【摘要】 目的 探讨不同型别人乳头瘤病毒(HPV)感染联合细胞学检测对宫颈高级别病变检出的意义。方法 我们收集了2019年6月至2023年8月首都医科大学附属北京天坛医院病理科宫颈活检病例共4 131例，回顾性分析了单一和多重感染的HPV 16/18组、HPV 31/33/52/58组、其他高危HPV组联合液基细胞学检测对宫颈高级别上皮内病变(CIN 2级及以上的病变，CIN 2+)的检出率，并比较了组间的差异，旨在探讨进一步优化HPV风险分层的可能性。结果 在细胞学阴性单一型别HPV感染中，共有1 264例，HPV 16/18组、HPV 31/33/52/58组和其他高危HPV组的高级别病变检出率依次降低，分别为26.26%、16.33%和7.75%,差异具有统计学意义。而细胞学阴性多重HPV感染中，共有577例，HPV 16/18组的CIN2+检出率为24.92%,显著高于HPV 31/33/52/58组(12.65%)和其他高危多重组(7.31%),而后两组的检出率差异则无统计学意义。细胞学阳性HPV 16/18、HPV 31/33/52/58及其他高危单一感染的CIN2+检出率分别为56.83%、41.74%和17.12%,这些差异均具有统计学意义。细胞学结果为ASC-US(atypical squamous cells of undetermined significance, ASC-US)的病例中，3组的高级别检出率分别为44.11%、28.5%和9.7%,χ~2分析结果为10.097,P值<0.001,以及25.303,P值<0.001。HPV 16/18、HPV 31/33/52/58及其他高危多重感染的CIN2+检出率分别为54.54%、37.50%和16.76%,这种差异也具有统计学意义。无论是细胞学阴性还是阳性，相同型别组的单一和多重感染的高级别检出率差异无统计学意义。结论本研究认为在HPV感染中，其他12型高危HPV的风险分级需要进一步优化，而HPV 31/33/52/58的风险程度高于其他高危HPV组。此外，对于细胞学阴性的情况，应该缩短随访周期。而对于感染其他高危HPV组的病例，细胞学ASC-US的风险较低，可以选择随访观察。更多还原

【Abstract】 Objective To explore the significance of combining human papillomavirus(HPV) infection and cytology testing in detecting cervical high-grade lesions.Methods We collected a total of 4 131 cases of cervical biopsies from the Department of Pathology at Beijing Tiantan Hospital, Capital Medical University, between June 2019 and August 2023. We retrospectively analyzed the detection rates of high-grade cervical intraepithelial neoplasia(CIN 2 and above, CIN 2+) caused by single or multiple infections of HPV16/18, HPV31/33/52/58, and other high-risk HPV types, as well as liquid-based cytology testing. We evaluated differences among different groups and explored optimization strategies of risk stratification for HPV infection.Results Among cytology-negative single-type HPV infections, there were 1 264 cases. The detection rates of high-grade lesions in the HPV 16/18 group, HPV 31/33/52/58 group, and other high-risk HPV groups decreased sequentially, at 26.26%, 16.33%, and 7.75%, respectively, with statistically significant differences. In cytology-negative multiple HPV infections, there were 577 cases, and the CIN2+ detection rate in the HPV 16/18 group was 24.92%, significantly higher than that in the HPV 31/33/52/58 group(12.65%) and other high-risk multiple infection groups(7.31%), with no significant difference between the latter two groups. The CIN2+ detection rates for cytology-positive HPV16/18, HPV31/33/52/58, and other high-risk single infections were 56.83%, 41.74%, and 17.12%, respectively, with statistically significant differences. In cases with cytology results of ASC-US(atypical squamous cells of undetermined significance, ASC-US), the detection rates of high-grade lesions in these three groups were 44.11%, 28.5%, and 9.7%, respectively, with χ~2 analysis results of 10.097, P<0.001, and 25.303, P<0.001. The CIN2+ detection rates for HPV 16/18, HPV 31/33/52/58, and other high-risk multiple infections were 54.54%, 37.50%, and 16.76%, respectively, with statistically significant differences. There were no statistically significant differences in the detection rates of high-grade lesions between single and multiple infections within the same type group, whether cytology was negative or positive.Conclusion This study suggests that risk stratification of other 12 high-risk HPV types can be further optimized, and the risk level of HPV31/33/52/58 is higher than that of other high-risk HPV groups. In cases with negative cytology, the follow-up time interval should be shortened. For infections with other high-risk HPV groups, a low-risk ASC-US cytology result can be managed with follow-up observations.更多还原