摘要
目的调查黑龙江省大庆市某区政府女职工宫颈人乳头状瘤病毒（HPV）感染状况并分析其危险因素。方法于2010年6—10月，选取黑龙江省大庆市某区参加宫颈癌筛查项目的政府女职工作为调查对象，共2015名。通过问卷调查收集调查对象人口学信息和相关危险因素信息，进行细胞学诊断，并对宫颈细胞HPVDNA分型检测。对可疑宫颈上皮内瘤样病变或宫颈癌患者行阴道镜取活检，并进行组织病理学诊断。采用Segi’s世界标准人VI对HPV感染率进行标化，比较不同类型HPV感染率的差异；应用非条件logistic回归比较宫颈病变者和宫颈正常者HPV感染状况，同时探讨目标人群HPV感染可能的危险因素。结果2015名调查对象中，最终有1759名接受妇科检查，HPV阳性者152例，感染率为8．64％（95％CI：7．37％～10．05％），标化感染率为8．47％（95％CI：7．93％～9．03％）。调查对象中宫颈病变者（宫颈上皮内瘤样病变l度或细胞学低度及以上病变）57例、宫颈正常者1702名，宫颈病变率为3．24％。宫颈病变和宫颈正常者中，HPV感染率分别为73．68％（42／57）和6．46％（110／1702），差异有统计学意义（x^2=307．23，P〈0．05）。HPV阳性者发生宫颈病变的风险是阴性者的40．52倍（95％CI：21．79—75．36）。宫颈病变者中感染率前3位的HPV亚型分别为HPVl6[28．07％（16／57）]、HPV52[14．04％（8／57）]和HPV58[12．28％（7／57）]；而宫颈正常者中感染率前3位的HPV亚型分别为HPV52[1．23％（21／1702）]、HPVl6[1．00％（17／1702）]和HPV58[0．71％（12／1702）]。在宫颈病变者和宫颈正常者中，HPVCladeA9感染率最高，分别为59．65％（34／57）和3．23％（55／1702）。危险因素分析显示：按年龄校正后，吸烟、初潮年龄晚（≥15岁）、初婚年龄早（≤20岁）、多性伴侣（〉12个）、丈夫有婚外性行为、多产次（≥2次）分别会增加2．71倍（95％CI：1．00～7．33）、1．44倍（95％CI：1．00～2．05）、3．09倍（95％CI：1．30～7．35）、2．69倍（95％CI：1．46～4．95）、2．77倍（95％CI：1．25～6．12）和1．77倍（95％CI：1．03～3．03）的HPV感染风险。结论研究人群HPV感染率在宫颈病变组中明显高于宫颈正常组，HPVl6、52、58是最常见感染亚型。吸烟、初潮年龄晚、初婚年龄早、多性伴侣、丈夫婚外性行为、多产次是该人群HPV感染的危险因素。
Objective The aim of the study was to investigate the positivity of human papillomavirus （HPV） and the possible related risk factors for HPV infection in certain district government in Daqing city, Heilon^iang province. Methods A total of 2015 female staffs who participated cervical cancer screening were selected as subjects, in certain district government in Daqing city, Heilongjiang province,from June to October, 2010. First of all, a standardized questionnaire was used for collection of subject＇s demographic information and possible risk factors. Afterwards, cervical cytological and HPV DNA testing were applied to all participants. Subjects with suspected cervical intraepithelial neoplasia （CIN） or cervical cancer were recalled for taking biopsy under colposcopy for further histopathological diagnosis. Standardized HPV positivity by Segi＇s world population and compared the difference of HPV positivity of different types. The positivity of HPV between women with and without cervical abnormalities were compared by unconditional logistic regression. And the possible risk factors for HPV infection were also investigated. Results A total of 1759 out of 2015 subjects had gynecological examination, among which 152 subjects were HPV positive. The positivity of HPV was 8.64% （95% CI： 7.37% - 10. 05% ） ,and it was 8.47% （ 95% CI： 7. 93% - 9. 03%） after age standardization. Finally, 57 （ 3.24% ） and 1702 （96. 76% ） subjects had abnormal （≥ CIN1 or low-grade squamous intraepithelial lesion （LSIL）） and normal cervix, respectively. The HPV positivity between women with and without cervical abnormalities were 73.68% （42/57） and 6. 46% （ 110/1702 ）, respectively. There was a significant difference （ X^2 = 307.23, P 〈 0.05） in HPV positivity between women with and without cervical abnormalities. The risk of cervical abnormalities for women with HPV positivity was 40. 52 times （95% CI： 21.79 -75.36） higher than that for women with HPV negativity. Among women with cervical abnormalities, the most three common HPV types,in descending order,were HPV16 （ 28.07% （ 16/57 ） ）, HPV52 （ 14. 04% （ 8/57 ） ） and HPV58 （ 12. 28% （7/57））. While among women with normal cervix, the most three common HPV types were HPV52 （1.23% （21/1702）） ,HPV16 （ 1.00% （17/1702） ） and HPV58 （0. 71% （12/1702） ）. The positivity of HPV clade A9 among women with and without cervical abnormalities were 59. 65% （34/57） and 3.23% （55/1702）, which were higher than that of other clades. Analysis for risk factors of HPV infection showed that smoking （ OR = 2. 71,95 % CI： 1.00 - 7.33 ）, late age （ ≥ 15 years old） of menarche （ OR = 1.44,95 % CI： 1. 00 - 2. 05 ）, early age （ ≤ 20 years old） of marriage （ OR = 3.09,95 % CI： 1.30 - 7. 35 ）, multiple （≥ 2 ） sexual partners （ OR = 2. 69,95 % CI： 1.46 - 4. 95 ）, husband＇s extramarital sexual behaviors （ OR = 2. 77,95 % CI： 1.25 - 6. 12） and multiple （ ≥2 times） parity （ OR = 1.77,95 % CI： 1.03 - 3.03 ） would increase the risk of HPV positivity. Conclusion HPV positivity among women with cervical abnormalities was significantly higher than that among women with normal cervix. HPV16,52,58 were the major genotypes among the study population. Smoking, late age of menarche, early age of marriage, multiple sexual partners, husband extramarital sexual behaviors and multiple parity increase the risk of HPV infection.
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2013年第2期118-123,共6页
Chinese Journal of Preventive Medicine
基金
基金项目：国家自然科学基金（30901236,81172757）
北京市自然科学基金（7123225）
中国医学科学院肿瘤医院院所科研课题（2010YF45）
