【摘要】：目的 旨在摸清武漢市農(nóng)村戶籍婦女宮頸癌及癌前病變流行狀況和流行特征,利用大樣本資料分析比較不同的宮頸癌篩查方法,探討更加有效、適宜,便于推廣的篩查方法；對宮頸癌及癌前病變影響因素進(jìn)行研究,為武漢市制定宮頸癌的預(yù)防策略提供科學(xué)依據(jù)。 方法 采取整群抽樣的方法于2011年6月至2012年6月期間對武漢市16個區(qū)170401名25-64歲的農(nóng)村戶籍婦女進(jìn)行宮頸癌篩查和診斷,宮頸癌初篩采用液基薄層細(xì)胞學(xué)技術(shù)(TCT)和DNA倍體定量分析技術(shù),初篩陽性者進(jìn)行HPV-DNA檢測,并在陰道鏡下取宮頸活體組織病理檢查進(jìn)行確診。采用自編問卷,對初篩陽性者進(jìn)行問卷調(diào)查,調(diào)查內(nèi)容包括一般人口學(xué)情況、環(huán)境因素、遺傳因素、既往史及現(xiàn)病史、女性個人健康史、生活習(xí)慣及飲食習(xí)慣以及社會心理因素等七大方面。采取1：1病例對照研究方法對宮頸癌和癌前病變的危險(xiǎn)因素進(jìn)行分析。使用SPSS13.0軟件包對數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。 結(jié)果 1、武漢市宮頸癌及癌前病變檢出情況：武漢市農(nóng)村戶籍婦女宮頸癌患病率為27.13/10萬,按年齡標(biāo)化的患病率為34.71/10萬。 2、宮頸癌及癌前病變地域和年齡分布特征：宮頸癌檢出率最高的是江夏區(qū)29.67/10萬,檢出率最低的是漢南區(qū)為0,其次是蔡甸區(qū)4.95/10萬。宮頸CIN1-3級病變均以40-45歲檢出率最高,而宮頸癌檢出率隨年齡呈現(xiàn)上升趨勢,以60-64歲組檢出率最高。 3、初篩陽性婦女HPV感染和分型情況：宮頸癌初篩陽性婦女HPV感染率為57.03%,宮頸炎、宮頸上皮內(nèi)瘤變和宮頸癌婦女HPV的感染率分別為40.72%,89.64%和92.86%,差異具有統(tǒng)計(jì)學(xué)意義。HPV16型檢出率最高,占檢測人群的18.16%,其次是58型(13.55%),52型(11.00%),33型(5.68%)。宮頸癌患者中64.29%感染HPV16型。 4、兩種初篩方法的比較：TCT和細(xì)胞DNA倍體定量分析的靈敏度、特異度、陽性預(yù)測值、陰性預(yù)測值、診斷準(zhǔn)確率分別為70.03%、51.52%、36.99%、80.88%、56.87%和80.26%、39.61%、35.02%、83.17%、51.33%,TCT靈敏度低于細(xì)胞DNA倍體分析,但特異度較高,總體診斷正確率TCT高于DNA倍體定量分析。 5、HPV-DNA檢測：在初篩陽性婦女中靈敏度為92.18%,特異度為56.73%,靈敏度顯著高于TCT和DNA倍體分析,特異度也略高。HPV-DNA檢測在ASC-US組的診斷正確率較高,達(dá)到68.62%。 6、宮頸癌及癌前病變影響因素分析：將病例組和對照組7大類106個因素進(jìn)行單因素條件logistic回歸分析,結(jié)果顯示HPV感染、初婚年齡、初次性行為年齡、首次妊娠年齡、生育第一胎年齡、使用手機(jī)或吹風(fēng)機(jī)、接觸噪音強(qiáng)光、婦科疾病未治療、月經(jīng)持續(xù)時(shí)間短、放置宮內(nèi)節(jié)育器、使用避孕套、被動吸煙等14項(xiàng)為宮頸癌和癌前病變的影響因素。多因素條件Logistic回歸分析結(jié)果表明,有宮頸癌家族史(OR=191.07)、HPV感染(OR=247.66)為宮頸癌及癌前病變發(fā)生的危險(xiǎn)因素,而絕經(jīng)(OR=0.13)、首次妊娠年齡晚(OR=0.30)為宮頸癌及癌前病變發(fā)生的保護(hù)因素。 結(jié)論 武漢市農(nóng)村戶籍婦女宮頸癌患病率為34.71/10萬,高于經(jīng)濟(jì)發(fā)達(dá)地區(qū)但低于西部落后地區(qū)。宮頸癌的患病率隨年齡增長呈現(xiàn)上升趨勢,漢南區(qū)和蔡甸區(qū)宮頸癌發(fā)生率明顯低于其他區(qū)。在初篩陽性婦女中的HPV感染率為57.03%,宮頸病變級別越高,高危型HPV感染率越高。HPV16型是最主要的致癌HPV亞型,多重HPV亞型感染沒有致癌協(xié)同作用。篩查方法中TCT靈敏度低于細(xì)胞DNA倍體分析,但特異度較高,總體診斷正確率高于DNA倍體定量分析。HPV-DNA檢測靈敏度、特異度均高于TCT和DNA倍體分析,但由于HPV-DNA檢測陽性預(yù)測值低,不適合單獨(dú)用于初篩,可以用于TCT初篩后結(jié)果為ASC-US病人的分診,具有較強(qiáng)的臨床和篩查應(yīng)用價(jià)值。