宫颈HPV亚临床感染与外阴湿疣及宫颈糜烂的相关性研究
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摘要
目的
本研究旨在探讨外阴湿疣及宫颈炎症与宫颈HPV亚临床感染(SPI)的关系以及宫颈SPI与高危型HPV DNA感染的相关性。
材料与方法
实验对象包括实验组129例(其中外阴湿疣组32例，宫颈糜烂组97例)。正常宫颈对照组40例(因子宫良性病变行子宫全切、病理证实)。对实验组患者行基本情况问卷调查，通过进行宫颈液基细胞检查、行阴道镜检查及阴道镜下取组织进行病理诊断，或术后行宫颈病理检查，判定有无SPI感染。通过杂交捕获试验Ⅱ检测高危型HPV DNA感染。
结果
1．一般情况：平均年龄：外阴湿疣组为26岁(17—35岁)，宫颈糜烂组为35岁(21—40岁)。首次性生活平均年龄：外阴湿疣组为20岁(17—24岁)，宫颈糜烂组为24岁(21—28岁)；性伴侣数2—3个者：外阴湿疣组占21.8％(7／32)，宫颈糜烂组占7.2％(7／97)；无固定职业者：外阴疣组占56.25％(18／32)，宫颈糜烂组占20.6％(20／97)。
2．宫颈SPI的检出率：外阴湿疣组为53.1％，宫颈糜烂组为22.7％；正常对照组无SPI。实验组(宫颈糜烂组+外阴湿疣组)与正常对照组比较，SPI感染率明显提高(P＜0.01)；外阴湿疣组SPI感染率明显高于宫颈糜烂组(P＜0.05)。
3．宫颈糜烂中不同分型及分度的SPI检出率：97例宫颈糜烂患者中，
I、n、m度患者的SPI感染率分别为17.4%、23.1%、27.3%，随宫颈糜烂面
积增加SPI感染率呈逐渐上升趋势，但三者差异无显著性(P>0.05);单纯
型、颗粒型、乳头型宫颈糜烂组SPI感染率分别为20%、23.4%、22.5%，颗
粒型和乳头型糜烂中的SPI感染率略高于单纯型，但三者差异无显著性(P
>0 .05)。
4.高危HPV DNA的检出率:外阴湿庆组为41.7%;宫颈糜烂组为28.
7%;正常对照组为 8.3%。与正常对照组比较，实验组高危HPV DNA检出
率明显提高(P<0.01);宫颈糜烂组与外阴湿优组比较，高危HPV DNA检
出率差异无统计学意义(P<0.05)。
5.高危型HPv DNA感染与宫颈SPI的相关性:高危型HPV DNA检出
率在SPI阳性病例与阴性病例中的检出率分别为69.2%和7.8%;SPI阳
性病例与阴性病例比较，高危型HPv DNA检出率明显提高(P<0.01)。
结论
外阴湿疵及宫颈糜烂组宫颈SPI的感染率明显高于对照组，外阴湿庆、
宫颈炎症患者是宫颈SPI的高危人群，且SPI病例中高危HPV DNA的检出
率高于非SPI病例，应重点随访管理，以期达到宫颈癌的早期预防、早期发
现、早期治疗的目的。
The perpose of this study was to investigated the ralation of subclinical cervical human papillomavirus infection ( SPI) to vulvar condyloma and cervical e-rosion and the ralation between cevical SPI and high - risk HPV DNA.
Methed
We monitored by thinprep cytology , colposcopy, biopsy , and testing for high -risk human papillomavirus 169 women reffered to gynecologists with vulvar condyloma , cervical erosion or normal cevix.
