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目的:分析宫颈上皮内瘤变(CIN)及宫颈癌(CC)中人乳头状瘤病毒(HPV)亚型,探讨HPV感染与宫颈病变的相关性。方法:慢性宫颈炎或液基细胞学异常的妇女检测21种HPV基因亚型和阴道镜下宫颈定位活检,分析2 481例CC和CIN患者的HPV感染情况。结果:在2 481例CIN和CC患者中,HPV感染率85.0%,HPV感染与宫颈组织学结果有较强的相关性(P<0.001,Pearson列联系数=0.648)。CC及CINⅢ、CINⅡ患者以HPV16、18感染最多见,其次见HPV58、33、31、52、45、59、68等亚型。304例患者宫颈感染HPV16、18、58、52、33等亚型后,发生高度鳞状上皮内病变(HSIL)、不明意义的非典型鳞状细胞(ASCUS)及低度鳞状上皮内病变(LSIL)的频率增加,TCT分型与HPV分型有较弱的相关关系(P=0.002,Pearson列联系数=0.322)。细胞学结果提示HSIL、ASCUS,宫颈组织学诊断以CC、CINIII和CINII为多,TCT分型与组织学分型也有较弱的相关性(P=0.026,Pearson列联系数=0.172)。结论:HPV16、18、58、33、52、31、45等高危型HPV感染是宫颈癌(CC)及癌前病变(CIN)最常见的风险因素。高危型HPV单独或混合感染宫颈后,细胞学检测HSIL、ASCUS及LSIL的发生率增加,细胞学结果与组织学分型的相关性促进了CC和CIN的及时诊治。
Objective: To analyze the subtype of human papillomavirus (HPV) in cervical intraepithelial neoplasia (CIN) and cervical cancer (CC) and to explore the correlation between HPV infection and cervical lesions. METHODS: Twenty-one HPV subtypes and colposcopic cervical biopsies were examined in women with chronic cervicitis or fluid-based cytology and analyzed for HPV infection in 2 481 CC and CIN patients. RESULTS: Among 2 481 patients with CIN and CC, the HPV infection rate was 85.0%. There was a strong correlation between HPV infection and cervical histology (P <0.001, Pearson’s correlation coefficient = 0.648). CC and CIN Ⅲ, CIN Ⅱ patients with HPV16,18 infection the most common, followed by HPV58,33,31,52,45,59,68 and other subtypes. 304 cases of cervical infection of HPV16,18,58,52,33 and other subtypes, the occurrence of high grade squamous intraepithelial lesions (HSIL), atypical squamous cell carcinoma (ASCUS) and low grade squamous intraepithelial lesion LSIL). TCT typing and HPV typing had a weaker correlation (P = 0.002, Pearson’s co-incidence = 0.322). The results of cytology suggested that the diagnosis of HSIL, ASCUS and cervical tissue were much more than that of CC, CINIII and CINII. TCT classification and histological classification also had a weak correlation (P = 0.026, Pearson’s coherence coefficient = 0.172). Conclusion: HPV16,18,58,33,52,31,45 and other high-risk HPV infections are the most common risk factors of cervical cancer (CC) and precancerous lesions (CIN). High-risk HPV alone or mixed infection of the cervix, cytology detection of HSIL, ASCUS and LSIL increased the incidence of cytological findings and histological classification of CC and CIN to promote timely diagnosis and treatment.