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目的:探讨采用杂交捕获2代试验(HC2)检测妇女生殖道感染高危型人乳头瘤病毒(HR-HPVDNA)的载量与各级别宫颈病变的关系。方法:回顾性分析2009年2～12月在石河子大学医学院第一附属医院妇科就诊妇女963例,均实施医生取材收集子宫颈脱落细胞,进行细胞学检查及HC2检测HR-HPVDNA,细胞学检查包括薄层液基细胞学(TCT)或传统宫颈刮片检查。HR-HPVDNA载量由样本的相对光单位与标准阳性对照之比(RLU/PC)来衡量,载量<1.00为阴性,载量≥1.00为阳性,将阳性分为3组:低度载量组(1.00,10.00),中度载量组(10.00,100.00)和高度载量组(≥100.00)。有244例行宫颈活检,依据病理结果分为慢性宫颈炎105例、轻度宫颈上皮内瘤变(CIN1)35例、中度宫颈上皮内瘤变(CIN2)29例、重度宫颈上皮内瘤变(CIN3)40例和子官颈癌35例。对实施宫颈病理检查的244例,采用非条件多项式Logistic回归分析病毒载量、年龄与子宫颈病变级别的关系。结果:HR-HPV感染率为74.6%(182/244),其中88.6%(31/35)的宫颈癌、97.5%(39/40)的CIN3、96.6%(28/29)的CIN2、74.3%(26/35)的CIN1和55.2%(58/105)的慢性宫颈炎病毒载量中位数分别是宫颈癌:197.13、CIN3:77.78、CIN2:47.63、CIN1:15.11、慢性宫颈炎:1.13。各级病变中病毒载量的分布差异有统计学意义(χ2=42.82,P<0.05);病毒载量越高,CIN程度越高(χ2=66.49,P<0.05),低、中和高度载量组与阴性组相比,发生CIN2～3的危险性增加[OR(95%CI):18.11(1.60～205.28)、36.49(2.72～490.09)和39.35(3.91～396.16)],且有明显的剂量反应关系;高病毒载量的35岁～组、45～岁组患CIN2+风险较大,[OR(95%CI):4.5(1.52～13.30)、7.75(2.74～21.96)]。结论:采用HC2检测子宫颈HR-HPVDNA结果显示,病毒载量与子宫颈病变程度高度相关,高病毒载量是宫颈癌、CIN3和CIN2的主要危险因素,其对45岁以上女性的致病风险更大。综合HC2检测HR-HPVDNA定性及定量结果以及患者年龄指导临床筛查更具意义。
Objective: To investigate the relationship between the load of high-risk human papillomavirus (HR-HPVDNA) and cervical lesions at various levels in women with genital tract infection by using the hybridization capture 2nd generation test (HC2). Methods: A retrospective analysis of 963 women with gynecological visit in the First Affiliated Hospital of Shihezi University from February to December in 2009 were performed by a doctor to collect cervical exfoliated cells, cytology and HC2 detection of HR-HPVDNA, cytology Including thin-layer liquid-based cytology (TCT) or conventional cervical smear. The HR-HPVDNA load was measured by the ratio of the relative light units to the standard positive control (RLU / PC) of the sample. The loading <1.00 was negative and the loading ≥1.00 was positive. The positives were divided into 3 groups: low load Group (1.00,10.00), medium load group (10.00,100.00) and high load group (≥100.00). There were 244 cases of cervical biopsy, according to the pathological findings were divided into chronic cervicitis in 105 cases, mild cervical intraepithelial neoplasia (CIN1) in 35 cases, moderate cervical intraepithelial neoplasia (CIN2) in 29 cases, severe cervical intraepithelial neoplasia (CIN3) 40 cases and cervical cancer in 35 cases. 244 cases of cervical pathological examination were performed using non-conditional polynomial Logistic regression analysis of the relationship between viral load, age and the level of cervical lesions. Results: The HR-HPV infection rate was 74.6% (182/244), 88.6% (31/35) of cervical cancer, 97.5% (39/40) of CIN3, 96.6% (28/29) (26/35) CIN1 and 55.2% (58/105) of the chronic cervicitis viral load median cervical cancer were: 197.13, CIN3: 77.78, CIN2: 47.63, CIN1: 15.11, chronic cervicitis: 1.13. There were significant differences in the distribution of viral load between the various stages of disease (χ2 = 42.82, P <0.05). The higher the viral load, the higher the CIN level (χ2 = 66.49, P <0.05) Compared with the negative group, the risk of CIN2 ~ 3 was increased in the quantitative group (OR (95% CI): 18.11 (1.60-205.28), 36.49 (2.72-490.09) and 39.35 (3.91-396.16) (95% CI) 4.5 (1.52-13.30) and 7.75 (2.74-21.96), respectively. The incidence of CIN2 + was significantly higher in the 35-year-old group with high viral load and in the 45-year-old group. Conclusion: The detection of cervical HR-HPVDNA using HC2 results showed that the viral load was highly correlated with the severity of cervical lesions. High viral load was the major risk factor for cervical cancer, CIN3 and CIN2. The risk of cervical cancer was higher for women over 45 years old Bigger Comprehensive HC2 detection of HR-HPVDNA qualitative and quantitative results as well as the patient’s age-guided clinical screening more meaningful.