维吾尔族妇女高危型HPV感染与免疫功能的相关性研究

发布时间：2018-05-13 09:07

本文选题：人乳头瘤病毒 + 宫颈病变　；参考：《新疆大学》2017年硕士论文

【摘要】：目的:宫颈癌是新疆维吾尔族妇女发病率极高的恶性肿瘤之一。利用分子生物学和免疫检测法,分析维吾尔族妇女高危型HPV感染的情况及危险因素;探讨维吾尔族妇女高危型HPV感染与多项免疫指标的变化及血清抗体水平之间的相关性,为建立宫颈癌筛查的辅助指标体系提供了依据。方法:2015年12月至2016年12月就诊于新疆维吾尔自治区人民医院门诊或住院的妇女,自愿接受HCII法检测HPV感染联合或者未联合液基细胞学检查,从中筛选出HPV感染阳性或者液基细胞学诊断≥非典型鳞状上皮细胞(atypical squamous cell of Undetermined signification,ASC-US)患者,进一步进行阴道镜下检查和活检送病理检查;同时抽取静脉血3~5毫升,分离出2毫升用于流式细胞仪法检测T淋巴细胞亚群;剩余的血清/血浆利用酶联免疫吸附法(ELISA)检测人乳头瘤病毒16型L1-IgG抗体水平。结果:1.(1)维吾尔族与汉族宫颈癌HPV阳性率分别为87.93%、68.04%;两民族之间有显著性差异(P0.01)。(2)HPV载量RLU/CO≥1.0为阳性,1.0为阴性,根据HPV载量高低分为1、1~100、100~1000、1000共4个载量组;宫颈病变与HPV载量(RLU/CO)之间存在正相关关系,HPV载量越高,宫颈病变程度越重(P0.01)。(3)维吾尔族和汉族两组中,HPV阴性(RLU/CO1)组分别与1~100组、100~1000组、1000组;且1~100组和1000组;100~1000组和1000组,各组间有显著性差异(P0.05)。(4)液基细胞学(TCT)检查结果分为宫颈上皮内病变阴性(NILM)、非典型鳞状上皮细胞(ASC-US)、低级别宫颈鳞状上皮内病变(LSIL)、高级别宫颈鳞状上皮内病变(HSIL)、宫颈鳞状细胞癌和非典型腺细胞(SCC+AGUS)等5个组;NILM、ASC-US、LSIL、HSIL、SCC+AGUS组与HPV阳性率两组之间有显著性差异(P0.01)。(5)在NILM组和SCC+AGUS组,汉族患者所占30.77%(4/13)、而维吾尔族患者所占69.23%(9/13),两组之间有显著性差异(P0.01)。(6)年龄和HPV载量也逐步升高,35~45岁和45~55岁之间明显升高(P0.05)。(7)宫颈病变与年龄有一定的关系,两组之间有显著性差异(P0.05)。2.(1)CD4辅助/诱导T细胞百分比参考范围33%~58%,根据参考范围高低分为33、33~45、45~58、58等4个组;随着宫颈病变程度的加重,CD4辅助/诱导T细胞百分比在33、33~45范围内明显下降,各组之间有显著性差异(P0.01)。(2)CD4/CD8比值参考范围0.71~2.78,根据参考范围高低分为0.71、0.71~1.74、1.74~2.78、2.78等4个组;随着宫颈病变程度的加重,CD4/CD8比值在0.71、0.71~1.74范围内明显下降,各组之间有显著性差异(P0.01)。(3)CD3总T细胞百分比参考范围56%~86%,根据参考范围高低分为56、56~71、71~86、86等4个组;随着宫颈病变的加重,CD3总T细胞百分比56~71、71~86范围有下降趋势,但差异无统计学意义(P0.05)。(4)CD8抑制/杀伤T细胞百分比参考范围13%~39%,根据参考范围高低分为13、13~26、26~39、39等4个组;随着宫颈病变的加重,CD8抑制/杀伤T细胞百分比39范围有下降趋势,但差异无统计学意义(P0.05)。3.(1)随着宫颈病变加重,HPV 16 L1-IgG抗体水平下降趋势,但各组之间无显著差异(P0.05)。(2)HPV载量(RLU/CO)不同的与HPV 16 L1-IgG抗体水平无显著性差异(P0.05)。(3)HPV16 L1-IgG抗体水平与不同民族之间没有相关性(P0.05)。(4)HPV16 L1-IgG抗体水平与年龄之间没有相关性(P0.05)。结论:1.宫颈病变级别与HR-HPV感染率呈正相关。HPV载量增加与高级别宫颈上皮内病变和宫颈癌的患病风险正相关。随着细胞学及宫颈病变病理学级别的升高,HR-HPV载量及HPV的阳性率均随之升高。2.机体免疫功能低下和免疫功能紊乱均使宫颈病变的危险度增高。高级别宫颈病变患者的细胞免疫功能均有不同程度的降低,其中宫颈癌患者的细胞免疫功能降低最为显著。3.血清HPV16 L1-IgG抗体检测阳性既可代表现存HPV感染,也可表示既往HPV感染。HPV 16 L1-IgG抗体阳性率随宫颈病变级别增高呈下降趋势,但血清抗体水平之间无显著性差异,试验结果可能与HPV清除与宫颈病变逆转有关。
[Abstract]:Objective: cervical cancer is one of the malignant tumors of Uygur women in Xinjiang. Using molecular biology and immunoassay, the situation and risk factors of high risk HPV infection in Uygur women are analyzed, and the correlation between high risk HPV infection of Uygur women and the changes of multiple immune markers and the level of serum antibody are discussed. To establish a basis for establishing an auxiliary index system for screening for cervical cancer. Methods: from December 2015 to December 2016, women who were hospitalized at the the Xinjiang Uygur Autonomous Region people's hospital were admitted to the the Xinjiang Uygur Autonomous Region people's hospital. The HPV infection combined with or without the combined liquid based cytological examination was tested voluntarily, and the positive or liquid based cytological diagnosis of HPV infection was screened out. Patients with atypical squamous cells (atypical squamous cell of Undetermined signification, ASC-US) were further examined under colposcopy and biopsy, and 3~5 milliliters of venous blood were extracted at the same time, and 2 ml was isolated for the detection of T lymphatic subsets by flow cytometry; the remaining serum / plasma was used for enzyme linked immunosorbent assay. Method (ELISA) detection of human papillomavirus type 16 L1-IgG antibody level. Results: 1. (1) the Uygur and Han cervical cancer HPV positive rate is 87.93%, 68.04%; two ethnic groups have significant difference (P0.01). (2) HPV load RLU/CO > 1 as positive, 1 as negative, according to the HPV load level is divided into 1,1~100100~10001000, 4 load groups; cervical disease There was a positive correlation between change and HPV load (RLU/CO), the higher the load of HPV, the higher the degree of cervical lesions (P0.01). (3) in two groups of Uygur and Han, HPV negative (RLU/CO1) group was respectively with 1~100 group, 100~1000 group and 1000 groups, and 