HPV亞型與宮頸病變發(fā)生及預(yù)后的相關(guān)性研究
發(fā)布時間：2018-07-31 15:00
【摘要】：目的：高危型人乳頭瘤病毒亞型與不同程度宮頸病變及預(yù)后相關(guān)性研究 方法：選擇我院HPV(人乳頭瘤病毒)高危亞型檢測陽性且病理診斷為宮頸病變的患者，對其行相應(yīng)治療后3-12個月行HR-HPV(高危型人乳頭瘤病毒)分型檢測及細胞學(xué)檢查，必要再次活檢。 結(jié)果：①慢性宮頸炎、CINI、CINII-CINIII及宮頸癌的高危型HPV感染率分別為：53.79%、61.9%、77.5%、93.02%，對其各組病變組的高危型HPV感染率行X2檢驗，差異有統(tǒng)計學(xué)意義（X2=38.752，P0.05）。②16亞型在慢性宮頸炎及CINI、CINII+CINIII及宮頸癌中的檢測率都處于所有亞型中的首位，且檢出率在不同宮頸病變中差異有統(tǒng)計學(xué)意義(P0.05)，說明高危型16影響著宮頸病變的程度，隨著宮頸病變級別的升高，16亞型檢出率也隨之升高。15種檢出亞型在不同宮頸病變中的檢出率差異均有統(tǒng)計學(xué)意義（P0.05）。③300例隨訪患者檢出率最高的五種亞型為：HPV16、58、52、53、18；宮頸癌HPV16檢出率達到62.5%；HPV16型與HPV53型在不同宮頸病變檢出率差異有統(tǒng)計學(xué)意義（P0.05）；HPV16、18、33、39、52、53及58亞型在同一宮頸病變中占有率差異有統(tǒng)計學(xué)意義（P0.05）；16、58亞型在不同宮頸病變治療后的轉(zhuǎn)陰率差異有統(tǒng)計學(xué)意義(P0.05)。58亞型各載量之間轉(zhuǎn)陰率比較差異有統(tǒng)計學(xué)意義（P0.05）④單一高危型HPV感染中不同治療方式其轉(zhuǎn)陰率之間差異有統(tǒng)計學(xué)意義（P0.05）,二重及多重感染在經(jīng)不同治療方式后轉(zhuǎn)陰率差異無統(tǒng)計學(xué)意義（P0.05）。單一感染在不同宮頸病變轉(zhuǎn)陰率之間差異有統(tǒng)計學(xué)意義（P0.05），其在慢性炎和CINI、CINII和CINIIII及宮頸癌中的轉(zhuǎn)陰率分別為50.75%(67/132)、62.96%（51/81）及78.12%（25/32）,可見隨著宮頸病變級別的升高，單一高危型HPV感染經(jīng)治療后轉(zhuǎn)陰率也隨之升高。⑤16亞型轉(zhuǎn)陰率分別為：36.67%、62.07%、75%、72%經(jīng)四種治療方式后轉(zhuǎn)陰率比較有統(tǒng)計學(xué)意義（P0.05），39亞型無根治術(shù)治療方式，其他三種治療方式轉(zhuǎn)陰率分別為：0、71.43%、50%，差異有統(tǒng)計學(xué)意義（P0.05），四種治療方式總的轉(zhuǎn)陰率分別為：43.65%、63.53%、69.39%、72.50%，差異有統(tǒng)計學(xué)意義（P0.05）。說明HPV轉(zhuǎn)陰率與治療方式有關(guān)。單純干擾素治療與其他三種治療方式比較轉(zhuǎn)陰率差異均有統(tǒng)計學(xué)意義（P0.05）。⑥≤35歲、36~50歲、≥50歲三組，其HPV轉(zhuǎn)陰率分別為66.7%（26/39）、58.9%(112/190)、40.8%（29/71），三者比較有統(tǒng)計學(xué)意義（P0.05），58型HPV轉(zhuǎn)陰率在各年齡層差異有統(tǒng)計學(xué)意義（P0.05）。