郭菲菲+南蓓蓓

[摘要]目的 探讨高危型人乳头状瘤病毒（HPV）感染与宫颈病变的关系。方法 抽取2015年1～12月在大连市瓦房店妇幼保健院采用HPV检测进行宫颈癌初筛的9672例作为研究对象，分析高危型HPV感染与宫颈病变的关系。结果 HPV阴性8741例，阳性931例，24例为宫颈活检低级别病变，93例宫颈高级别病变，1例高级别病变可疑浸润癌，1例宫颈鳞癌。HPV检测阳性组学历及患阴道炎率明显高于HPV阴性组，差异有统计学意义（P<0.01）。HPV16、18和52型最容易引起宫颈病变。结论 高危型HPV感染与宫颈癌前病变及宫颈癌的关系较为密切，在高危型HPV感染中，HPV16、18和52型为主要的感染因素。高危型HPV感染检测对宫颈癌筛查具有诊断意义。

[关键词]子宫颈癌；筛查；宫颈活检；人乳头状瘤病毒；宫颈脱落细胞学

[中图分类号] R711.74 [文献标识码] A [文章编号] 1674-4721（2017）01（c）-0086-04

[Abstract]Objective To investigate the relationship between high-risk HPV infection and cervical lesions.Methods A total of 9672 patients with cervical cancer who were screened by HPV method in Dalian Wafangdian Women and Children′s Hospital from January to December in 2015 were selected as research subjects，and the relationship between high-risk HPV infection and cervical lesions was analyzed.Results 8741 cases were HPV negative，and 931 cases were HPV positive.24 cases were low-grade lesions diagnosed by cervical biopsy，93 cases were cervical high-grade lesions，1 case was high-grade lesion with suspected invasive carcinoma，and 1 case was cervical squamous cell carcinoma；the educational background and incidence rate of vaginitis in patients with HPV positive were significantly higher than those in patients with HPV negative，and the differences were significant （P<0.01）.HPV 16，18 and 52 were most likely to cause cervical lesions.Conclusion There is a close relationship between high-risk HPV infection and cervical precancerous lesions and cervical cancer.HPV 16，18 and 52 are the main infection factors in the high-risk HPV infection.Test of high-risk HPV infection has diagnostic significance in the screening of cervical cancer.

[Key words]Cervical cancer；Screening；Cervical biopsy；HPV；Cervical exfoliative cytology

宮颈癌是女性生殖道最常见的恶性肿瘤。统计资料表明，每年全球约有46万宫颈癌新发病例，其中80%发生在发展中国家。我国每年新增病例约15万人，占世界总发病人数的1/3，每年约有3万人死于宫颈癌。人乳头状瘤病毒（human papillomavirus，HPV）属于乳头多瘤空泡病毒科乳头瘤病毒属，是一种环状双链DNA病毒。目前已知HPV共有120多个型别，30余种与生殖道感染有关，其中10余种与宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）和子宫颈癌发病密切相关。本文旨在探讨高危型HPV感染与宫颈病变组织间相互关系，现报道如下。

1对象与方法

1.1对象

选取2015年1～12月在辽宁省大连市瓦房店市妇幼保健院（国家农村妇女“两癌”筛查项目县之一）选用HPV检测进行免费宫颈癌筛查的9672例个案作为研究对象，年龄36～64岁，平均（49.92±7.26）岁；小学及以下学历2782例，初中学历4661例，高中或中专学历1582例，大专及以上647例；均为有性生活史两年以上，无全子宫切除、宫颈手术、子宫颈病变史，检查前48 h避免性生活、妇科检查、阴道冲洗和放置药物。……