摘要
目的检测西安市妇产科患者人乳头瘤病毒(human papillomavirus,HPV)及其它病原体感染情况,并分析HPV感染的危险因素。方法 2015年3月-2018年3月西安医学院第一附属医院妇产科收治的患者共1 000例,采用PCR法检测HPV感染情况并进行分型;采用微生物检验法、胶体金法、革兰染色法及悬滴湿片法检查其它病原体感染情况。对入选病例的民族,文化程度,初次性生活年龄,孕产次数,性伴侣数等因素进行非条件Logistic回归分析,确定HPV感染危险因素。结果 1 000例妇产科患者中HPV检测阳性249例,阳性率为24.90%。其中HPV高危型(HPV16、HPV18、HPV30、HPV31、HPV33)感染占52.21%,HPV低危型(HPV6、HPV32)感染占47.79%。随着年龄增长,患者感染低危型HPV的概率逐渐降低,感染高危型HPV的概率逐渐增加。生殖道内解脲支原体、衣原体、及乳酸杆菌感染率在HPV阴性组分别为2.93%、2.53%和3.06%,HPV阳性组分别为20.48%、27.31%和32.93%,差异均有统计学意义(均P<0.05)。非条件Logistic回归分析,初次性生活年龄过早(<18岁)、孕产次数过多(≥3次)及多个性伴侣(≥2个)均为HPV感染高危因素(P<0.05)。结论西安医学院第一附属医院妇产科患者HPV感染率较高,生殖道微生物感染、性生活过早,孕产次数及多个性伴侣为HPV感染风险因素。因此应加强对相关人群的健康教育,并定期对中老年妇女进行HPV筛查,预防和控制HPV感染。
Objective To detect human papillomavirus(HPV)and other pathogens in patients in Obstetrics and Gynecology in Xi'an and to analyze the risk factors for HPV infection. Methods Subjects were a total of 1,000 patients who were treated by Obstetrics and Gynecology,the First Hospital Affiliated with Xi'an Medical College,from March 2015 to March 1818.The prevalence of HPV infection was determined using PCR and HPV was typed.Microbial testing,the colloidal gold method,Gram staining,and a hanging drop wet preparation were used to check for infection with other pathogens.Unconditional logistic regression analysis was performed using factors such as ethnicity,level of education,age of first sexual encounter,parity,and the number of sexual partners to determine the risk factors for HPV infection.Results Of 1,000 patients seen in Obstetrics and Gynecology,249 tested positive for HPV at a rate of 24.90%.Of those,52.21% were infected with a high-risk type of HPV(HPV16,HPV18,HPV30,HPV31,or HPV33)while47.79% were infected with a low-risk type of HPV(HPV6 or HPV32).The probability of infection with a low-risk type of HPV gradually decreased with age while the probability of infection with a high-risk type of HPV gradually increased with age.Ureaplasma urealyticum was detected at a rate of 2.93%in the reproductive tract of patients who tested negative for HPV,Chlamydia was detected at a rate of 2.53%,and Lactobacillus was detected at a rate of 3.06%.Ureaplasma urealyticum was detected at a rate of 20.48% in the reproductive tract of patients who tested positive for HPV,Chlamydia was detected at a rate of 27.31%,and Lactobacillus was detected at a rate of 32.93%.The rate of detection of other pathogens differed significantly between the 2 groups(P<0.05 for both).Unconditional logistic regression analysis indicated that early sexual encounters(< 18 years of age),an excessive number of pregnancies(> 3 pregnancies),and multiple sexual partners(> 2 partners)were high-risk factors for HPV infection(P<0.05). Conclusion The rate of HPV infection is high in Obstetrics and Gynecology of the First Hospital Affiliated with Xi'an Medical College.A microbial infection of the genital tract,early sexual encounters,numerous pregnancies,and multiple sexual partners are risk factors for HPV infection.Therefore,health education for the relevant population should be enhanced,and regular HPV screening should be performed for middle-aged and elderly women to prevent and control HPV infection.
引文
[1] Thapa N,Maharjan M,Shrestha G,et al.Prevalence and type-specific distribution of human papillomavirus infection amongwomen in mid-western rural,Nepal-A population-based study[J].BMC Infect Dis,2018,18(1):338.
[2] Harder T,Wichmann O,Klug SJ,et al.Efficacy,effectivenessand safety of vaccination against human papillomavirus in males:asystematic review[J].BMC Med,2018,16(1):110.
[3] Bidinotto LT,Véo CAR,Loaiza EA,et al.Loss of Raf kinaseinhibitor protein expression is associated with human papilloma-virus 16infection in anal tumors[J].Oncol Lett,2018,16(2):1785-1790.
[4] Pańczyszyn A,Boniewska-Bernacka E,Glab G.Telomeres andtelomerase during human papillomavirus-induced carcinogenesis[J].Mol Diagn Ther,2018,22(4):421-30.
[5] 刘晓霞,何茵芳.宫颈癌对阴道内环境及常见菌群的影响[J].实用癌症杂志,2015,30(8):1135-8.
[6] 张岚,李康明,蒋美萍,等.下生殖道微生物在宫颈癌发生发展中的研究现状及展望[J].中国病原生物学杂志,2018,13(4):428-31.
[7] 陆宏,周桂华.阴道微生物菌群失调及pH值变化与宫颈上皮内瘤变的关系[J].海南医学,2017,28(20):3401-2.
[8] 郭远瑜,汪敏,赵成国,等.杭州市萧山区女性HPV感染及分子流行病学研究[J].中国微生态学杂志,2012,24(5):453-6.
[9] 韦敏,黄宁,林晓琰,等.南宁市妇女人乳头状瘤病毒感染及阴道微生态状况的流行病学调查[J].中国微生态学杂志,2015,27(6):722-5.
[10] 邱琳,张雅琪,周爱芬,等.1955例武汉市农村妇女HPV感染状况与危险因素分析[J].实用妇产科杂志,2013,29(9):662-6.
[11] 侯萌,李娜,朱广霞,等.妇科门诊患者宫颈人乳头瘤病毒的感染情况分析[J].西安交通大学学报(医学版),2013,34(2):229-232,262.
[12] Lee JE,Lee S,Lee H,et al.Association of the vaginal microbi-ota with human papillomavirus infection in a Korean twin cohort[J].Plos One,2013,8(5):e63514.
[13] Haedicke J,Iftner T.Human papillomaviruses and cancer.[J].Radiother Oncol,2013,108(3):397-402.
[14] Peres AL,Camarotti JR,Cartaxo M,et al.Molecular analysisand conventional cytology:association between HPV and bacteri-al vaginosis in the cervical abnormalities of a Brazilian population[J].Genet Mol Res,2015,14(3):9497-505.
[15] Wohlmeister D,Vianna DR,Helfer V E,et al.Association ofhuman papillomavirus and Chlamydia trachomatis with intraepi-thelial alterations in cervixsamples[J].Mem Inst Oswaldo Cruz,2016,111(2):106.
[16] Dols JA,Reid G,Kort R,et al.PCR-based identification ofeight Lactobacillus species and 18hr-HPV genotypes in fixed cer-vical samples of South African women at risk of HIV and BV[J].Diagn Cytopathol,2012,40(6):472-7.
