本文關鍵詞： 宮頸病變 微量元素 維生素 診斷價值 相關性　出處：《新疆醫(yī)科大學》2016年博士論文　論文類型：學位論文

【摘要】：目的:研究新疆巴楚縣維吾爾族婦女HPV感染、宮頸高級別病變及宮頸癌(CINⅡ+)的行為危險因素及其與血清微量元素、維生素的關系;分析血清微量元素和維生素水平預測HPV感染、CINⅡ+的價值;探討巴楚縣土壤和飲用水中微量元素水平與當?shù)鼐S吾爾族婦女HPV感染率、CINⅡ+之間的相關性。從而為新疆維吾爾族宮頸癌的干預提供依據(jù)。方法:1.自2014年3月1日至6月15日,通過整群抽樣的方法,在巴楚縣的9個鄉(xiāng)鎮(zhèn)進行維吾爾族婦女的宮頸癌篩查,共篩查5045名婦女。選擇細胞學ASC-US及以上、care HPV檢測陽性或VIA/VILI陽性者646例進入研究隊列。此外,選擇2011年3月1日至2014年6月15日期間,在新疆腫瘤醫(yī)院婦科住院確診的來自巴楚縣的宮頸疾病患者187例進入研究隊列。檢出CINⅡ+者作為病例組,慢性宮頸炎及CINⅠ級者作為對照組;HPV感染者作為陽性組,未感染者作為陰性組。研究對象均進行宮頸癌相關行為危險因素問卷調(diào)查,并檢測血清微量元素、維生素的含量。2.在每個鄉(xiāng)鎮(zhèn),隨機選取農(nóng)田土地42處,按同種土壤取5個點取樣;并于一年內(nèi)的2、5、8和12月定點采集每個鄉(xiāng)鎮(zhèn)的飲用水30份,每份至少1L。測定土壤和飲用水中As、Cd、Co、Ni、Cu、Zn、Mn、Se和Fe的含量水平。3.采用卡方檢驗對病例組和對照組、陽性組和陰性組進行單因素分析,將P0.1的因素納入多因素Logistic回歸分析;采用診斷試驗評價與接收者工作特征曲線分析微量元素和維生素水平預測HPV感染、CINⅡ+的診斷價值;采用偏相關分析,研究土壤和飲用水中微量元素水平與維吾爾族婦女CINⅡ+檢出率和HPV感染率之間的相關性。結果:1.多因素分析顯示,結婚年齡≤15歲、結婚次數(shù)3次、同房次數(shù)≥3次/周、在家分娩、經(jīng)期用衛(wèi)生紙、廁所用土塊、個人護理得分低、洗澡頻率低、未避孕和配偶吸煙是新疆巴楚縣維吾爾族婦女HPV感染的高危行為因素,而家庭收入5000元和5000~1萬元、結婚次數(shù)3次、在家分娩、宮頸癌家族史、個人護理得分低、經(jīng)期用衛(wèi)生紙和配偶吸煙是其宮頸高級病變及宮頸癌的高危行為因素。2.血清中As≥0.02 mg/Kg和維生素D3≥49.6434ng/L是HPV感染的危險因素,而Ni≥0.1232 mg/Kg、Se≥0.02 mg/Kg和葉酸≥17.6705 ug/L是其保護因素;血清中Fe≥6.9153 mmol/L和As≥0.02 mg/Kg是宮頸高級病變及宮頸癌的危險因素,而Ni≥0.0965mg/Kg、Se≥0.02 mg/Kg和維生素C≥0.6857ug/L則是其保護因素。3.As、Ni、Se及維生素D3和葉酸預測HPV感染的診斷價值均較低,ROC曲線下面積小于0.7。4.單用Se、Se和As聯(lián)合、Se和Ni聯(lián)合可以用于預測宮頸高級病變及宮頸癌,診斷價值可達中等(ROC曲線下面積0.7以上),其靈敏度和陰性預測價值較高、假陰性率較低,但特異度、正確率和陽性預測價值較低,假陽性率較高。5.巴楚縣土壤和飲用水中微量元素的含量未超過國家土壤環(huán)境和生活飲用水的標準;CINⅡ+級宮頸病變的檢出率與土壤中As和Cu呈正相關、與Se呈負相關,與飲用水中As呈正相關、與Zn呈負相關;HPV感染率與土壤中As呈正相關、與Se呈負相關,與飲用水中Cu呈正相關、與Se呈負相關。結論:行為因素在新疆巴楚縣維吾爾族婦女HPV感染和宮頸病變的發(fā)生過程中具有重要作用,應該針對性地對行為危險因素進行干預,提倡晚婚、配偶戒煙、入廁用衛(wèi)生紙、加強個人護理及經(jīng)期衛(wèi)生等;血清中微量元素和維生素的含量與巴楚縣維吾爾族婦女HPV感染、CINⅡ+的發(fā)生有關,應改善婦女微量元素狀況,從而降低宮頸病變的發(fā)生;血清Se、Se和As聯(lián)合、Se和Ni聯(lián)合可用于新疆巴楚縣維吾爾族婦女CINⅡ+的初步篩檢;巴楚縣土壤和飲用水中微量元素的含量與當?shù)鼐S吾爾族婦女HPV感染率、高級別宮頸病變和宮頸癌的發(fā)生具有一定相關性。
[Abstract]:Objective: To study the Xinjiang County of Bachu Uygur HPV infected women, high grade cervical lesions and cervical cancer (CIN +) and the behavioral risk factors of trace elements and serum vitamin; analysis of serum trace elements and vitamin HPV levels in the prediction of infection, CIN II + value; explore the Bachu County Soil and drinking water in the levels of trace elements with the local Uygur women's HPV infection rate, the correlation between CIN II +. In order to provide the basis for the intervention of Xinjiang Uygur cervical cancer. Methods: 1. from March 1, 2014 to June 15th, by the method of cluster sampling, screening for cervical cancer in Uygur women in 9 townships in Bachu County, a total of 5045 women. Cytology screening ASC-US and above, care HPV positive or VIA/VILI positive in 646 cases in the study cohort. In addition, during the period from March 1, 2011 to June 15, 2014 in Xinjiang Cancer Hospital Gynecological hospitalized from Bachu County in 187 cases of cervical disease patients into the study cohort. Detection of CIN II + as the case group, chronic cervicitis and CIN grade as control group; HPV infection as a positive group, negative group. As uninfected subjects were the risk factors of cervical cancer related behavior questionnaire, and serum levels of trace elements, the content of vitamin.2. were randomly selected in each township, land 42, 5 point sampling by the same soil; and within one year of 2,5,8 and December collected each township drinking water 30, each at least 1L. determination of soil and drinking water in As, Cd, Co Ni, Cu, Zn, Mn, Se, Fe and.3. levels by chi square test of the patients and the control group, positive group and negative group were analyzed by