HPV亚型与宫颈病变发生及预后的相关性研究
发布时间：2018-07-31 15:00
【摘要】：目的：高危型人乳头瘤病毒亚型与不同程度宫颈病变及预后相关性研究 方法：选择我院HPV(人乳头瘤病毒)高危亚型检测阳性且病理诊断为宫颈病变的患者，对其行相应治疗后3-12个月行HR-HPV(高危型人乳头瘤病毒)分型检测及细胞学检查，必要再次活检。 结果：①慢性宫颈炎、CINI、CINII-CINIII及宫颈癌的高危型HPV感染率分别为：53.79%、61.9%、77.5%、93.02%，对其各组病变组的高危型HPV感染率行X2检验，差异有统计学意义（X2=38.752，P0.05）。②16亚型在慢性宫颈炎及CINI、CINII+CINIII及宫颈癌中的检测率都处于所有亚型中的首位，且检出率在不同宫颈病变中差异有统计学意义(P0.05)，说明高危型16影响着宫颈病变的程度，随着宫颈病变级别的升高，16亚型检出率也随之升高。15种检出亚型在不同宫颈病变中的检出率差异均有统计学意义（P0.05）。③300例随访患者检出率最高的五种亚型为：HPV16、58、52、53、18；宫颈癌HPV16检出率达到62.5%；HPV16型与HPV53型在不同宫颈病变检出率差异有统计学意义（P0.05）；HPV16、18、33、39、52、53及58亚型在同一宫颈病变中占有率差异有统计学意义（P0.05）；16、58亚型在不同宫颈病变治疗后的转阴率差异有统计学意义(P0.05)。58亚型各载量之间转阴率比较差异有统计学意义（P0.05）④单一高危型HPV感染中不同治疗方式其转阴率之间差异有统计学意义（P0.05）,二重及多重感染在经不同治疗方式后转阴率差异无统计学意义（P0.05）。单一感染在不同宫颈病变转阴率之间差异有统计学意义（P0.05），其在慢性炎和CINI、CINII和CINIIII及宫颈癌中的转阴率分别为50.75%(67/132)、62.96%（51/81）及78.12%（25/32）,可见随着宫颈病变级别的升高，单一高危型HPV感染经治疗后转阴率也随之升高。⑤16亚型转阴率分别为：36.67%、62.07%、75%、72%经四种治疗方式后转阴率比较有统计学意义（P0.05），39亚型无根治术治疗方式，其他三种治疗方式转阴率分别为：0、71.43%、50%，差异有统计学意义（P0.05），四种治疗方式总的转阴率分别为：43.65%、63.53%、69.39%、72.50%，差异有统计学意义（P0.05）。说明HPV转阴率与治疗方式有关。单纯干扰素治疗与其他三种治疗方式比较转阴率差异均有统计学意义（P0.05）。⑥≤35岁、36~50岁、≥50岁三组，其HPV转阴率分别为66.7%（26/39）、58.9%(112/190)、40.8%（29/71），三者比较有统计学意义（P0.05），58型HPV转阴率在各年龄层差异有统计学意义（P0.05）。⑦不同随访时间各组高危型HPV转阴率在不同宫颈病变及宫颈癌中经多样本率X2检验比较，差异都有统计学意义（P0.05），四种治疗方式不同随访时间各个样本率X2检验比较，差异都有统计学意义（P0.05），说明随着时间的推移四种治疗方法都会使转阴率提高。⑧对患者进行随访的过程中有3例患者出现转阴后再次感染，2例患者在同一亚型感染的同时新增亚型感染。 结论：1.高危型HPV感染是影响各级别宫颈病变的发生和发展，且随着宫颈病变级别的升高，其感染高危型HPV的概率也随之升高。2.16亚型在是各级别宫颈病变最常见的亚型，尤其在宫颈癌中检出率最高，，其次为58亚型。且16亚型随着宫颈病变级别的升高感染率也随之提高。再次印证16亚型最易导致宫颈癌发生。3.常见58亚型在治疗前HPV载量高低影响宫颈病变患者的预后，而16亚型与其载量高低无关，治疗后各高危亚型持续感染预示宫颈病变存在或复发。4.宫颈病变级别只在16亚型中影响患者的转阴率，其余亚型在不同宫颈病变级别中转阴率无差别，所以尚不能确定宫颈病变的严重程度是否影响高危型HPV的转阴因素。5.不同治疗方式都能有效清除高危型HPV感染，宫颈癌根治术转阴率较高，本资料显示不同手术治疗方式的效果明显优于干扰素治疗。在16亚型中各个治疗方式对预后影响最明显。6.单一亚型感染预后的转阴率明显高于双重及多重感染。说明阴道对单一亚型的清除率明显高于多亚型。7.本资料显示患者年龄越大，转阴率越低，说明年龄也是影响转阴率的因素。8.各宫颈病变级别经过不同治疗后随着时间推移转阴率逐渐提高。综合来看宫颈癌根治术后转阴率最高，可能与该手术范围大，预防了宫颈病变残留及复发。9.即使患者在治疗后可以转阴，但是也有再次感染高危型HPV的可能，也可能是重复感染或重新感染新的亚型。
[Abstract]:Objective: To study the correlation between high risk human papillomavirus subtypes and cervical lesions and prognosis.
Methods: the patients with high risk subtype of HPV (human papillomavirus) and pathological diagnosis of cervical lesions were selected, and the HR-HPV (high risk human papillomavirus) typing and cytological examination were performed 3-12 months after the corresponding treatment, and the need for re biopsy was necessary.
Results: (1) the high risk HPV infection rates of chronic cervicitis, CINI, CINII-CINIII and cervical cancer were 53.79%, 61.9%, 77.5%, 93.02% respectively. The high risk HPV infection rate in each group was statistically significant (X2=38.752, P0.05). (2) 16 subtypes were detected in chronic cervicitis and CINI, CINII+CINIII and cervical cancer. In all subtypes, the difference of the detection rate in different cervical lesions was statistically significant (P0.05), indicating that high risk type 16 