Results
The rate of findings for cervical SPI in vulvar condyloma , cervical erosion and nonnal cervix was 53.1% ,22.7% and 0% Respectively P <0. 01 and P < 0.05 . The rate of findings for cervical SPI in 97 cervical erosion with I II III and purely, granule, papilla forms were respectively 17. 4% ,23. 1% ,27. 3% ; 20% ,23.4% ,22. 5% ( P > 0. 05 ). The rate of findings for high - risk human papillomavirus DNA in vulvar condyloma , cervical erosion and normal cervix was 41.7% ,28. 7% and 8. 3% respectively ( P < 0. 01). The rate of findings for high - risk HPV DNA in cervical SPI women and non SPI women were respectively 69.2% ,7. 8% ( P <0.01).
Conclusion
Vulvar condyloma and cervical erosion women was the high - risk persons of cervical SPI with high - risk HPV DNA,we should take a high light on them.
本研究旨在探讨外阴湿疣及宫颈炎症与宫颈HPV亚临床感染(SPI)的关系以及宫颈SPI与高危型HPV DNA感染的相关性。
材料与方法
实验对象包括实验组129例(其中外阴湿疣组32例，宫颈糜烂组97例)。正常宫颈对照组40例(因子宫良性病变行子宫全切、病理证实)。对实验组患者行基本情况问卷调查，通过进行宫颈液基细胞检查、行阴道镜检查及阴道镜下取组织进行病理诊断，或术后行宫颈病理检查，判定有无SPI感染。通过杂交捕获试验Ⅱ检测高危型HPV DNA感染。
结果
1．一般情况：平均年龄：外阴湿疣组为26岁(17—35岁)，宫颈糜烂组为35岁(21—40岁)。首次性生活平均年龄：外阴湿疣组为20岁(17—24岁)，宫颈糜烂组为24岁(21—28岁)；性伴侣数2—3个者：外阴湿疣组占21.8％(7／32)，宫颈糜烂组占7.2％(7／97)；无固定职业者：外阴疣组占56.25％(18／32)，宫颈糜烂组占20.6％(20／97)。
2．宫颈SPI的检出率：外阴湿疣组为53.1％，宫颈糜烂组为22.7％；正常对照组无SPI。实验组(宫颈糜烂组+外阴湿疣组)与正常对照组比较，SPI感染率明显提高(P＜0.01)；外阴湿疣组SPI感染率明显高于宫颈糜烂组(P＜0.05)。
3．宫颈糜烂中不同分型及分度的SPI检出率：97例宫颈糜烂患者中，
I、n、m度患者的SPI感染率分别为17.4%、23.1%、27.3%，随宫颈糜烂面
积增加SPI感染率呈逐渐上升趋势，但三者差异无显著性(P>0.05);单纯
型、颗粒型、乳头型宫颈糜烂组SPI感染率分别为20%、23.4%、22.5%，颗
粒型和乳头型糜烂中的SPI感染率略高于单纯型，但三者差异无显著性(P
>0 .05)。
4.高危HPV DNA的检出率:外阴湿庆组为41.7%;宫颈糜烂组为28.
7%;正常对照组为 8.3%。与正常对照组比较，实验组高危HPV DNA检出
率明显提高(P<0.01);宫颈糜烂组与外阴湿优组比较，高危HPV DNA检
出率差异无统计学意义(P<0.05)。
5.高危型HPv DNA感染与宫颈SPI的相关性:高危型HPV DNA检出
率在SPI阳性病例与阴性病例中的检出率分别为69.2%和7.8%;SPI阳
性病例与阴性病例比较，高危型HPv DNA检出率明显提高(P<0.01)。
结论
外阴湿疵及宫颈糜烂组宫颈SPI的感染率明显高于对照组，外阴湿庆、
宫颈炎症患者是宫颈SPI的高危人群，且SPI病例中高危HPV DNA的检出
率高于非SPI病例，应重点随访管理，以期达到宫颈癌的早期预防、早期发
现、早期治疗的目的。
The perpose of this study was to investigated the ralation of subclinical cervical human papillomavirus infection ( SPI) to vulvar condyloma and cervical e-rosion and the ralation between cevical SPI and high - risk HPV DNA.