univariate analysis, the factors of P0.1 included in the multivariate Logistic regression analysis; the evaluation of diagnostic test and receiver technology Characteristic curve analysis of trace elements and vitamin HPV levels in the prediction of infection, the diagnostic value of CIN II +; by partial correlation analysis, soil and drinking water and the levels of trace elements in Uygur women CIN II + detection rate and the correlation between the infection rate of HPV. Results: 1. multivariate analysis showed that age less than 15 years, get married the number of 3 times, with more than 3 times per week, home delivery, toilet paper period, toilet clod, personal care score low, bathing frequency is low, without contraception and spouse smoking is high risk behavior factors in Xinjiang Uygur women in Bachu County of HPV infection, and family income of 5000 yuan and 5000~1 million yuan, get married the number of 3 times, in the home delivery, family history of cervical cancer, personal care score low, sanitary toilet paper and smoking are risk factors of.2. spouse behavior serum to the cervical lesions and cervical cancer in advanced As = 0.02 mg/Kg and vitamin D3 than 49.6434n G/L is a risk factor for HPV infection, and Ni = 0.1232 mg/Kg, Se = 0.02 and mg/Kg = 17.6705 ug/L folic acid was the protective factor in serum; Fe = 6.9153 and As = 0.02, mmol/L mg/Kg is the senior risk factors of cervical lesions and cervical cancer, and Ni is larger than 0.0965mg/Kg, Se = 0.02 mg/Kg and vitamin C 0.6857ug/L is the protective factors of.3.As, Ni, Se and the value of vitamin D3 and folic acid to predict the diagnosis of HPV infection was low, the area under the ROC curve is less than 0.7.4. with Se, Se and As combined with Se, and Ni can be used to predict advanced cervical lesions and cervical cancer, the diagnostic value of medium (ROC curve area up to under the above 0.7), the sensitivity and negative predictive value, false negative rate is low, but the specificity, accuracy and positive predictive value is low, the content of trace elements of high false positive rate of.5. in Bachu County Soil and drinking water did not exceed the national soil environment and drinking Water standard; CIN II + cervical lesion detection rate was positively correlated with As and Cu in the soil, and negatively correlated with Se, positively correlated with As in drinking water, and negatively correlated with Zn; the infection rate of HPV was positively correlated with soil As and negatively correlated with Se, positively correlated with Cu in drinking water. Was negatively correlated with Se. Conclusion: behavioral factors play an important role in the process of Xinjiang County of Bachu Uygur women's HPV infection and cervical lesions, should be targeted on the risk factors of behavior intervention, advocate late marriage, spouse quit smoking, toilet paper toilet, strengthen personal care and menstrual health; trace elements and vitamins in the serum content of Uygur and Bachu County women's HPV infection, CIN II + associated, should improve women's status of trace elements, so as to reduce the occurrence of cervical lesions; serum Se, Se and As, Se and Ni can be used in Xinjiang County of Bachu Uygur joint The primary screening of CIN II + in women is that the content of trace elements in soil and drinking water in Bachu county has certain correlation with the HPV infection rate of the Uygur women, the occurrence of high-grade cervical lesions and cervical cancer.

【學位授予單位】：新疆醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R737.33

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