⑦不同隨訪時間各組高危型HPV轉(zhuǎn)陰率在不同宮頸病變及宮頸癌中經(jīng)多樣本率X2檢驗比較，差異都有統(tǒng)計學(xué)意義（P0.05），四種治療方式不同隨訪時間各個樣本率X2檢驗比較，差異都有統(tǒng)計學(xué)意義（P0.05），說明隨著時間的推移四種治療方法都會使轉(zhuǎn)陰率提高。⑧對患者進行隨訪的過程中有3例患者出現(xiàn)轉(zhuǎn)陰后再次感染，2例患者在同一亞型感染的同時新增亞型感染。 結(jié)論：1.高危型HPV感染是影響各級別宮頸病變的發(fā)生和發(fā)展，且隨著宮頸病變級別的升高，其感染高危型HPV的概率也隨之升高。2.16亞型在是各級別宮頸病變最常見的亞型，尤其在宮頸癌中檢出率最高，，其次為58亞型。且16亞型隨著宮頸病變級別的升高感染率也隨之提高。再次印證16亞型最易導(dǎo)致宮頸癌發(fā)生。3.常見58亞型在治療前HPV載量高低影響宮頸病變患者的預(yù)后，而16亞型與其載量高低無關(guān)，治療后各高危亞型持續(xù)感染預(yù)示宮頸病變存在或復(fù)發(fā)。4.宮頸病變級別只在16亞型中影響患者的轉(zhuǎn)陰率，其余亞型在不同宮頸病變級別中轉(zhuǎn)陰率無差別，所以尚不能確定宮頸病變的嚴(yán)重程度是否影響高危型HPV的轉(zhuǎn)陰因素。5.不同治療方式都能有效清除高危型HPV感染，宮頸癌根治術(shù)轉(zhuǎn)陰率較高，本資料顯示不同手術(shù)治療方式的效果明顯優(yōu)于干擾素治療。在16亞型中各個治療方式對預(yù)后影響最明顯。6.單一亞型感染預(yù)后的轉(zhuǎn)陰率明顯高于雙重及多重感染。說明陰道對單一亞型的清除率明顯高于多亞型。7.本資料顯示患者年齡越大，轉(zhuǎn)陰率越低，說明年齡也是影響轉(zhuǎn)陰率的因素。8.各宮頸病變級別經(jīng)過不同治療后隨著時間推移轉(zhuǎn)陰率逐漸提高。綜合來看宮頸癌根治術(shù)后轉(zhuǎn)陰率最高，可能與該手術(shù)范圍大，預(yù)防了宮頸病變殘留及復(fù)發(fā)。9.即使患者在治療后可以轉(zhuǎn)陰，但是也有再次感染高危型HPV的可能，也可能是重復(fù)感染或重新感染新的亞型。
[Abstract]:Objective: To study the correlation between high risk human papillomavirus subtypes and cervical lesions and prognosis.
Methods: the patients with high risk subtype of HPV (human papillomavirus) and pathological diagnosis of cervical lesions were selected, and the HR-HPV (high risk human papillomavirus) typing and cytological examination were performed 3-12 months after the corresponding treatment, and the need for re biopsy was necessary.