Methed
We monitored by thinprep cytology , colposcopy, biopsy , and testing for high -risk human papillomavirus 169 women reffered to gynecologists with vulvar condyloma , cervical erosion or normal cevix.
Results
The rate of findings for cervical SPI in vulvar condyloma , cervical erosion and nonnal cervix was 53.1% ,22.7% and 0% Respectively P <0. 01 and P < 0.05 . The rate of findings for cervical SPI in 97 cervical erosion with I II III and purely, granule, papilla forms were respectively 17. 4% ,23. 1% ,27. 3% ; 20% ,23.4% ,22. 5% ( P > 0. 05 ). The rate of findings for high - risk human papillomavirus DNA in vulvar condyloma , cervical erosion and normal cervix was 41.7% ,28. 7% and 8. 3% respectively ( P < 0. 01). The rate of findings for high - risk HPV DNA in cervical SPI women and non SPI women were respectively 69.2% ,7. 8% ( P <0.01).
Conclusion
Vulvar condyloma and cervical erosion women was the high - risk persons of cervical SPI with high - risk HPV DNA,we should take a high light on them.
引文
1. Jamison JH, Kaplan DW, Hamman R. Spectrum of genital human papillomavirus infection in a female adolescent population. Sex Transm Dis. 1995 Jul-Aug; 22 (4): 236-43.
2. Plummer M, Franceschi S. Strategies for HPV prevention. Virus Res 2002 Nov; 89 (2): 285-93
3. Riethmuller D, Schaal JP, Mougin C. Epidemiology and natural history of genital infection by human papillomavirus. Gynecol Obstet Fertil 2002 Feb; 30(2): 139-46
4. Mougin C, Dalstein V, Pretet JL. Epidemiology of cervical papillomavirus infections. Recent knowledge. Presse Med 2001 Jun 9; 30(20): 1017-23
5. Doorn LJ, Kleter B, Quint WG. Molecular detection and genotyping of human papillomavirus. Expert Rev Mol Diagn 2001 Nov;1(4):394-402
6. Einstein MH, Goldberg GL. Human papillomavirus and cervical neoplasia. Cancer Invest,2002; 20(7-8): 1080-5
7. Stone KM, Karem KL, Sternberg MR. Seroprevalence of human papillomavirus type 16 infection in the United States. J Infect Dis 2002 Nov 15;186 (10): 1396-402 Weismanova E, Weismann P,
8. Vizvaryova M. New approach to human high-risk papillomavirus (HRHPV) genotyping. Neoplasma 2002; 49(4): 217-24
9. Sisk EA, Robertson ES. Clinical implication of human papillomavirus infection. Front Bisci,2002 Mar 1; 7: e77-84
10. Jamison JH, Kaplan DW, Hamman R. Spectrum of genital human papillomavirus infection in a female adolescent population. Sex Transm Dis. 1995 Jul-Aug;22(4): 236-43.
11. Ferenczy A, Franco E. Persistent human papillomavirus infection and cervical neoplasia, Lancet Oncol 2002 Jan;3(1):11-6
12. Scimia M. The Thin Prep Pap Test: a platform for gynecologic diagnosis, Pathologica 2002 Feb; 94 (1): 63-4
13．章文华．阴道镜在诊断宫颈人乳头瘤病毒感染中的作用．中华肿瘤杂
志．1992；14(3)：197-200．
14. Kahn JA, Rosenthal SL, Succop PA. The interval between menarehe and age of first sexual intercourse as a risk factor for subsequent HPV infection in adolescent and young adult women. J Pediatr 2002 Nov; 141 (5): 718-23
15. Cothran MM, White JP. Adolescent behavior and sexually transmitted diseases: the dilemma of human papillomavirus. Health Care Women Int 2002 Apr-May; 23 (3): 3
16. Rager KM, Kahn JA. Human papillomavirus and adolescent girls. Curr Womens Health Rep 2002 Dec;2(6):468-75
17. Bekkers RL, Massuger LF, Bulten J. Epidemiological and chnical aspects of human papillomavirus detection in the prevention of cervical, cancer. Rev Med Virol. 2004 Mar-Apr;14(2): 95-105.
