武汉市农村户籍妇女宫颈癌筛查及影响因素研究
发布时间：2018-07-20 12:17
【摘要】：目的 旨在摸清武汉市农村户籍妇女宫颈癌及癌前病变流行状况和流行特征,利用大样本资料分析比较不同的宫颈癌筛查方法,探讨更加有效、适宜,便于推广的筛查方法；对宫颈癌及癌前病变影响因素进行研究,为武汉市制定宫颈癌的预防策略提供科学依据。 方法 采取整群抽样的方法于2011年6月至2012年6月期间对武汉市16个区170401名25-64岁的农村户籍妇女进行宫颈癌筛查和诊断,宫颈癌初筛采用液基薄层细胞学技术(TCT)和DNA倍体定量分析技术,初筛阳性者进行HPV-DNA检测,并在阴道镜下取宫颈活体组织病理检查进行确诊。采用自编问卷,对初筛阳性者进行问卷调查,调查内容包括一般人口学情况、环境因素、遗传因素、既往史及现病史、女性个人健康史、生活习惯及饮食习惯以及社会心理因素等七大方面。采取1：1病例对照研究方法对宫颈癌和癌前病变的危险因素进行分析。使用SPSS13.0软件包对数据进行统计分析。 结果 1、武汉市宫颈癌及癌前病变检出情况：武汉市农村户籍妇女宫颈癌患病率为27.13/10万,按年龄标化的患病率为34.71/10万。 2、宫颈癌及癌前病变地域和年龄分布特征：宫颈癌检出率最高的是江夏区29.67/10万,检出率最低的是汉南区为0,其次是蔡甸区4.95/10万。宫颈CIN1-3级病变均以40-45岁检出率最高,而宫颈癌检出率随年龄呈现上升趋势,以60-64岁组检出率最高。 3、初筛阳性妇女HPV感染和分型情况：宫颈癌初筛阳性妇女HPV感染率为57.03%,宫颈炎、宫颈上皮内瘤变和宫颈癌妇女HPV的感染率分别为40.72%,89.64%和92.86%,差异具有统计学意义。HPV16型检出率最高,占检测人群的18.16%,其次是58型(13.55%),52型(11.00%),33型(5.68%)。宫颈癌患者中64.29%感染HPV16型。 4、两种初筛方法的比较：TCT和细胞DNA倍体定量分析的灵敏度、特异度、阳性预测值、阴性预测值、诊断准确率分别为70.03%、51.52%、36.99%、80.88%、56.87%和80.26%、39.61%、35.02%、83.17%、51.33%,TCT灵敏度低于细胞DNA倍体分析,但特异度较高,总体诊断正确率TCT高于DNA倍体定量分析。 5、HPV-DNA检测：在初筛阳性妇女中灵敏度为92.18%,特异度为56.73%,灵敏度显著高于TCT和DNA倍体分析,特异度也略高。HPV-DNA检测在ASC-US组的诊断正确率较高,达到68.62%。 6、宫颈癌及癌前病变影响因素分析：将病例组和对照组7大类106个因素进行单因素条件logistic回归分析,结果显示HPV感染、初婚年龄、初次性行为年龄、首次妊娠年龄、生育第一胎年龄、使用手机或吹风机、接触噪音强光、妇科疾病未治疗、月经持续时间短、放置宫内节育器、使用避孕套、被动吸烟等14项为宫颈癌和癌前病变的影响因素。多因素条件Logistic回归分析结果表明,有宫颈癌家族史(OR=191.07)、HPV感染(OR=247.66)为宫颈癌及癌前病变发生的危险因素,而绝经(OR=0.13)、首次妊娠年龄晚(OR=0.30)为宫颈癌及癌前病变发生的保护因素。 结论 武汉市农村户籍妇女宫颈癌患病率为34.71/10万,高于经济发达地区但低于西部落后地区。宫颈癌的患病率随年龄增长呈现上升趋势,汉南区和蔡甸区宫颈癌发生率明显低于其他区。在初筛阳性妇女中的HPV感染率为57.03%,宫颈病变级别越高,高危型HPV感染率越高。HPV16型是最主要的致癌HPV亚型,多重HPV亚型感染没有致癌协同作用。筛查方法中TCT灵敏度低于细胞DNA倍体分析,但特异度较高,总体诊断正确率高于DNA倍体定量分析。HPV-DNA检测灵敏度、特异度均高于TCT和DNA倍体分析,但由于HPV-DNA检测阳性预测值低,不适合单独用于初筛,可以用于TCT初筛后结果为ASC-US病人的分诊,具有较强的临床和筛查应用价值。有HPV感染、宫颈癌家族史为武汉市农村户籍妇女宫颈癌和癌前病变发生的危险因素,而绝经、首次妊娠年龄晚为宫颈癌和癌前病变发生的保护因素。 创新之处 (1)首次摸清武汉市农村户籍妇女宫颈癌发生情况及其流行特征,并对宫颈癌发生的危险因素进行研究； (2)利用大样本资料,对三种筛查方法及其联合或序贯应用建立筛查模型,并进行筛查效果分析,为国内进行大规模宫颈癌筛查制定方案或临床有效运用这些宫颈癌筛查方法提供了科学依据。
[Abstract]:objective
The purpose of this study is to find out the prevalence and epidemic characteristics of cervical cancer and precancerous lesions in the rural household of Wuhan, and to analyze and compare different screening methods of cervical cancer by using large sample data to explore more effective, suitable and convenient screening methods, and to study the influence factors of cervical cancer and precancerous lesions, and to prevent cervical cancer in Wuhan. The strategy provides a scientific basis.
Method