affects the degree of cervical lesions. With the increase of cervical lesions, the detection rate of 16 subtypes also increases the detection rate of.15 subtypes in different uterine cervix lesions (P0.0 5) (5) (3) the five subtypes of 300 cases with the highest detection rate were: the detection rate of HPV16 in cervical cancer was 62.5%, and the difference between HPV16 and HPV53 in different cervical lesions was statistically significant (P0.05), and the difference in the proportion of HPV16,18,33,39,52,53 and 58 subtypes in the same cervical disease was statistically significant (P0.05); 1 The difference of the negative rate of the 6,58 subtype after the treatment of different cervical lesions was statistically significant (P0.05) the difference in the negative rate of the.58 subtypes was statistically significant (P0.05) (P0.05) there was a statistically significant difference between the different treatment modes of the single high-risk HPV infection (P0.05), and the double and multiple infection after different treatment methods. There was no significant difference in the negative rate (P0.05). The negative rate of single infection in different cervical lesions was statistically significant (P0.05). The negative rate in chronic inflammation and CINI, CINII and CINIIII and cervical cancer were 50.75% (67/132), 62.96% (51/81) and 78.12% (25/32) respectively. The negative rate of the infection was also increased after treatment. 5, the 16 subtype negative rate was 36.67%, 62.07%, 75%, 72% after four treatments, the negative rate was statistically significant (P0.05), 39 subtype without radical treatment, and the other three treatment methods were respectively: 0,71.43%, 50%, and the difference was statistically significant (P0.05), four therapeutic parties. The total conversion rate of the type was 43.65%, 63.53%, 69.39%, 72.50%, and the difference was statistically significant (P0.05). It indicated that the conversion rate of HPV was related to the treatment mode. The difference of the negative rate of the simple interferon treatment and the other three treatments were statistically significant (P0.05). (6) < 35 years old, 36~50 years, or 50 years old and three groups, and their HPV conversion rate was 66.7% (26/39 ), 58.9% (112/190), 40.8% (29/71), three were statistically significant (P0.05), and type 58 HPV negative rate was statistically significant in all age groups (P0.05). (P0.05) high risk HPV negative rate in different groups of cervical lesions and cervical cancer were compared with the multiple sample rate X2 test, the difference was statistically significant (P0.05) and four treatment methods. The differences were statistically significant (P0.05) in the X2 test of each sample rate at different follow-up times, indicating that the four treatments would increase the negative rate over time. In the follow-up period, 3 patients were reinfected and 2 were infected with the same subtype.