有HPV感染、宮頸癌家族史為武漢市農(nóng)村戶籍婦女宮頸癌和癌前病變發(fā)生的危險(xiǎn)因素,而絕經(jīng)、首次妊娠年齡晚為宮頸癌和癌前病變發(fā)生的保護(hù)因素。 創(chuàng)新之處 (1)首次摸清武漢市農(nóng)村戶籍婦女宮頸癌發(fā)生情況及其流行特征,并對宮頸癌發(fā)生的危險(xiǎn)因素進(jìn)行研究； (2)利用大樣本資料,對三種篩查方法及其聯(lián)合或序貫應(yīng)用建立篩查模型,并進(jìn)行篩查效果分析,為國內(nèi)進(jìn)行大規(guī)模宮頸癌篩查制定方案或臨床有效運(yùn)用這些宮頸癌篩查方法提供了科學(xué)依據(jù)。
[Abstract]:objective
The purpose of this study is to find out the prevalence and epidemic characteristics of cervical cancer and precancerous lesions in the rural household of Wuhan, and to analyze and compare different screening methods of cervical cancer by using large sample data to explore more effective, suitable and convenient screening methods, and to study the influence factors of cervical cancer and precancerous lesions, and to prevent cervical cancer in Wuhan. The strategy provides a scientific basis.
Method
From June 2011 to June 2012, a cluster sampling method was used to screen and diagnose cervical cancer of 170401 rural household registered women of 25-64 years old in 16 districts of Wuhan. Cervical cancer was screened by liquid based thin layer cytology (TCT) and DNA ploidy quantitative analysis technique. The initial sieves were detected by HPV-DNA and cervical biopsy under colposcopy. The body histopathological examination was made to make a diagnosis. A questionnaire survey was made by self compiled questionnaire. The questionnaire survey was carried out. The contents included general demographic, environmental, genetic, past and present history, women's personal health history, living habits and dietary habits, and social psychological factors. The 1:1 case control study was adopted. Methods the risk factors of cervical cancer and precancerous lesions were analyzed. Data were analyzed by SPSS13.0 software package.
Result
1, the detection of cervical cancer and precancerous lesions in Wuhan: the prevalence rate of cervical cancer in rural households in Wuhan is 27.13/10 million, and the prevalence rate of age standardized is 34.71/10 million.