From June 2011 to June 2012, a cluster sampling method was used to screen and diagnose cervical cancer of 170401 rural household registered women of 25-64 years old in 16 districts of Wuhan. Cervical cancer was screened by liquid based thin layer cytology (TCT) and DNA ploidy quantitative analysis technique. The initial sieves were detected by HPV-DNA and cervical biopsy under colposcopy. The body histopathological examination was made to make a diagnosis. A questionnaire survey was made by self compiled questionnaire. The questionnaire survey was carried out. The contents included general demographic, environmental, genetic, past and present history, women's personal health history, living habits and dietary habits, and social psychological factors. The 1:1 case control study was adopted. Methods the risk factors of cervical cancer and precancerous lesions were analyzed. Data were analyzed by SPSS13.0 software package.
Result
1, the detection of cervical cancer and precancerous lesions in Wuhan: the prevalence rate of cervical cancer in rural households in Wuhan is 27.13/10 million, and the prevalence rate of age standardized is 34.71/10 million.
2, the region and age distribution of cervical cancer and precancerous lesions: the highest detection rate of cervical cancer was 29.67/10 million in Jiangxia district. The lowest detection rate was 0 in Hannan District, followed by 4.95/10 million in Caidian district. The highest detection rate of cervical CIN1-3 grade lesions was 40-45 years old, while the detection rate of cervical cancer increased with age, and the detection rate of 60-64 year old group was the most. High.
3, HPV infection and typing of positive women with early screening: the incidence of HPV infection in cervical cancer positive women was 57.03%, cervicitis, cervical intraepithelial neoplasia and HPV of cervical cancer were 40.72%, 89.64% and 92.86% respectively. The difference was statistically significant in.HPV16 detection rate, accounting for 18.16% of the test population, followed by type 58 (13.55%), 52 (1 1%), type 33 (5.68%). 64.29% of cervical cancer patients were infected with HPV16.
4, the comparison of the two screening methods: the sensitivity, specificity, positive predictive value and negative predictive value of TCT and DNA ploidy quantitative analysis were 70.03%, 51.52%, 36.99%, 80.88%, 56.87% and 80.26%, 39.61%, 35.02%, 83.17%, 51.33%, and the sensitivity of TCT was lower than the cell DNA ploidy analysis, but the specificity was higher and the overall diagnostic accuracy was TCT The quantitative analysis was higher than DNA ploidy.
5, HPV-DNA detection: the sensitivity of the positive women was 92.18%, the specificity was 56.73%, the sensitivity was significantly higher than the TCT and DNA ploidy analysis, and the specificity was also slightly higher in the ASC-US group, the accuracy of the diagnosis was higher in the ASC-US group, and reached 68.62%..