18. Muckerman DR. Subclinical human papillomavirus infection in a high-risk population. J Am Osteopath Assoc. 1994 Jul; 94(7): 545-50,555-7.
19. Sanclemente G, Gill DK. Human papillomavirus molecular biology, and pathogenesis. J Eur Acad Dermatol Venereol 2002 May; 16 (3): 231-40
2. Plummer M, Franceschi S. Strategies for HPV prevention. Virus Res 2002 Nov; 89 (2): 285-93
3. Riethmuller D, Schaal JP, Mougin C. Epidemiology and natural history of genital infection by human papillomavirus. Gynecol Obstet Fertil 2002 Feb; 30(2): 139-46
4. Mougin C, Dalstein V, Pretet JL. Epidemiology of cervical papillomavirus infections. Recent knowledge. Presse Med 2001 Jun 9; 30(20): 1017-23
5. Doorn LJ, Kleter B, Quint WG. Molecular detection and genotyping of human papillomavirus. Expert Rev Mol Diagn 2001 Nov;1(4):394-402
6. Einstein MH, Goldberg GL. Human papillomavirus and cervical neoplasia. Cancer Invest,2002; 20(7-8): 1080-5
7. Stone KM, Karem KL, Sternberg MR. Seroprevalence of human papillomavirus type 16 infection in the United States. J Infect Dis 2002 Nov 15;186 (10): 1396-402 Weismanova E, Weismann P,
8. Vizvaryova M. New approach to human high-risk papillomavirus (HRHPV) genotyping. Neoplasma 2002; 49(4): 217-24
9. Sisk EA, Robertson ES. Clinical implication of human papillomavirus infection. Front Bisci,2002 Mar 1; 7: e77-84
10. Jamison JH, Kaplan DW, Hamman R. Spectrum of genital human papillomavirus infection in a female adolescent population. Sex Transm Dis. 1995 Jul-Aug;22(4): 236-43.
11. Ferenczy A, Franco E. Persistent human papillomavirus infection and cervical neoplasia, Lancet Oncol 2002 Jan;3(1):11-6
12. Scimia M. The Thin Prep Pap Test: a platform for gynecologic diagnosis, Pathologica 2002 Feb; 94 (1): 63-4
13．章文华．阴道镜在诊断宫颈人乳头瘤病毒感染中的作用．中华肿瘤杂
志．1992；14(3)：197-200．
14. Kahn JA, Rosenthal SL, Succop PA. The interval between menarehe and age of first sexual intercourse as a risk factor for subsequent HPV infection in adolescent and young adult women. J Pediatr 2002 Nov; 141 (5): 718-23
15. Cothran MM, White JP. Adolescent behavior and sexually transmitted diseases: the dilemma of human papillomavirus. Health Care Women Int 2002 Apr-May; 23 (3): 3
16. Rager KM, Kahn JA. Human papillomavirus and adolescent girls. Curr Womens Health Rep 2002 Dec;2(6):468-75
17. Bekkers RL, Massuger LF, Bulten J. Epidemiological and chnical aspects of human papillomavirus detection in the prevention of cervical, cancer. Rev Med Virol. 2004 Mar-Apr;14(2): 95-105.
18. Muckerman DR. Subclinical human papillomavirus infection in a high-risk population. J Am Osteopath Assoc. 1994 Jul; 94(7): 545-50,555-7.
19. Sanclemente G, Gill DK. Human papillomavirus molecular biology, and pathogenesis. J Eur Acad Dermatol Venereol 2002 May; 16 (3): 231-40