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目的:探讨粤北地区门诊就诊人群人乳头状瘤病毒(HPV)感染不同亚型的分布情况和年龄特征以及HPV不同亚型引起宫颈癌的风险情况。方法:采用PCR体外扩增和DNA反向点杂交相结合的DNA芯片技术对3 247例不同年龄妇女进行宫颈细胞液基细胞学检查和23种HPV亚型感染检测,对HPV检测为阳性及细胞学诊断≥ASCUS的妇女阴道镜下进行宫颈组织活检,根据细胞异型性的程度和范围进行病理学分析。结果:①HPV总感染率23.19%(753/3 247),液基细胞学诊断≥AS-CUS为4.87%(158/3247)。在不典型鳞状上皮细胞(ASCUS)、低度鳞状上皮内瘤变(LSIL)、高度鳞状上皮内瘤变(HSIL)、鳞状细胞癌(SCC)病例中HPV的检出率分别为49.57%、68.97%、80.00%、100.00%。②细胞学诊断阳性≥LSIL(1.26%,41/3 247)与组织学诊断阳性≥CINⅠ(1.82%,59/3247)比较差异无统计学意义(P>0.05),组织学诊断CINⅠ、CINⅡ、CINⅢ和SCC病变中HPV检出率以62.50%、84.62%、100%和100%依次递增。③3247例样本中HPV感染22种亚型被检出,感染率最高的型别是HPV43,其他常见型别依次为52、16、58、11、6、18、33、66、68和42型;高危型感染18.02%,低危型感染9.45%,交叉型感染4.71%;单重感染17.31%,双重感染4.22%,多重感染1.66%。④3 247例HPV感染高峰年龄在<25岁占4.16%,45～49岁年龄段下降到2.37%,各年龄段HPV感染检出率差异有统计学意义(P<0.01)。结论:韶关地区门诊高危人群HPV感染率23.19%,宫颈病变常见型别为HPV43、52、16、58、11、6、18、33、66、68和42型,HPV16致癌性最强;人群感染高峰在<25岁年龄段。HPV分型检测准确性高并能明确基因类型,联合液基细胞学和宫颈组织学检测能提高筛查宫颈病变细胞的阳性率。
Objective: To investigate the distribution and age characteristics of different subtypes of human papillomavirus (HPV) inpatients in northern Guangdong and the risk of cervical cancer caused by different subtypes of HPV. Methods: The cytology-based cytology and 23 HPV subtypes of 3 247 women of different ages were detected by DNA microarray combined with PCR in vitro amplification and DNA reverse dot blot hybridization. Women diagnosed ≥ASCUS colposcopic biopsy of the cervix, according to the extent and extent of cellular atypia of pathological analysis. Results: ① The total HPV infection rate was 23.19% (753/3 247), liquid-based cytology diagnosis was 4.87% (158/3247). The detection rates of HPV in atypical squamous cell carcinoma (ASCUS), low-grade squamous intraepithelial neoplasia (LSIL), high-grade squamous intraepithelial neoplasia (HSIL) and squamous cell carcinoma (SCC) 49.57%, 68.97%, 80.00%, 100.00%. (2) There was no significant difference between positive cytological diagnosis of LSIL (1.26%, 41/3 247) and positive histological diagnosis of CINⅠ (1.82%, 59/3247) The detection rate of HPV in CIN Ⅲ and SCC lesions was 62.50%, 84.62%, 100% and 100% respectively. 2247 cases of HPV infection in 22 subtypes were detected, the highest infection rate of the type is HPV43, followed by other common types were 52,16,58,11,6,18,33,66,68 and 42; High-risk infection was 18.02%, low-risk infection was 9.45%, cross-infection was 4.71%, single infection was 17.31%, double infection was 4.22% and multiple infection was 1.66%. ④3 The peak age of HPV infection in 247 cases was 4.16% at <25 years old and 2.37% in 45-49 years old. There was significant difference in HPV infection among all age groups (P <0.01). Conclusion: The prevalence of HPV infection in clinics in Shaoguan area is 23.19%. The common types of cervical lesions are HPV43, 52, 16, 58, 11, 6, 18, 33, 66, 68 and 42, HPV16 is the most carcinogenic. Peak at <25 years of age. HPV genotyping test with high accuracy and a clear genotype, combined with liquid-based cytology and cervical histology can improve the screening of cervical lesions positive rate.