2, the region and age distribution of cervical cancer and precancerous lesions: the highest detection rate of cervical cancer was 29.67/10 million in Jiangxia district. The lowest detection rate was 0 in Hannan District, followed by 4.95/10 million in Caidian district. The highest detection rate of cervical CIN1-3 grade lesions was 40-45 years old, while the detection rate of cervical cancer increased with age, and the detection rate of 60-64 year old group was the most. High.
3, HPV infection and typing of positive women with early screening: the incidence of HPV infection in cervical cancer positive women was 57.03%, cervicitis, cervical intraepithelial neoplasia and HPV of cervical cancer were 40.72%, 89.64% and 92.86% respectively. The difference was statistically significant in.HPV16 detection rate, accounting for 18.16% of the test population, followed by type 58 (13.55%), 52 (1 1%), type 33 (5.68%). 64.29% of cervical cancer patients were infected with HPV16.
4, the comparison of the two screening methods: the sensitivity, specificity, positive predictive value and negative predictive value of TCT and DNA ploidy quantitative analysis were 70.03%, 51.52%, 36.99%, 80.88%, 56.87% and 80.26%, 39.61%, 35.02%, 83.17%, 51.33%, and the sensitivity of TCT was lower than the cell DNA ploidy analysis, but the specificity was higher and the overall diagnostic accuracy was TCT The quantitative analysis was higher than DNA ploidy.
5, HPV-DNA detection: the sensitivity of the positive women was 92.18%, the specificity was 56.73%, the sensitivity was significantly higher than the TCT and DNA ploidy analysis, and the specificity was also slightly higher in the ASC-US group, the accuracy of the diagnosis was higher in the ASC-US group, and reached 68.62%..
6, analysis of the influencing factors of cervical cancer and precancerous lesions: a single factor conditional logistic regression analysis was carried out between the case group and the control group of 7 major factors. The results showed that the HPV infection, the age of first marriage, the first sexual age, the first pregnancy age, the first birth age, the use of hand machine or hair dryer, the exposure to the noise, the untreated gynecopathy, and the untreated gynecologic diseases. After a short duration of time, 14 items such as intrauterine device, condom and passive smoking were the factors affecting cervical cancer and precancerous lesions. Multiple factor Logistic regression analysis showed that there were family history of cervical cancer (OR=191.07), HPV infection (OR=247.66) as a risk factor for cervical cancer and precancerous lesions, and OR=0.13 (OR=0.13), for the first time. Late pregnancy (OR=0.30) is a protective factor for cervical cancer and precancerous lesions.
conclusion
The prevalence rate of cervical cancer in rural households in Wuhan is more than 34.71/10 million, which is higher than that in the economically developed areas but lower than that in the western regions. The prevalence of cervical cancer increases with age, and the incidence of cervical cancer in Hannan and Caidian areas is significantly lower than that in other areas. The rate of HPV infection in the early screening positive women is 57.03%, and the higher the cervical lesions are. High risk type HPV infection rate is higher.HPV16 type is the most important carcinogenic HPV subtype, multiple HPV subtype infection has no carcinogenic synergism. TCT sensitivity is lower than cell DNA ploidy analysis, but the specificity is higher, the overall diagnostic accuracy is higher than the DNA ploidy quantitative analysis.HPV-DNA detection sensitivity, the specificity is higher than TCT and DNA ploidy. Analysis, however, because of low HPV-DNA positive predictive value, it is not suitable to be used alone for initial screening. It can be used for the diagnosis of ASC-US patients after TCT initial screening. It has a strong clinical and screening application value. There are HPV infection, the family history of cervical cancer is the risk factor of cervical cancer and precancerous lesions in rural women of Wuhan, and menopause, first pregnancy. Late pregnancy age is a protective factor for cervical cancer and precancerous lesions.
Innovation
(1) for the first time to find out the occurrence and epidemiological characteristics of cervical cancer in rural women in Wuhan, and to study the risk factors of cervical cancer.
(2) using large sample data to establish screening models for three screening methods and their joint or sequential applications, and to analyze the effect of screening, which provides a scientific basis for large-scale cervical cancer screening and the clinical effective application of these screening methods for cervical cancer.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R737.33

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