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目的通过采用高危型人乳头瘤病毒(HPV)作为宫颈癌初筛方法,了解北京地区35~64岁农村妇女高危型HPV感染现状及高危型HPV作为初筛的效果。方法回顾性分析2014年10月至2015年3月北京市5个农村两癌筛查区县,年龄35~64岁农村户籍人口20 076名,以高危型HPV作为初筛进行宫颈癌筛查试点的结果,使用SPSS17.0软件对数据进行描述性分析。结果北京地区35~64岁20 076名农村妇女中,高危型HPV总感染率为7.6%(1 535/20 076),其中单一感染排前五位的高危亚型分别是HPV16型219例,占14.3%,HPV52型146例,占9.5%,HPV58型101例,占6.6%,HPV18型84例,占5.5%,HPV51型66例,占4.3%。高危型HPV混合感染率为7.6%(116/1 535),最多同时感染四种高危亚型。35~40岁、41~45岁、46~50岁、51~55岁、56~60岁、61~64岁高危型HPV检测率分别为50.0%(192/384)、38.9%(330/848)、33.0%(388/1 177)、6.3%(298/4 757)、3.4%(251/7 438)和1.4%(76/5 472)。除高危型HPV16/18感染者外,其他型感染者细胞学阳性检出率为13.0%(154/1 188);转诊阴道镜检查率为2.3%(461/20 076);阴道镜下活检组织病理学检出CIN2 27例,CIN3 39例,宫颈微小浸润癌2例,浸润癌1例,癌及癌前病变检出率为343.7/10万,宫颈癌检出率为14.9/10万,早诊率为98.6%(68/69);在宫颈高级别病变及癌中,HPV16/18亚型感染占71.0%(49/69)。结论 HPV16、52和58型是北京地区35~64岁农村妇女单一感染的主要基因亚型,高危型HPV检出率最高为35~40岁,HPV16/18感染是导致宫颈高级别病变及癌的主要亚型。用高危型HPV作为初筛方法,初筛阳性病历检出率提高,而且用高危型HPV分流后,细胞学的工作量明显减少。
Objective To understand the status of high-risk HPV infection in rural women aged 35-64 years in Beijing and the effect of high-risk HPV as a primary screening by using high-risk human papillomavirus (HPV) as a screening method for cervical cancer. Methods From October 2014 to March 2015, 20 076 rural residents aged 35-64 years with two rural cancer screening districts in Beijing were retrospectively analyzed. The screening of high-risk HPV as the primary screening test for cervical cancer The results, the use of SPSS17.0 software for descriptive analysis of the data. Results The prevalence of high-risk HPV in 20 076 rural women aged 35-64 years in Beijing was 7.6% (1535/20 076). Among them, the top five high-risk subtypes of single infection were HPV16 (219 cases) 14 cases were HPV52 type, accounting for 9.5%; 101 cases were HPV58 type, accounting for 6.6%; 84 cases were HPV18 type, accounting for 5.5%; 66 cases were HPV51 type, accounting for 4.3%. High-risk HPV infection was 7.6% (116/1 535) with up to four high-risk subtypes. The detection rates of high-risk HPV in 35- 40 years old, 41-45 years old, 46-50 years old, 51-55 years old, 56-60 years old, 61-64 years old were 50.0% (192/384), 38.9% (330/848 ), 33.0% (388/1 177), 6.3% (298/4 757), 3.4% (251/7 438) and 1.4% (76/5 472). In addition to the high-risk HPV16 / 18 infection, the positive rate of cytology in other types of infection was 13.0% (154/1 188); referral colposcopy was 2.3% (461/20 076); colposcopy biopsy Histopathology detected 27 cases of CIN2, 39 cases of CIN3, 2 cases of micro-invasive cervical cancer and 1 case of invasive carcinoma. The detection rate of cancer and precancerous lesions was 343.7 / 100000, the detection rate of cervical cancer was 14.9 / 100000, The diagnosis rate was 98.6% (68/69). Among the high grade cervical lesions and cancers, HPV16 / 18 subtype infections accounted for 71.0% (49/69). Conclusion HPV16, 52 and 58 are the major genotypes of single infection in rural women aged 35-64 years in Beijing. The highest detection rate of high-risk HPV is 35-40 years old. HPV16 / 18 infection is the cause of high-grade cervical lesions and cancer The main subtype. With high-risk HPV as a screening method, the positive screening positive screening rate increased, and with high-risk HPV shunt, the cytology workload significantly reduced.