本文關(guān)鍵詞： 人乳頭瘤病毒 宮頸上皮內(nèi)瘤變 宮頸癌 基因型　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 研究濟(jì)南市正常人群、宮頸癌前病變及宮頸癌患者中HPV感染型別的分布,探討濟(jì)南市高危人群高危型HPV感染在不同年齡組的分布差異和HPV感染的常見(jiàn)亞型與宮頸病變級(jí)別的相關(guān)性。 方法： 收集2009年3月至2013年3月在濟(jì)南市中心醫(yī)院婦科門診行HPV檢查的健康查體人群資料共9976例,HPV感染陽(yáng)性者1618例。采用HPV分型檢測(cè)方法對(duì)HPV陽(yáng)性者進(jìn)行分型,同時(shí)進(jìn)行液基細(xì)胞學(xué)檢查。對(duì)HPV陽(yáng)性,細(xì)胞學(xué)結(jié)果為意義不明確的非典型鱗狀細(xì)胞及以上者進(jìn)行陰道鏡檢查及組織病理學(xué)活檢,對(duì)診斷為宮頸上皮內(nèi)瘤變及以上的患者,回顧分析其HPV分型及與疾病相關(guān)性。 結(jié)果： 1.濟(jì)南市HPV感染陽(yáng)性率為16.22%,其中高危型HPV的陽(yáng)性率為11.73%,低危型HPV陽(yáng)性率為7.96%。常見(jiàn)高危型HPV由高到低為HPV16、18、33型,常見(jiàn)低危型HPV由高到低為HPV11、6型。 2.HPV感染率以25-34歲女性最高(17.6%),之后隨年齡的增長(zhǎng)HPV感染率呈下降趨勢(shì)。高危型HPV感染陽(yáng)性率有兩個(gè)年齡高峰,第一個(gè)在25-34歲(13.8%),第二個(gè)在45-54歲(13.2%),低危型HPV感染陽(yáng)性率有一個(gè)年齡高峰,在25歲以下(9.4%),之后隨年齡的增長(zhǎng)逐漸下降。 3.高危型HPV陽(yáng)性率隨著宮頸病變級(jí)別的升高而升高,宮頸病變的程度與年齡無(wú)明顯相關(guān)性。 4.不同級(jí)別宮頸病變中HPV亞型分布由高到低排列：宮頸癌中依次為：HPV16、18、33型,CINIII中依次為：HPV16、18、58、33、56型；CIN II中依次為：HPV16、18、31、58、52、56、66型；CIN I中依次為：HPV16、18、59型。 5.各年齡組HPV單一感染人數(shù)均多于多重感染人數(shù)。單一感染及多重感染均在25-34歲年齡組呈現(xiàn)最高峰,然后逐漸下降,在≥55歲年齡組降到最低點(diǎn)。在各級(jí)別宮頸病變之間多重感染率差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論： 1.濟(jì)南市常見(jiàn)的高危型HPV亞型為HPV16、18、33型,低危型HPV亞型為HPV11、6型。首次檢測(cè)出濟(jì)南地區(qū)不同級(jí)別宮頸病變中高危型HPV亞型分布,根據(jù)檢出率由高到低如下：宮頸癌中為：HPV16、18、33型,CINIII中為：HPV16、18、58、33、56型；CINⅡ中為：HPV16、18、31、58、52、56、66型；CIN I中為：HPV16、18、59型。目前第一代HPV預(yù)防性疫苗適用于濟(jì)南地區(qū)女性接種以預(yù)防宮頸癌。 2.HPV感染與年齡相關(guān),在25-34歲達(dá)到最高峰,之后隨年齡的增長(zhǎng)HPV的感染率呈下降趨勢(shì)。高危型HPV感染率有兩個(gè)年齡高峰,25-34歲為第一個(gè)高峰,45-54歲為第二個(gè)高峰；低危型HPV感染率在25歲以下就達(dá)到高峰,之后隨著年齡的增長(zhǎng)逐漸下降。 3.隨著宮頸病變程度的加重高危型HPV的感染率增加。宮頸癌及癌前病變的發(fā)病與高危型HPV感染密切相關(guān)。 4.HPV感染以單一感染為主,多重感染與宮頸癌及癌前病變的發(fā)生率無(wú)直接關(guān)系。
[Abstract]:Objective: To study the distribution of HPV infection type in normal population, precancerous lesion and cervical cancer patients in Jinan. To investigate the distribution of high risk HPV infection in different age groups and the correlation between the common subtypes of HPV infection and the grade of cervical lesions in high risk population in Jinan. Methods: From March 2009 to March 2013, we collected data of 9 976 health examiners who were examined by HPV in gynecological outpatient department of Jinan central hospital from March 2009 to March 2013. 1618 cases were positive for HPV infection. HPV positive cases were classified by HPV typing method, and liquid-based cytology was performed. HPV was positive. Cytological results showed that atypical squamous cells with unclear significance were examined by colposcopy and histopathological biopsy. The patients with cervical intraepithelial neoplasia or above were diagnosed as cervical intraepithelial neoplasia or above. HPV classification and its correlation with disease were analyzed retrospectively. Results: 1. The positive rate of HPV infection was 16.22 in Jinan, and the positive rate of high-risk type HPV was 11.73%. The positive rate of low risk type HPV was 7.96. The common high risk type HPV from high to low was HPV16 / 1833, and the common low risk type HPV from high to low was HPV11 / 6 type. 2. The infection rate of HPV was the highest in women aged 25 to 34 years, and then decreased with the increase of age. The positive rate of high risk HPV infection had two age peaks. The first was aged 25-34 and the second was 13.22.The positive rate of low-risk HPV infection had a peak at an age of 9.4% under the age of 25). After that, it gradually declined with the increase of age. 3. The positive rate of high risk HPV increased with the increase of cervical lesion grade, and there was no significant correlation between the degree of cervical lesion and age. 4. The distribution of HPV subtypes in cervical lesions of different grades ranged from high to low. In cervical cancer, the order was: 1: HPV16, 1833, CINIII, 1: HPV16, 1858, respectively. Type 33C56; In CIN II, the order was: type 1: HPV16, 1831, 582, 562, 6N66; In CIN I, the order is: HPV16 / 1859. 5. The number of HPV single infection was higher than that of multiple infection in all age groups. Both single infection and multiple infection showed the highest peak in the age group of 25-34 years, and then decreased gradually. In the age group of 鈮，

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