Conclusion: 1. high risk HPV infection is the occurrence and development of cervical lesions at all levels, and with the increase of cervical lesions, the probability of infection of high risk type HPV also increases the most common subtype of.2.16 subtype in all levels of cervical lesions, especially in cervical cancer, followed by the 58 subtype. And the 16 subtype with cervical disease. The rate of change in the level of infection also increased. Again, it was confirmed that the 16 subtype of the 16 subtype was the most likely to lead to the prognosis of the patients with cervical lesions before the treatment of the 58 subtypes of cervical cancer, but the 16 subtype was not related to the load. The persistent infection of the high risk subtypes indicated the existence of cervical lesions or the recurrence of the.4. cervix lesion level only after treatment. In the 16 subtype, the negative rate of the patients was affected, the other subtypes had no difference in the different cervical lesions, so it was not possible to determine whether the severity of the cervical lesions affected the negative factors of high risk HPV..5. could effectively remove the high risk HPV infection. The effect of the same surgical treatment was obviously better than that of interferon. In the 16 subtype, the effect of each treatment on the prognosis was most obvious. The negative rate of.6. single subtype infection was significantly higher than that of double and multiple infection. The clearance rate of the single subtype of vagina was significantly higher than that of the multisubtype.7.. The older the patient was, the lower the negative rate was. It shows that the age is also a factor that affects the negative rate of.8.. After different treatment, the rate of changing the negative rate of the cervix is gradually increased after different treatment. The risk of infection with high-risk HPV may also be repeated infection or re infection of new subtypes.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
[Abstract]:Objective: To study the correlation between high risk human papillomavirus subtypes and cervical lesions and prognosis.
Methods: the patients with high risk subtype of HPV (human papillomavirus) and pathological diagnosis of cervical lesions were selected, and the HR-HPV (high risk human papillomavirus) typing and cytological examination were performed 3-12 months after the corresponding treatment, and the need for re biopsy was necessary.
Results: (1) the high risk HPV infection rates of chronic cervicitis, CINI, CINII-CINIII and cervical cancer were 53.79%, 61.9%, 77.5%, 93.02% respectively. The high risk HPV infection rate in each group was statistically significant (X2=38.752, P0.05). (2) 16 subtypes were detected in chronic cervicitis and CINI, CINII+CINIII and cervical cancer. In all subtypes, the difference of the detection rate in different cervical lesions was statistically significant (P0.05), indicating that high risk type 16 affects the degree of cervical lesions. With the increase of cervical lesions, the detection rate of 16 subtypes also increases the detection rate of.15 subtypes in different uterine cervix lesions (P0.0 5) (5) (3) the five subtypes of 300 cases with the highest detection rate were: the detection rate of HPV16 in cervical cancer was 62.5%, and the difference between HPV16 and HPV53 in different cervical lesions was statistically significant (P0.05), and the difference in the proportion of HPV16,18,33,39,52,53 and 58 subtypes in the same cervical disease was statistically significant (P0.05); 1 The difference of the negative rate of the 6,58 subtype after the treatment of different cervical lesions was statistically significant (P0.05) the difference in the negative rate of the.58 subtypes was statistically significant (P0.05) (P0.05) there was a statistically significant difference between the different treatment modes of the single high-risk HPV infection (P0.05), and the double and multiple infection after different treatment methods. There was no significant difference in the negative rate (P0.05). The negative rate of single infection in different cervical lesions was statistically significant (P0.05). The negative rate in chronic inflammation and CINI, CINII and CINIIII and cervical cancer were 50.75% (67/132), 62.96% (51/81) and 78.12% (25/32) respectively. The negative rate of the infection was also increased after treatment. 