+的发生有关,应改善妇女微量元素状况,从而降低宫颈病变的发生;血清Se、Se和As联合、Se和Ni联合可用于新疆巴楚县维吾尔族妇女CINⅡ+的初步筛检;巴楚县土壤和饮用水中微量元素的含量与当地维吾尔族妇女HPV感染率、高级别宫颈病变和宫颈癌的发生具有一定相关性。
[Abstract]:Objective: To study the Xinjiang County of Bachu Uygur HPV infected women, high grade cervical lesions and cervical cancer (CIN +) and the behavioral risk factors of trace elements and serum vitamin; analysis of serum trace elements and vitamin HPV levels in the prediction of infection, CIN II + value; explore the Bachu County Soil and drinking water in the levels of trace elements with the local Uygur women's HPV infection rate, the correlation between CIN II +. In order to provide the basis for the intervention of Xinjiang Uygur cervical cancer. Methods: 1. from March 1, 2014 to June 15th, by the method of cluster sampling, screening for cervical cancer in Uygur women in 9 townships in Bachu County, a total of 5045 women. Cytology screening ASC-US and above, care HPV positive or VIA/VILI positive in 646 cases in the study cohort. In addition, during the period from March 1, 2011 to June 15, 2014 in Xinjiang Cancer Hospital Gynecological hospitalized from Bachu County in 187 cases of cervical disease patients into the study cohort. Detection of CIN II + as the case group, chronic cervicitis and CIN grade as control group; HPV infection as a positive group, negative group. As uninfected subjects were the risk factors of cervical cancer related behavior questionnaire, and serum levels of trace elements, the content of vitamin.2. were randomly selected in each township, land 42, 5 point sampling by the same soil; and within one year of 2,5,8 and December collected each township drinking water 30, each at least 1L. determination of soil and drinking water in As, Cd, Co Ni, Cu, Zn, Mn, Se, Fe and.3. levels by chi square test of the patients and the control group, positive group and negative group were analyzed by univariate analysis, the factors of P0.1 included in the multivariate Logistic regression analysis; the evaluation of diagnostic test and receiver technology Characteristic curve analysis of trace elements and vitamin HPV levels in the prediction of infection, the diagnostic value of CIN II +; by partial correlation analysis, soil and drinking water and the levels of trace elements in Uygur women CIN II + detection rate and the correlation between the infection rate of HPV. Results: 1. multivariate analysis showed that age less than 15 years, get married the number of 3 times, with more than 3 times per week, home delivery, toilet paper period, toilet clod, personal care score low, bathing frequency is low, without contraception and spouse smoking is high risk behavior factors in Xinjiang Uygur women in Bachu County of HPV infection, and family income of 5000 yuan and 5000~1 million yuan, get married the number of 3 times, in the home delivery, family history of cervical cancer, personal care score low, sanitary toilet paper and smoking are risk factors of.2. spouse behavior serum to the cervical lesions and cervical cancer in advanced As = 0.02 mg/Kg and vitamin D3 than 49.6434n G/L is a risk factor for HPV infection, and Ni = 0.1232 mg/Kg, Se = 0.02 and mg/Kg = 17.6705 ug/L folic acid was the protective factor in serum; Fe = 6.9153 and As = 0.02, mmol/L mg/Kg is the senior risk factors of cervical lesions and cervical cancer, and Ni is larger than 0.0965mg/Kg, Se = 0.02 mg/Kg and vitamin C 0.6857ug/L is the protective factors of.3.As, Ni, Se and the value of vitamin D3 and folic acid to predict the diagnosis of HPV infection was low, the area under the ROC curve is less than 0.7.4. with Se, Se and As combined with Se, and Ni can be used to predict advanced cervical lesions and cervical cancer, the diagnostic value of medium (ROC curve area up to under the above 0.7), the sensitivity and negative predictive value, false negative rate is low, but the specificity, accuracy and positive predictive value is low, the content of trace elements of high false positive rate of.5. in Bachu County Soil and drinking water did not exceed the national soil environment and drinking Water standard; CIN II + cervical lesion detection rate was positively correlated with As and Cu in the soil, and negatively correlated with Se, positively correlated with As in drinking water, and negatively correlated with Zn; the infection rate of HPV was positively correlated with soil As and negatively correlated with Se, positively correlated with Cu in drinking water. Was negatively correlated with Se. Conclusion: behavioral factors play an important role in the process of Xinjiang County of Bachu Uygur women's HPV infection and cervical lesions, should be targeted on the risk factors of behavior intervention, advocate late marriage, spouse quit smoking, toilet paper toilet, strengthen personal care and menstrual health; trace elements and vitamins in the serum content of Uygur and Bachu County women's HPV infection, CIN II + associated, should improve women's status of trace elements, so as to reduce the occurrence of cervical lesions; serum Se, Se and As, Se and Ni can be used in Xinjiang County of Bachu Uygur joint The primary screening of CIN II + in women is that the content of trace elements in soil and drinking water in Bachu county has certain correlation with the HPV infection rate of the Uygur women, the occurrence of high-grade cervical lesions and cervical cancer.

【学位授予单位】：新疆医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R737.33

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