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目的:分析宫颈癌及高危型癌前病变组中高危型人乳头瘤病毒(HPV)载量、HPV多重感染情况,探讨HPV载量及多重感染与宫颈病变关系。方法:采用液基薄层细胞涂片(TCT)、高危型HPV-DNA(HC-Ⅱ)检测,进行宫颈病变筛查。筛查异常进行组织病理学检查,确诊为宫颈癌(ICC)及高危型癌前病变(CINⅡ、CINⅢ、原位癌),术前未进行放疗及化疗为研究对象。运用SPF10-PCR技术对HPV阳性标本进行HPV分型检测。结果:筛查异常510例,活检病理确诊:宫颈正常(≤CINⅠ)398例,高危型癌前病变(≥CINⅡ)64例,宫颈癌48例。HC-Ⅱ检测筛查,HPV阳性465例(91.18%)。其中,≤CINⅠ356例(89.45%),≥CINⅡ63例(98.44%),ICC46例(95.83%),差别有显著性。HPV载量分5组,1～9、10～99、100～999、≥1000。各组比较,≤CINⅠ、≥CINⅡ、ICC差异均有显著性。组织学检测HPV感染,≥CINⅡ组62例(96.37%),ICC组46例(95.83%)。其中,两种或两种以上型别混合感染分别为30.43%、38.71%,较正常宫颈明显增高,且均有高危型别参与感染。结论:HC-Ⅱ检测是筛查宫颈病变,预防宫颈癌发生的有效手段,但HPV载量在不同程度宫颈病变中表达不确定。HPV多型别混合感染对宫颈病变发展程度有潜在影响,应引起临床医生重视。
Objective: To analyze the high-risk human papillomavirus (HPV) and multiple HPV infections in cervical cancer and high-risk precancerous lesions and to explore the relationship between HPV load, multiple infections and cervical lesions. Methods: Cervical lesions were screened by liquid-based thin-layer cytology (TCT) and high-risk HPV-DNA (HC-Ⅱ). Histopathological examination of abnormal screening, diagnosed as cervical cancer (ICC) and high-risk precancerous lesions (CIN Ⅱ, CIN Ⅲ, carcinoma in situ), preoperative radiotherapy and chemotherapy for the study. The HPV typing was detected by using SPF10-PCR in HPV positive specimens. Results: There were 510 cases of abnormal screening and 398 cases of normal cervical lesions (≤CINⅠ), 64 cases of high-risk precancerous lesions (≥CINⅡ) and 48 cases of cervical cancer. HC-Ⅱ test screening, HPV-positive 465 cases (91.18%). Among them, ≤366 cases of CINⅠ (89.45%), ≥63 cases of CINⅡ (98.44%), 46 cases of ICC (95.83%), the difference was significant. HPV load in 5 groups, 1 ~ 9,10 ~ 99,100 ~ 999, ≥1000. All groups, ≤CIN Ⅰ, ≥CIN Ⅱ, ICC differences were significant. Histological examination of HPV infection, ≥ CIN Ⅱ group of 62 patients (96.37%), ICC group of 46 patients (95.83%). Among them, two or more types of mixed infections were 30.43%, 38.71%, significantly higher than normal cervix, and high-risk type are involved in the infection. Conclusion: HC-Ⅱ test is an effective method to detect cervical lesions and prevent cervical cancer. However, the expression of HPV load in cervical lesions with different degrees of expression is uncertain. HPV multi-type mixed infection has a potential impact on the development of cervical lesions should be caused by clinicians attention.