李丽,刘佳麒,魏海波,李芳,张会辰,王建
LI Li,LIU Jiaqi,WEI Haibo,LI Fang,ZHANG Huichen,WANG Jian

• 1:保定市妇幼保健院病理科
• 2:保定市妇幼保健院遗传室
• 3:保定市第二医院病理科
• 4:保定市妇幼保健院妇产科

摘要(Abstract)：

目的 探讨保定地区育龄期妇女人群中人乳头瘤病毒（HPV）感染状况和危险因素。方法 选取接受HPV检测的育龄期妇女2 938例，收集临床资料（年龄、初次性生活年龄、生育史、初次妊娠年龄、流产次数、性伴侣数、性生活频率、是否采用避孕套避孕、性伴侣是否包皮过长等）；采用宫颈刷采集宫颈脱落细胞标本，膜杂交法检测HPV感染及亚型[高危型HPV(HR-HPV）和低危型HPV(LR-HPV）亚型]；取其中同意行液基薄层细胞学（TCT）检测的育龄期妇女宫颈脱落细胞标本1 939例，采用贝塞斯达诊断系统（TBS）分为未见上皮内病变或恶性病变（NILM）、宫颈炎症（Cervitis）、非典型鳞状上皮细胞增生（ASC）、低级别鳞状上皮内病变（LSIL）及高级别鳞状上皮内病变（HSIL）；采用二元logistic回归分析育龄期妇女HPV感染的危险因素。结果 2 938例育龄期妇女中HPV阳性817例（27.81%），其中单一感染659例（80.66%）、双重及以上感染158例（19.34%);31～40岁组育龄期妇女HPV阳性率高于20～30岁组和41～50岁组（P<0.01);HPV分型检测结果显示，检出HR-HPV 827例次、16种亚型，其中HPV-52、HPV-16、HPV-58检出率较高；检出LR-HPV 205例次、6种亚型，其中HPV-81、HPV-42、HPV-43检出率较高；TCT检测及TBS分级结果显示，1 939例标本TCT检测NILM、Cervitis、ASC、LSIL及HSIL分别为1 728、40、128、24及19例，HPV阳性率分别为15.80%(273/1 728）、27.50%(11/40）、63.28%(81/128）、87.50%(21/24）及94.74%(18/19），且HPV阳性率随宫颈细胞病变程度加重而升高（P<0.01）；二元logistic回归分析结果显示，初次性生活年龄<22岁、流产次数≥1次、性伴侣数≥3个、不采用避孕套避孕、性伴侣包皮过长均提高育龄期妇女HPV阳性率（P<0.05或P<0.01）。结论 保定地区育龄期妇女HPV感染以HPV-52、HPV-16、HPV-58亚型为主，31～40岁为高发年龄段，HPV感染率与宫颈细胞病变程度呈正相关，初次性生活年龄<22岁、流产次数≥1次、性伴侣数≥3个、不采用避孕套及性伴侣包皮过长是当地育龄期妇女HPV感染的危险因素。
Objective To investigate the human papillomavirus (HPV) infection status and risk factors of women of childbearing age in Baoding area.Methods A total of 2 938 women of childbearing age who underwent HPV testing were selected.Clinical data (age,the age at first sexual activity,birth history,the age at first pregnancy,the number of miscarriages,the number of sexual partners,frequency of sexual activity,whether condoms for contraception was used,whether the foreskin of sexual partners was too long,etc.) were collected.Cervical brush was applied to collect cervical exfoliated cells.Membrane hybridization was used to detect HPV infection and HPV subtypes(high-risk HPV as HR-HPV,low-risk HPV as LR-HPV).ThinPrep cytologic test (TCT) was used to examine 1 939 cervical exfoliated cell specimens from the women of childbearing age who agreed to be given TCT test.The Bethesda System (TBS) was applied to diagnose no visible intraepithelial lesions or malignant lesions (NILM),cervitis,atypical squamous cell hyperplasia (ASC),low-grade squamous intraepithelial lesion (LSIL),and high-grade SIL(HSIL).Binary logistic regression was performed to analyze the risk factors of HPV infection in women of childbearing age.Results Among2 938 women of childbearing age,817 were HPV~+(27.81%),of which 659 with single infection(80.66%) and 158 with double or more infections (19.34%).HPV typing test results showed that there were 827 HR-HPV and 16 subtypes of HR-HPV,among which HPV-52,HPV-16,and HPV-58with high detection rates.Detected LR-HPV had 205 women,including 6 subtypes,among which HPV-81,HPV-42 and HPV-43 with high detection rates.TCT test and TBS grading results showed that the numbers of NILM,Cervitis,ASC,LSIL,and HSIL were 1 728,40,128,24,and 19 cases among 1 939 cases,respectively.HPV~+ rates of NILM,Cervitis,ASC,LSIL,and HSIL were15.80%(273/1 728),27.50%(11/40),63.28%(81/128),87.50%(21/24),and 94.74%(18/19),respectively.HPV~+ rates were increased with the degree of cervical cytopathy (P<0.01).Binary logistic regression analysis showed that the age of first sexual activity<22 years old,the number of miscarriages≥1,the number of sexual partners≥3,contraception without condoms and long foreskin of sexual partners increased the HPV+ rates (P<0.05 or P<0.01).Conclusion HPV subtypes among women of childbearing age in Baoding area mainly include HPV-52,HPV-16,and HPV-58 subtypes.The group with age 31-40-year-old has the highest HPV~+rate.HPV infection rate is positively correlated with the degree of cervical cytopathy.The age of first sexual activity<22years of age,the number of abortions≥1,the number of sexual partners≥3,no condom for contraception,and long foreskin of sexual partners are the risk factors for HPV infection in women of childbearing age.

关键词(KeyWords)： 妇女;感染;宫颈炎;危险因素;育龄期;人乳头瘤病毒;宫颈癌
women;infection;cervicitis;risk factors;childbearing age;human papillomavirus (HPV);cervical cancer

Abstract:

Keywords:

基金项目(Foundation): 保定市科技计划项目（1941ZF067）

作者(Author): 李丽,刘佳麒,魏海波,李芳,张会辰,王建
LI Li,LIU Jiaqi,WEI Haibo,LI Fang,ZHANG Huichen,WANG Jian

DOI: 10.19367/j.cnki.2096-8388.2022.03.010

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