6, analysis of the influencing factors of cervical cancer and precancerous lesions: a single factor conditional logistic regression analysis was carried out between the case group and the control group of 7 major factors. The results showed that the HPV infection, the age of first marriage, the first sexual age, the first pregnancy age, the first birth age, the use of hand machine or hair dryer, the exposure to the noise, the untreated gynecopathy, and the untreated gynecologic diseases. After a short duration of time, 14 items such as intrauterine device, condom and passive smoking were the factors affecting cervical cancer and precancerous lesions. Multiple factor Logistic regression analysis showed that there were family history of cervical cancer (OR=191.07), HPV infection (OR=247.66) as a risk factor for cervical cancer and precancerous lesions, and OR=0.13 (OR=0.13), for the first time. Late pregnancy (OR=0.30) is a protective factor for cervical cancer and precancerous lesions.
conclusion
The prevalence rate of cervical cancer in rural households in Wuhan is more than 34.71/10 million, which is higher than that in the economically developed areas but lower than that in the western regions. The prevalence of cervical cancer increases with age, and the incidence of cervical cancer in Hannan and Caidian areas is significantly lower than that in other areas. The rate of HPV infection in the early screening positive women is 57.03%, and the higher the cervical lesions are. High risk type HPV infection rate is higher.HPV16 type is the most important carcinogenic HPV subtype, multiple HPV subtype infection has no carcinogenic synergism. TCT sensitivity is lower than cell DNA ploidy analysis, but the specificity is higher, the overall diagnostic accuracy is higher than the DNA ploidy quantitative analysis.HPV-DNA detection sensitivity, the specificity is higher than TCT and DNA ploidy. Analysis, however, because of low HPV-DNA positive predictive value, it is not suitable to be used alone for initial screening. It can be used for the diagnosis of ASC-US patients after TCT initial screening. It has a strong clinical and screening application value. There are HPV infection, the family history of cervical cancer is the risk factor of cervical cancer and precancerous lesions in rural women of Wuhan, and menopause, first pregnancy. Late pregnancy age is a protective factor for cervical cancer and precancerous lesions.
Innovation
(1) for the first time to find out the occurrence and epidemiological characteristics of cervical cancer in rural women in Wuhan, and to study the risk factors of cervical cancer.
(2) using large sample data to establish screening models for three screening methods and their joint or sequential applications, and to analyze the effect of screening, which provides a scientific basis for large-scale cervical cancer screening and the clinical effective application of these screening methods for cervical cancer.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R737.33
[Abstract]:objective
The purpose of this study is to find out the prevalence and epidemic characteristics of cervical cancer and precancerous lesions in the rural household of Wuhan, and to analyze and compare different screening methods of cervical cancer by using large sample data to explore more effective, suitable and convenient screening methods, and to study the influence factors of cervical cancer and precancerous lesions, and to prevent cervical cancer in Wuhan. The strategy provides a scientific basis.
Method
From June 2011 to June 2012, a cluster sampling method was used to screen and diagnose cervical cancer of 170401 rural household registered women of 25-64 years old in 16 districts of Wuhan. Cervical cancer was screened by liquid based thin layer cytology (TCT) and DNA ploidy quantitative analysis technique. The initial sieves were detected by HPV-DNA and cervical biopsy under colposcopy. The body histopathological examination was made to make a diagnosis. A questionnaire survey was made by self compiled questionnaire. The questionnaire survey was carried out. The contents included general demographic, environmental, genetic, past and present history, women's personal health history, living habits and dietary habits, and social psychological factors. The 1:1 case control study was adopted. Methods the risk factors of cervical cancer and precancerous lesions were analyzed. Data were analyzed by SPSS13.0 software package.
Result
1, the detection of cervical cancer and precancerous lesions in Wuhan: the prevalence rate of cervical cancer in rural households in Wuhan is 27.13/10 million, and the prevalence rate of age standardized is 34.71/10 million.