5, the 16 subtype negative rate was 36.67%, 62.07%, 75%, 72% after four treatments, the negative rate was statistically significant (P0.05), 39 subtype without radical treatment, and the other three treatment methods were respectively: 0,71.43%, 50%, and the difference was statistically significant (P0.05), four therapeutic parties. The total conversion rate of the type was 43.65%, 63.53%, 69.39%, 72.50%, and the difference was statistically significant (P0.05). It indicated that the conversion rate of HPV was related to the treatment mode. The difference of the negative rate of the simple interferon treatment and the other three treatments were statistically significant (P0.05). (6) < 35 years old, 36~50 years, or 50 years old and three groups, and their HPV conversion rate was 66.7% (26/39 ), 58.9% (112/190), 40.8% (29/71), three were statistically significant (P0.05), and type 58 HPV negative rate was statistically significant in all age groups (P0.05). (P0.05) high risk HPV negative rate in different groups of cervical lesions and cervical cancer were compared with the multiple sample rate X2 test, the difference was statistically significant (P0.05) and four treatment methods. The differences were statistically significant (P0.05) in the X2 test of each sample rate at different follow-up times, indicating that the four treatments would increase the negative rate over time. In the follow-up period, 3 patients were reinfected and 2 were infected with the same subtype.
Conclusion: 1. high risk HPV infection is the occurrence and development of cervical lesions at all levels, and with the increase of cervical lesions, the probability of infection of high risk type HPV also increases the most common subtype of.2.16 subtype in all levels of cervical lesions, especially in cervical cancer, followed by the 58 subtype. And the 16 subtype with cervical disease. The rate of change in the level of infection also increased. Again, it was confirmed that the 16 subtype of the 16 subtype was the most likely to lead to the prognosis of the patients with cervical lesions before the treatment of the 58 subtypes of cervical cancer, but the 16 subtype was not related to the load. The persistent infection of the high risk subtypes indicated the existence of cervical lesions or the recurrence of the.4. cervix lesion level only after treatment. In the 16 subtype, the negative rate of the patients was affected, the other subtypes had no difference in the different cervical lesions, so it was not possible to determine whether the severity of the cervical lesions affected the negative factors of high risk HPV..5. could effectively remove the high risk HPV infection. The effect of the same surgical treatment was obviously better than that of interferon. In the 16 subtype, the effect of each treatment on the prognosis was most obvious. The negative rate of.6. single subtype infection was significantly higher than that of double and multiple infection. The clearance rate of the single subtype of vagina was significantly higher than that of the multisubtype.7.. The older the patient was, the lower the negative rate was. It shows that the age is also a factor that affects the negative rate of.8.. After different treatment, the rate of changing the negative rate of the cervix is gradually increased after different treatment. The risk of infection with high-risk HPV may also be repeated infection or re infection of new subtypes.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
【参考文献】
相关期刊论文 前5条
1 杨英捷;赵健;李雪倩;廖秦平;;人乳头状瘤病毒不同亚型感染与宫颈病变的相关性[J];中国妇产科临床杂志;2006年04期
2 廖兵;张双庆;魏祥松;;某地区妇女HPV感染情况及基因型的分布[J];国际检验医学杂志;2011年04期
3 孙蓬明;陈贤t
本文编号：2155949
本文链接：https://www.wllwen.com/yixuelunwen/fuchankeerkelunwen/2155949.html
最近更新
教材专著
