医院机会性筛查人群HR-HPV感染的流行病学特征及与宫颈癌前病变的关系

发布时间：2018-07-04 19:42

  本文选题：高危型人乳头瘤病毒 + 流行病学　； 参考：《首都医科大学学报》2015年02期

【摘要】：目的研究医院机会性筛查人群高危型人乳头瘤病毒(high risk-human papillomavirus,HR-HPV)感染的流行病学特征,探讨HR-HPV感染与宫颈癌前病变的关系。方法收集2012年1月1日至2012年12月31日期间,就诊于首都医科大学附属北京朝阳医院妇科门诊,同时接受HR-HPV和宫颈薄层液基细胞学检查(thinprep cytologic test,TCT)符合纳入标准的2 305例患者资料。采用二代杂交捕获法(hybird capture II,HC-II)进行HR-HPV检测。结果 1)医院机会性筛查人群HR-HPV感染率为34.84%,年轻女性(20~24岁)感染率最高(50.0%),随着年龄的增加,感染率逐渐下降,45~49岁女性感染率最低(24.18%),≥55岁者感染率升高(47.02%),感染率呈双高现象。宫颈薄层液基细胞学异常率的年龄分布特点,与HR-HPV感染率的年龄分布特点一致。2)TCT结果为正常或者炎性反应、不典型鳞状上皮细胞(atypical squamous cells undetermined significance,ASCUS)、低度鳞状上皮内瘤样病变(low squamous intraepithelial lesion,LSIL)、高度鳞状上皮内瘤样病变(high squamous intraepithelial lesion,HSIL)、宫颈鳞状细胞癌(squamous of cervical carcinoma,SCC)中,HR-HPV的感染率分别是23.98%、66.47%、87.21%、98.04%、100%。宫颈组织活检病理为正常或炎性反应、宫颈上皮内瘤样病变1级(cervical intraepithelial lesions-Ⅰ,CIN-Ⅰ)、CIN-Ⅱ、CIN-Ⅲ、SCC患者HR-HPV的感染率分别为67.44%、86.96%、88.24%、94.57%、90.48%。3)在ASCUS患者中,宫颈高级别病变(≥CIN-Ⅱ)的发生率31.73%,HRHPV阳性组宫颈高级别病变(≥CIN-Ⅱ)的检出率36.93%,HR-HPV阴性组宫颈高级别病变(≥CIN-Ⅱ)的检出率21.43%,两组间的差异具有统计学意义(χ2=4.13,P=0.042)。4)在LSIL患者中,宫颈高级别病变的发生率34.40%,HR-HPV阳性组宫颈高级别病变的检出率37.37%,HR-HPV阴性组宫颈高级别病变的检出率14.29%,两组间的差异具有统计学意义(χ2=5.76,P=0.016)。结论不同年龄,HR-HPV感染率及TCT异常率不同,24岁和≥55岁为HR-HPV感染及异常宫颈薄层液基细胞学高峰年龄。HRHPV感染率和宫颈病变严重程度呈显著正相关。HR-HPV检测不能作为ASCUS和LSIL患者分流管理的唯一手段,HR-HPV阴性的ASCUS和LSIL不能排除≥CIN-Ⅱ级病变,仍然需要做阴道镜检查。
[Abstract]:Objective to study the epidemiological characteristics of high-risk human papillomavirus (high risk-human papillomavirus-HR-HPV) infection in hospital opportunistic screening population, and to explore the relationship between HR-HPV infection and cervical precancerous lesions. Methods from January 1, 2012 to December 31, 2012, data of 2 305 patients who were admitted to gynecological clinic of Beijing Chaoyang Hospital affiliated to Capital Medical University and received HR-HPV and (thinprep cytologic TCT were collected. HR-HPV was detected by (hybird capture II HC-II. Results 1) the infection rate of HR-HPV in hospital opportunistic screening population was 34.844.The infection rate of young women (20 ~ 24 years old) was the highest (50.0%). With the increase of age, the infection rate of women aged 45 to 49 years was the lowest (24.18%), and the infection rate of those over 55 years old was increased (47.02%). The age distribution of the abnormal rate of liquid-based cytology of the cervix and the age distribution of HR-HPV infection rate were consistent with the age distribution of HR-HPV infection rate. 2) the results of TCT showed normal or inflammatory reaction. The infection rates of HR-HPV in atypical squamous epithelial cells (atypical squamous cells undetermined), low-grade squamous intraepithelial neoplasia (low squamous intraepithelial lesion/ lsil), high squamous intraepithelial neoplasia (high squamous intraepithelial lesionlsil), and cervical squamous cell carcinoma (squamous of cervical carcinoma-SCC) were 23.9866.4787.217.21, 98.04 and 100, respectively. The infection rate of HR-HPV in patients with (cervical intraepithelial lesions- 鈪，

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