2, the region and age distribution of cervical cancer and precancerous lesions: the highest detection rate of cervical cancer was 29.67/10 million in Jiangxia district. The lowest detection rate was 0 in Hannan District, followed by 4.95/10 million in Caidian district. The highest detection rate of cervical CIN1-3 grade lesions was 40-45 years old, while the detection rate of cervical cancer increased with age, and the detection rate of 60-64 year old group was the most. High.
3, HPV infection and typing of positive women with early screening: the incidence of HPV infection in cervical cancer positive women was 57.03%, cervicitis, cervical intraepithelial neoplasia and HPV of cervical cancer were 40.72%, 89.64% and 92.86% respectively. The difference was statistically significant in.HPV16 detection rate, accounting for 18.16% of the test population, followed by type 58 (13.55%), 52 (1 1%), type 33 (5.68%). 64.29% of cervical cancer patients were infected with HPV16.
4, the comparison of the two screening methods: the sensitivity, specificity, positive predictive value and negative predictive value of TCT and DNA ploidy quantitative analysis were 70.03%, 51.52%, 36.99%, 80.88%, 56.87% and 80.26%, 39.61%, 35.02%, 83.17%, 51.33%, and the sensitivity of TCT was lower than the cell DNA ploidy analysis, but the specificity was higher and the overall diagnostic accuracy was TCT The quantitative analysis was higher than DNA ploidy.
5, HPV-DNA detection: the sensitivity of the positive women was 92.18%, the specificity was 56.73%, the sensitivity was significantly higher than the TCT and DNA ploidy analysis, and the specificity was also slightly higher in the ASC-US group, the accuracy of the diagnosis was higher in the ASC-US group, and reached 68.62%..
6, analysis of the influencing factors of cervical cancer and precancerous lesions: a single factor conditional logistic regression analysis was carried out between the case group and the control group of 7 major factors. The results showed that the HPV infection, the age of first marriage, the first sexual age, the first pregnancy age, the first birth age, the use of hand machine or hair dryer, the exposure to the noise, the untreated gynecopathy, and the untreated gynecologic diseases. After a short duration of time, 14 items such as intrauterine device, condom and passive smoking were the factors affecting cervical cancer and precancerous lesions. Multiple factor Logistic regression analysis showed that there were family history of cervical cancer (OR=191.07), HPV infection (OR=247.66) as a risk factor for cervical cancer and precancerous lesions, and OR=0.13 (OR=0.13), for the first time. Late pregnancy (OR=0.30) is a protective factor for cervical cancer and precancerous lesions.
conclusion
The prevalence rate of cervical cancer in rural households in Wuhan is more than 34.71/10 million, which is higher than that in the economically developed areas but lower than that in the western regions. The prevalence of cervical cancer increases with age, and the incidence of cervical cancer in Hannan and Caidian areas is significantly lower than that in other areas. The rate of HPV infection in the early screening positive women is 57.03%, and the higher the cervical lesions are. High risk type HPV infection rate is higher.HPV16 type is the most important carcinogenic HPV subtype, multiple HPV subtype infection has no carcinogenic synergism. TCT sensitivity is lower than cell DNA ploidy analysis, but the specificity is higher, the overall diagnostic accuracy is higher than the DNA ploidy quantitative analysis.HPV-DNA detection sensitivity, the specificity is higher than TCT and DNA ploidy. Analysis, however, because of low HPV-DNA positive predictive value, it is not suitable to be used alone for initial screening. It can be used for the diagnosis of ASC-US patients after TCT initial screening. It has a strong clinical and screening application value. There are HPV infection, the family history of cervical cancer is the risk factor of cervical cancer and precancerous lesions in rural women of Wuhan, and menopause, first pregnancy. Late pregnancy age is a protective factor for cervical cancer and precancerous lesions.
Innovation
(1) for the first time to find out the occurrence and epidemiological characteristics of cervical cancer in rural women in Wuhan, and to study the risk factors of cervical cancer.
(2) using large sample data to establish screening models for three screening methods and their joint or sequential applications, and to analyze the effect of screening, which provides a scientific basis for large-scale cervical cancer screening and the clinical effective application of these screening methods for cervical cancer.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R737.33
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