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目的探讨山东省门诊女性就诊者人乳头状瘤病毒(human papillomavirus,HPV)感染及其亚型分布状况。方法收集2014年3月至2015年6月期间,山东省171家医院和社区卫生服务站妇科门诊4161例女性门诊就诊者宫颈拭子标本,送济南金域医学检验中心用导流杂交与基因芯片结合技术进行21种HPV基因型检测后,分析6个年龄组(≤20岁组101例、21~30岁组953例、31~40岁组1368例、41~50岁组1262例、51~60岁组330例、>61岁组56例)的阳性率和亚型分布。结果 4161例女性中,检出HPV阳性1325例,总阳性率31.8%,其中:高危型HPV(high-risk HPV,hr HPV)和低危型HPV(low-risk HPV,lr HPV)阳性检出率分别为27.3%和10.4%。hr HPV(46.5%)和lr HPV(45.5%)阳性率均以≤20岁年龄组阳性率最高,后随年龄增加而逐渐下降,而hr HPV阳性率在51~60岁组略有升高(26.1%)。此外,随着年龄的增加,各年龄组单一性感染构成比(依次为37.1%、55.9%、67.2%、67.4%、72.3%、73.4%)和单一性hr HPV感染构成比(依次为25.8%、57.2%、72.9%、76.8%、78.7%、73.3%)所占比例逐渐增加,而各年龄组多重感染构成比(依次为63.9%、44.1%、32.8%、32.6%、27.7%、26.7%)、单一性lr HPV感染构成比(依次为24.2%、16.9%、13.0%、12.2%、8.5%、20.0%)和高低危HPV混合感染构成比(依次为50.0%、25.9%、14.1%、11.0%、12.8%、6.7%)所占比例逐渐减少。21种HPV亚型均有检出(范围为0.1%~18.3%),hr HPV前5位的分别为HPV16(13.6%)、HPV52(11.1%)、HPV58(7.7%)、HPV53(6.9%)和HPV51(4.7%);lr HPV前3位分别为HPV6(6.8%)、HPV11(5.5%)和HPV81(5.4%)。多重感染中HPV16所占比率明显低于单重感染(10.7%比18.3%),而HPV53(8.1%比4.9%)和HPV33(4.0%比2.3%)则相反。在多重感染病例中,随着感染不同亚型HPV数量的增多,高低危混合感染例数所占比例明显增加(287例二重感染中检出高低危HPV亚型混合感染病例占35.9%、125例三重感染中占61.6%、80例四重及以上感染中占78.7%)。结论山东省门诊女性HPV感染率和不同亚型分布受年龄、感染重数和感染模式的影响。山东省门诊女性的这些HPV感染特征,可为宫颈癌筛查和HPV疫苗接种及推广提供科学依据。
Objective To investigate the prevalence and distribution of human papillomavirus (HPV) in outpatients in Shandong Province. Methods From March 2014 to June 2015, 4161 women outpatient clinics in 171 outpatient clinics and community health service stations in Shandong Province were included in the study. Cervical swab specimens were collected and sent to Ji’nan Jinyu Medical Laboratory Center for detection by flow-through hybridization and gene chip After 21 kinds of HPV genotypes were detected with combination of techniques, we analyzed 6 age groups (101 cases of ≤20 years old, 953 cases of 21 ~ 30 years old, 1368 cases of 31 ~ 40 years old, 1262 cases of 41 ~ 50 years old, 60 cases of age group 330 cases,> 61 years old group of 56 cases) the positive rate and subtype distribution. Results Of 4161 women, 1325 were positive for HPV, the total positive rate was 31.8%. Among them, the positive rate of high-risk HPV (hr HPV) and low-risk HPV (lr HPV) Rates were 27.3% and 10.4% respectively. The positive rates of HPV (46.5%) and lr HPV (45.5%) were the highest in ≤20 years of age group, and then gradually decreased with age, while the positive rate of hr HPV was slightly elevated in 51-60 years group 26.1%). In addition, with the increase of age, the proportions of single infection (37.1%, 55.9%, 67.2%, 67.4%, 72.3%, 73.4% , 57.2%, 72.9%, 76.8%, 78.7% and 73.3%, respectively, while the proportions of multiple infections in all age groups were 63.9%, 44.1%, 32.8%, 32.6%, 27.7% and 26.7% ), The constituent ratio of lh HPV infection (followed by 24.2%, 16.9%, 13.0%, 12.2%, 8.5% and 20.0%, respectively) and the mixed infection ratio of high and low risk HPV (50.0%, 25.9%, 14.1% 11.0%, 12.8%, 6.7%) gradually decreased. Twenty-one HPV subtypes were detected (range 0.1% -18.3%). The first five HPVs were HPV16 (13.6%), HPV52 (11.1%), HPV58 (7.7%) and HPV53 And HPV51 (4.7%). The first three HPVs were HPV6 (6.8%), HPV11 (5.5%) and HPV81 (5.4%) respectively. HPV16 in multiple infections was significantly lower than in single infections (10.7% versus 18.3%), whereas HPV53 (8.1% vs. 4.9%) and HPV33 (4.0% vs. 2.3%) were the opposite. In the case of multiple infections, with the increase in the number of different subtypes of HPV infection, the proportion of high and low risk mixed infections increased significantly (287 cases of double infection detected high and low risk HPV subtype mixed infections accounted for 35.9%, 125 Cases accounted for 61.6% of triple infection, 80 cases of quadruple infection or more accounted for 78.7%). Conclusion The prevalence of HPV infection and the distribution of different subtypes in outpatients in Shandong Province are affected by age, infection weight and infection pattern. These HPV infection characteristics of outpatients in Shandong Province can provide scientific evidence for cervical cancer screening and HPV vaccination and promotion.