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目的研究不同程度的子宫颈癌前病变者感染HPV的基因亚型,以探讨不同基因型HPV感染的致癌性。方法研究对象系356例宫颈HPV感染的患者。以第二代杂交捕获(HCⅡ)试验检测13种HPV-H,同时采用核酸分子快速杂交基因分型技术进行21种HPV-DNA亚型分析;所有研究对象均行宫颈薄层液基细胞学检测(LCT)及阴道镜下宫颈多点活检。根据细胞与病理学诊断有无宫颈病变及其病变程度分组。①宫颈癌与高度鳞状上皮内瘤变(HSIL)组:包括宫颈浸润癌9例、CINⅢ57例、CINⅡ53例;②低度鳞状上皮内瘤变(LSIL)组:包括CINⅠ112例、HPV感染52例;③正常或炎症组:宫颈细胞与组织学正常或炎症者73例。通过HPV-DNA亚型分布,分析HPV感染基因型与宫颈病变程度的关系。结果HPV-H与宫颈癌变密切相关,本组高度病变以上患者中HPV-H阳性率达98·4%;随着宫颈病变程度加重,HPV-H双重与多重感染有增加趋势,在正常与炎症组、LSIL组与HSIL组中两种以上HPV-H基因型感染者分别占13·7%、17·7%和36·6%,HSIL组明显高于其他两组,差异有显著性(P<0·01);本组HPV亚型感染频度由高到低依次为HPV-16(32·9%)、58(18·8%)、52(16·9%)、18(9·0%)、33(8·2%)、68(7·3%)、11(低危型,6·5%)、31(6·2%)、53(5·6%)、39(5·3%)、CP8304(5·1%)、66(3·9%)、6(2·5%)和51、56、45、35、59、43、44、82等少见型;HPV-16、58、33、52与18型在高度鳞状上皮内瘤样病变(HSIL)中感染率分别为56·4%、19·3%、16·0%、12·6%和8·4%,说明这些亚型致癌性更强;两种HPV-DNA检测技术所获结果,具有很高的一致性。结论本组宫颈病变患者感染HPV型别以16、58、52、18、33较为多见,HPV-16、58、33、52与18型致癌性较强;HPV-DNA分型检测在临床诊断与判断预后上具有重要意义。
Objective To study the genotypes of human papillomavirus (HPV) infected with premalignant lesions of cervical cancer in order to investigate the carcinogenicity of different genotypes of HPV infection. Methods A total of 356 patients with cervical HPV infection were enrolled in this study. Thirteen kinds of HPV-H were detected by the second-generation hybridization capture (HCⅡ) assay and 21 HPV-DNA subtypes were analyzed by rapid hybridization of nucleic acid molecules. All subjects were tested by liquid-based cervical cytology (LCT) and colposcopy multipoint biopsy. According to cell and pathological diagnosis of cervical lesions and the degree of disease grouping. ①The group of cervical cancer and highly squamous intraepithelial neoplasia (HSIL): including 9 cases of invasive cervical carcinoma, 57 cases of CINⅢ and 53 cases of CINⅡ; ②The group of low grade squamous intraepithelial neoplasia (LSIL): including CINⅠ12 cases, HPV infection 52 Cases; ③ normal or inflammatory group: cervical cells and histological normal or inflammatory in 73 cases. Through the distribution of HPV-DNA subtypes, the relationship between HPV genotypes and the degree of cervical lesions was analyzed. Results The HPV-H was closely related to cervical cancer. The positive rate of HPV-H in this group of patients with high grade disease was 98.4%. With the increase of cervical lesions, HPV-H double and multiple infection had an increasing tendency. In normal and inflammation In the LSIL group and the HSIL group, the infection rates of two or more HPV-H genotypes were 13.7%, 17.7% and 36.6%, respectively, which were significantly higher in the HSIL group than in the other two groups (P <0.01). The frequency of HPV subtype in this group was HPV-16 (32.9%), 58 (18.8%), 52 (16.9%), 18 (Low risk type, 6.5%), 31 (6.2%), 53 (5.6%), 39 (8.2%), 68 5.3%), 66% (3.9%), 6 (2.5%) and 51, 56, 45, 35, 59, 43, 44, The infection rates of -16, 58, 33, 52 and 18 in HSIL were 56.4%, 19.3%, 16.0%, 12.6% and 8 · 4%, indicating that these subtypes are more carcinogenic; the results obtained by the two HPV-DNA test techniques are highly consistent. CONCLUSIONS: HPV types in patients with cervical lesions are more common at 16, 58, 52, 18 and 33, and HPV-16, 58, 33, 52 and 18 are more carcinogenic. HPV- And to determine the prognosis of great significance.