1~100 group and 1000 group, 100~1000 group and 1000 groups, there were significant differences (P0.05). (4) liquid based cytology (TCT) examination The results were divided into 5 groups: negative cervical intraepithelial lesion (NILM), atypical squamous epithelial cell (ASC-US), low grade cervical squamous intraepithelial lesion (LSIL), high grade cervical squamous intraepithelial lesion (HSIL), cervical squamous cell carcinoma and atypical gland cell (SCC+AGUS), and NILM, ASC-US, LSIL, HSIL, SCC+AGUS group and HPV positive rate two groups Significant difference (P0.01). (5) in group NILM and group SCC+AGUS, 30.77% (4/13) of Han patients and 69.23% (9/13) of Uygur patients (9/13), there was a significant difference between two groups (P0.01). (6) age and HPV load increased gradually, 35~45 and 45~55 (P0.05). (7) there was a certain relationship between cervical lesions and age, two groups between the two groups. There were significant differences (P0.05).2. (1) CD4 auxiliary / inducement of T cell percentage reference range 33%~58%, according to the reference range of 33,33~45,45~58,58 and other groups, with the severity of cervical lesions, the percentage of CD4 assisted / induced T cells decreased significantly in the 33,33~45 range, there was a significant difference between each group (P0.01). (2) CD4/CD8 ratio reference. The range of 0.71~2.78 was divided into 4 groups according to the reference range of 0.71,0.71~1.74,1.74~2.78,2.78. With the aggravation of the degree of cervical lesions, the CD4/CD8 ratio decreased significantly within the range of 0.71,0.71~1.74. There was a significant difference between each group (P0.01). (3) the reference range of the total CD3 T cell percentage was 56%~86%, according to the reference range, 56,56~71,71 was divided into 56,56~71,71 ~86,86 and other 4 groups, with the aggravation of cervical lesions, the percentage of CD3 T cell percentage 56~71,71~86 decreased, but the difference was not statistically significant (P0.05). (4) the reference range of CD8 inhibition / killing T cell percentage was 13%~39%, according to the reference range, 4 groups were divided into 13,13~26,26~39,39 and so on. With the aggravation of cervical lesions, CD8 inhibition / killing T cells There was a downward trend in the percentage 39 range, but the difference was not statistically significant (P0.05).3. (1) with the aggravation of cervical lesions, HPV 16 L1-IgG antibody level decreased, but there was no significant difference between each group (P0.05). (2) there was no significant difference between HPV load (RLU/CO) and HPV 16 L1-IgG antibody water level (P0.05). (3) HPV16 L1-IgG antibody level and different ethnic groups. There is no correlation between (P0.05). (4) there is no correlation between HPV16 L1-IgG antibody level and age (P0.05). Conclusion: the level of cervical lesions and HR-HPV infection rate is positively correlated with the increase of.HPV load and high level cervical intraepithelial lesion and the risk of cervical cancer. With the increase of cytology and the pathological grade of cervical lesions, HR-HPV The positive rate of load and HPV increased with the immune function of.2. and the disorder of immune function, the risk of cervical lesions increased. The cellular immune function of patients with high grade cervical lesions decreased in varying degrees, and the most significant reduction of cellular immune function in cervical cancer patients was.3. serum HPV16 L1-IgG antibody test positive It can not only represent the existing HPV infection, but also indicate that the positive rate of.HPV 16 L1-IgG antibody in the previous HPV infection is decreasing with the increase of cervical lesions, but there is no significant difference between the serum antibody level and the results of the test may be related to the clearance of HPV and the reversal of cervical lesions.

【学位授予单位】：新疆大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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