摘要
目的:探讨采用杂交捕获2代试验(HC2)检测妇女生殖道感染高危型人乳头瘤病毒(HR-HPVDNA)的载量与各级别宫颈病变的关系。方法:回顾性分析2009年2～12月在石河子大学医学院第一附属医院妇科就诊妇女963例,均实施医生取材收集子宫颈脱落细胞,进行细胞学检查及HC2检测HR-HPVDNA,细胞学检查包括薄层液基细胞学(TCT)或传统宫颈刮片检查。HR-HPVDNA载量由样本的相对光单位与标准阳性对照之比(RLU/PC)来衡量,载量<1.00为阴性,载量≥1.00为阳性,将阳性分为3组:低度载量组(1.00,10.00),中度载量组(10.00,100.00)和高度载量组(≥100.00)。有244例行宫颈活检,依据病理结果分为慢性宫颈炎105例、轻度宫颈上皮内瘤变(CIN1)35例、中度宫颈上皮内瘤变(CIN2)29例、重度宫颈上皮内瘤变(CIN3)40例和子官颈癌35例。对实施宫颈病理检查的244例,采用非条件多项式Logistic回归分析病毒载量、年龄与子宫颈病变级别的关系。结果:HR-HPV感染率为74.6%(182/244),其中88.6%(31/35)的宫颈癌、97.5%(39/40)的CIN3、96.6%(28/29)的CIN2、74.3%(26/35)的CIN1和55.2%(58/105)的慢性宫颈炎病毒载量中位数分别是宫颈癌:197.13、CIN3:77.78、CIN2:47.63、CIN1:15.11、慢性宫颈炎:1.13。各级病变中病毒载量的分布差异有统计学意义(χ2=42.82,P<0.05);病毒载量越高,CIN程度越高(χ2=66.49,P<0.05),低、中和高度载量组与阴性组相比,发生CIN2～3的危险性增加[OR(95%CI):18.11(1.60～205.28)、36.49(2.72～490.09)和39.35(3.91～396.16)],且有明显的剂量反应关系;高病毒载量的35岁～组、45～岁组患CIN2+风险较大,[OR(95%CI):4.5(1.52～13.30)、7.75(2.74～21.96)]。结论:采用HC2检测子宫颈HR-HPVDNA结果显示,病毒载量与子宫颈病变程度高度相关,高病毒载量是宫颈癌、CIN3和CIN2的主要危险因素,其对45岁以上女性的致病风险更大。综合HC2检测HR-HPVDNA定性及定量结果以及患者年龄指导临床筛查更具意义。
Objective：To determine the association between viral load of high risk human papillomavirus （HR-HPV） which detected by Hybrid Capture2 and different grades of cervical neoplasia.Methods：Totally 963 patients who had received a dual screening with thinprep cytologic test （TCT） or traditional pap smear and HR-HPV in department of gynecology,the first affiliated hospital school of Shihezi medicine university.HR-HPV was detected by the Hybrid Capture 2 （hc2） system,and viral load was measured by the ratio of relative light units to standard positive control （RLU/PC）.RLU/PC was categorized for analysis into four groups：negative （0,1.00）,low viral load （1.0,10.00）,moderate viral load （10.00,100.00）,and high viral load≥100.00.244 patients received biopsy,cervical lesions were diagnosed by biopsies as cervicitis 105 cases,cervical intraepithelial neoplasia （CIN） l 35 cases,CIN2 29 cases,CIN3 40 cases and cervical cancer 35 cases.Association between HR-HPV viral load,age and different grades of cervical neoplasia was evaluated by unconditional multinomial logistic regression.Results：The HR-HPV infection rate of the population was 74.6% （182 /244）,88.6% （31/35） of cervical cancer,97.5% （39/40） of CIN3,96.6% （28/29） CIN2,74.3% （26/35） of CIN1 and 55.2% （58/105） of chronic cervicitis women,were positive for HR-HPV DNA.The median RLUs for the HR-HPV viral load with cervical cancer,CIN3,CIN2,CIN1 and chronic cervicitis were 197.13,77.78,47.63,15.11 and 1.13 respectively.There were significant differences among the distributions of viral loads in each lesion （χ2=42.82,P 0.05） ;The severity of lesion increased with the viral loads （χ2=66.49,P 0.05）.Compared with the risks of different grades of cervical neoplasia in HR-HPV negative population,the risks of CIN2 and CIN3 in low,moderate and high viral loads were increased gradually [OR （95% CI）：18.11 （1.60-205.28）,36.49 （2.72-490.09） and 39.35 （3.91-396.16） ]and there were obvious dose-response relationships.The risk of CIN 2 and CIN3 were high among the women aged 35-and 45-with high viral load [OR （95% CI）：4.5 （1.52-13.30）,7.75 （2.74-21.96） ].Conclusion：There is strong correlation between the HR-HPV viral load and the severity of different grades of cervical neoplasia.High viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN2 and CIN3,and there is a higher risk in the women aged 45 or older than the younger ones.Considering both the age and viral load could help the doctors to manage the screening women more effectively.
出处
《中国妇幼保健》
CAS
北大核心
2010年第28期4138-4142,共5页
Maternal and Child Health Care of China
基金
石河子大学医学院第一附属医院院级科研项目(YL2008-Y002)
关键词
人乳头瘤病毒
宫颈病变
宫颈上皮内瘤变
第二代杂交捕获试验
Human papillomavirus
Cervical neoplasms
Cervical intraepithelial neoplasia （CIN）
Hybrid Capture2
