【作者】 姚军；

【导师】 邵家松；

【作者基本信息】 桂林医学院 ， 外科学， 2012， 硕士

【摘要】 目的：1.探讨人乳头瘤病毒(HPV)型别感染与宫颈病变的关系。2.探讨HPV多重感染与宫颈病变的关系。方法：以桂北地区育龄妇女为研究对象,对门诊就诊的1086病例进行HPV分型检测和液基细胞学检查,对细胞学诊断≥ASC-US及HPV检测为阳性的病例进行阴道镜活检。结果：1.HPV检测阳性率为43.92%(477/1086)；液基细胞学诊断≥ASCUS为31.49%(342/1086)。在ASC-US、LSIL、HSIL、SCC中HPV的检出率分别为51.45%、70.27%、91.30%、100%。2.细胞学诊断阳性≥LSIL(18.78%,204/1086)与组织学诊断阳性≥CINI(21.36%,232/1086)比较差异无显著性(x2=2.250,P>0.05),细胞学与组织学诊断符合率为100%的SCC、80.23%的HSIL和90.98%的LSIL。组织学诊断CINI、CINⅡ、CINIⅢ、 SCC病变中HPV检出率以68.03%、81.67%、93.37%、100%依次递增。3.1086例样本中HPV感染共检出21种型别,低危型4种占17.19%、高危型17种占82.81%,随宫颈病变程度的增加HPV型别分布有所变化,低度病变组(CINI)以HPV16、58、18、56、11和52为常见类型；而高度病变组(CIN Ⅱ-Ⅲ)以高危型HPVI6、58、18、56、33、52和11型为最常见。24例宫颈癌共检出6种高危型别HPV,分别是HPV16、58、18、59、66和33型。HPV16型别随宫颈病变级别加重感染率呈上升趋势(P<0.0125)。4.本组资料中多重感染的比例为29.35%,最常见类型为HPV16、58及HPV16、18二重感染。除宫颈鳞组,HPV多重感染的比例随宫颈病变级别增加而增加,各组与正常组相比,差异显著(P<0.05)。5.138例ASC-US患者中HPV-DNA分型检测高危型别阳性者61例,占44.20%,其中HPV-DNA16或(和)58型别阳性者46例,占总数的33.33%,占高危阳性的75.41%。HPV-DNA高危型别阳性对CINⅡ及以上病变检出的敏感度和特异度分别为91.67%、60.32%,CINⅡ及以上患者的阴性预测值为98.70%。HPV-DNA16、58型别阳性对CINⅡ及以上病变检出的敏感度和特异度分别为58.33%、69.05%。结论：1.桂北地区宫颈病变常见的HPV型别是HPV16、58、18、56、33、52和11型,HPVI6致癌性最强。2.HPV分型检测因其准确性高并能明确基因类型,联合液基细胞学和组织学更能有效地筛查宫颈病变细胞,为临床防治宫颈癌提供更可靠的科学依据。3.HPV多重感染与宫颈病变的发生有关。更多还原

【Abstract】 Objective:1. To discuss the relation of HPV infection and cervix lesion.2. To investigate the role of multiple HPV infections in cervical dysplasia.Methods:1086reproductive life women were carried through HPV typing and liquid medium cytology examination, the patients who had cytology diagnosis>ASC-US and HPV positive were put up colposcope biopsy.Results:1. Positive rate of HPV was43.92%(477/1086). Liquid medium cytology diagnosis>ASC-US was31.49%(342/1086).Positive rate of HPV in ASC-US, LSIL, HSIL, SCC parted to51.45%,70.27%,91.30%,100%.2. There was no significant difference between positive of cytology diagnosis≥LSIL(18.78%,204/1086) and histology diagnosis≥CINI (21.36%,232/1086)(χ2=2.250, P>0.05), coincidence rate of cytology preventive histology diagnosis SCC100%, HSIL80.23%, LSIL90.98%.Positive rate of HPV in histology diagnosis CIN I, CINII, CINIH, SCC parted to68.03%,81.67%,93.37%,100%, which to increase progressively in turn.3.21isoforms were checked out in1086reproductive life women who had infected HPV, low risk form17.19%, high risk form82.81%.The HPV subtype varied with severity of cervix diseases increased, low grade of uterine cervix lesion group(CIN I)commonly presented with HPV16,58,18,56,11and52and high grade lesion group (CIN Ⅱ-Ⅲ) were found with high risk type HPV16,58,18,56,33,52and11.6types of high risk HPV were found in24cases with SCC, including types16,58,18,59,66and33.HPV16subtype increased significantly with higher grade of the cervix lesions(P<0.0125).4. The total multiple infection rate was29.35%. The most common models were HPV16/58and HPV16/18double infection. The multiple infection rates increased with the severity of cervical dysplasia (except for cancer), and are significant higher than the normal group.5. Among the138ASC-US patients,61cases had positive HPV-DNA genotyping assays high risk results (44.20%).46cases had positive HPV-DNA genotyping assays16or/and58results (46/138cases,33.33%vs46/61cases,75.41%). The positive HPV-DNA genotyping assays high risk type results had a sensitivity of91.67%and a specificity of60.32%in detecting CIN Ⅱ or more serious. And the positive HPV-DNA genotyping assays16/58type results had a sensitivity of58.33%and a specificity of69.05%.Conclusions:1. HPV16,58,18,56,33,52,11are common subtypes in cervical lesions of Guibei region, the most pathogenic genotype is HPV16. 2. because of high accuracy and definited gene type, HPV tying determination united liquid medium cytology and histology can screen cervix lesion cell more effectively, offer reliable cience bases for clinical prevention and cure cervix cancer.3. Multiple HPV infection is associated with the development of cervical neoplasia.更多还原