宫颈鳞状上皮内病变和宫颈癌患者HPV感染特征及病变级别的影响因素分析

Analysis of HPV Infection Characteristics and Influencing Factors for Lesion Grade in Patients with Cervical Squamous Intraepithelial Lesion and Cervical Cancer

  • 摘要: 目的 总结宫颈鳞状上皮内病变(squamous intraepithelial lesion,SIL)和宫颈癌(cervical cancer,CC)患者的人乳头瘤病毒(human papillomavirus,HPV)感染型别分布特征,并探究HPV疫苗接种、HPV感染类型及一般临床资料对不同级别宫颈病变的影响。方法 回顾性收集2020年1月-2023年12月于深圳市人民医院妇科阴道镜门诊就诊患者的临床资料。纳入具有HPV分型检测记录、经宫颈组织病理学诊断为SIL和CC者,并按照病理结果将其分为低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)组、高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)组和CC组。统计3组患者中高危型HPV亚型分布,并采用多因素Logistic回归分析高级别宫颈病变的影响因素。结果 共纳入4162例患者,包括4057例宫颈SIL患者(LSIL患者3317例、HSIL患者740例)和105例CC患者。整体人群平均年龄(39.9± 11.2)岁,HPV感染率为95.1%(3959/4162),25.0%(1040/4162)的患者接种了HPV疫苗。在高危型HPV感染者中,HPV 52、HPV 16、HPV 58和HPV 18为最常见的型别,其中LSIL组HPV 52感染率最高(27.6%),HSIL组(45.3%)和CC组(64.9%) HPV 16感染率最高。多因素Logistic回归分析结果显示,接种HPV疫苗(OR=0.63,95% CI:0.50~0.79,P<0.001)、非高危型HPV单一感染(OR=0.17,95% CI:0.09~0.33,P<0.001)、HPV 16单一感染(OR=7.05,95% CI:4.60~10.82,P<0.001)、多重HPV感染(OR=1.63,95% CI:1.08~2.48,P=0.022)、年龄>60岁(OR=2.22,95% CI:1.45~3.40,P<0.001)、产次为2(OR=1.52,95% CI:1.14~2.02,P=0.004)、产次≥ 3(OR=2.02,95% CI:1.44~2.84,P<0.001)是高级别宫颈病变(包括HSIL和CC)的影响因素。结论 宫颈SIL和CC患者普遍存在HPV感染,但不同级别宫颈病变人群中高危型HPV感染谱存在一定差异。建议加强深圳市高龄、多产次女性CC筛查和重点高危型别HPV感染监测,并持续推进HPV疫苗接种工作。

     

    Abstract: Objective To summarize the distribution characteristics of human papillomavirus (HPV) infection types in patients with cervical squamous intraepithelial lesion (SIL) and cervical cancer (CC), and to explore the impact of HPV vaccination, HPV infection types, and general clinical data on different grades of cervical lesions. Methods Clinical data of women attending the gynecological colposcopy clinic of Shenzhen People􀆳s Hospital from January 2020 to December 2023 were retrospectively collected. Patients with HPV geno- typing records and histopathologically diagnosed SIL or CC were included and divided into three groups based on pathological results:low-grade squamous intraepithelial lesion (LSIL) group, high-grade squamous intraepi- thelial lesion (HSIL) group, and CC group. The distribution of high-risk HPV subtypes was analyzed among the three groups, and multivariate Logistic regression was used to identify influencing factors for high-grade cer- vical lesions. Results A total of 4162 patients were included, comprising 4057 cervical SIL patients (3317 LSIL and 740 HSIL) and 105 CC patients. The overall mean age was (39.9±11.2) years. The HPV infection rate was 95.1% (3959/4162), and 25.0% (1040/4162) of patients had received HPV vaccination. Among high-risk HPV infections, HPV 52, HPV 16, HPV 58, and HPV 18 were the most common subtypes. HPV 52 had the highest infection rate in the LSIL group (27.6%), while HPV 16 was the most prevalent in the HSIL group (45.3%) and CC group (64.9%). Multivariate Logistic regression analysis showed that HPV vaccination (OR=0.63, 95% CI:0.50-0.79, P<0.001), non-high-risk HPV single infection (OR=0.17, 95% CI:0.09-0.33, P<0.001), HPV 16 single infection (OR=7.05, 95% CI:4.60-10.82, P<0.001), multiple HPV infections (OR=1.63, 95% CI:1.08-2.48, P=0.022), age > 60 years (OR=2.22, 95% CI:1.45-3.40, P<0.001), parity of 2 (OR=1.52, 95% CI:1.14-2.02, P=0.004), and parity ≥ 3 (OR=2.02, 95% CI:1.44-2.84, P<0.001) were influencing factors for high- grade cervical lesions (including HSIL and CC). Conclusions HPV infection is common in patients with SIL and CC, but the distribution of high-risk HPV subtypes varies among different grades of cervical lesions. It is recommended to strengthen cervical cancer screening and monitoring of key high-risk HPV infections in older and multiparous women in Shenzhen, and to continue promoting HPV vaccination.

     

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