Results: (1) the high risk HPV infection rates of chronic cervicitis, CINI, CINII-CINIII and cervical cancer were 53.79%, 61.9%, 77.5%, 93.02% respectively. The high risk HPV infection rate in each group was statistically significant (X2=38.752, P0.05). (2) 16 subtypes were detected in chronic cervicitis and CINI, CINII+CINIII and cervical cancer. In all subtypes, the difference of the detection rate in different cervical lesions was statistically significant (P0.05), indicating that high risk type 16 affects the degree of cervical lesions. With the increase of cervical lesions, the detection rate of 16 subtypes also increases the detection rate of.15 subtypes in different uterine cervix lesions (P0.0 5) (5) (3) the five subtypes of 300 cases with the highest detection rate were: the detection rate of HPV16 in cervical cancer was 62.5%, and the difference between HPV16 and HPV53 in different cervical lesions was statistically significant (P0.05), and the difference in the proportion of HPV16,18,33,39,52,53 and 58 subtypes in the same cervical disease was statistically significant (P0.05); 1 The difference of the negative rate of the 6,58 subtype after the treatment of different cervical lesions was statistically significant (P0.05) the difference in the negative rate of the.58 subtypes was statistically significant (P0.05) (P0.05) there was a statistically significant difference between the different treatment modes of the single high-risk HPV infection (P0.05), and the double and multiple infection after different treatment methods. There was no significant difference in the negative rate (P0.05). The negative rate of single infection in different cervical lesions was statistically significant (P0.05). The negative rate in chronic inflammation and CINI, CINII and CINIIII and cervical cancer were 50.75% (67/132), 62.96% (51/81) and 78.12% (25/32) respectively. The negative rate of the infection was also increased after treatment. 5, the 16 subtype negative rate was 36.67%, 62.07%, 75%, 72% after four treatments, the negative rate was statistically significant (P0.05), 39 subtype without radical treatment, and the other three treatment methods were respectively: 0,71.43%, 50%, and the difference was statistically significant (P0.05), four therapeutic parties. The total conversion rate of the type was 43.65%, 63.53%, 69.39%, 72.50%, and the difference was statistically significant (P0.05). It indicated that the conversion rate of HPV was related to the treatment mode. The difference of the negative rate of the simple interferon treatment and the other three treatments were statistically significant (P0.05). (6) < 35 years old, 36~50 years, or 50 years old and three groups, and their HPV conversion rate was 66.7% (26/39 ), 58.9% (112/190), 40.8% (29/71), three were statistically significant (P0.05), and type 58 HPV negative rate was statistically significant in all age groups (P0.05). (P0.05) high risk HPV negative rate in different groups of cervical lesions and cervical cancer were compared with the multiple sample rate X2 test, the difference was statistically significant (P0.05) and four treatment methods. The differences were statistically significant (P0.05) in the X2 test of each sample rate at different follow-up times, indicating that the four treatments would increase the negative rate over time. In the follow-up period, 3 patients were reinfected and 2 were infected with the same subtype.
Conclusion: 1. high risk HPV infection is the occurrence and development of cervical lesions at all levels, and with the increase of cervical lesions, the probability of infection of high risk type HPV also increases the most common subtype of.2.16 subtype in all levels of cervical lesions, especially in cervical cancer, followed by the 58 subtype. And the 16 subtype with cervical disease. The rate of change in the level of infection also increased. Again, it was confirmed that the 16 subtype of the 16 subtype was the most likely to lead to the prognosis of the patients with cervical lesions before the treatment of the 58 subtypes of cervical cancer, but the 16 subtype was not related to the load. The persistent infection of the high risk subtypes indicated the existence of cervical lesions or the recurrence of the.4. cervix lesion level only after treatment. In the 16 subtype, the negative rate of the patients was affected, the other subtypes had no difference in the different cervical lesions, so it was not possible to determine whether the severity of the cervical lesions affected the negative factors of high risk HPV..5. could effectively remove the high risk HPV infection. The effect of the same surgical treatment was obviously better than that of interferon. In the 16 subtype, the effect of each treatment on the prognosis was most obvious. The negative rate of.6. single subtype infection was significantly higher than that of double and multiple infection. The clearance rate of the single subtype of vagina was significantly higher than that of the multisubtype.7.. The older the patient was, the lower the negative rate was. It shows that the age is also a factor that affects the negative rate of.8.. After different treatment, the rate of changing the negative rate of the cervix is gradually increased after different treatment. The risk of infection with high-risk HPV may also be repeated infection or re infection of new subtypes.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33
[Abstract]:Objective: To study the correlation between high risk human papillomavirus subtypes and cervical lesions and prognosis.
Methods: the patients with high risk subtype of HPV (human papillomavirus) and pathological diagnosis of cervical lesions were selected, and the HR-HPV (high risk human papillomavirus) typing and cytological examination were performed 3-12 months after the corresponding treatment, and the need for re biopsy was necessary.
Results: (1) the high risk HPV infection rates of chronic cervicitis, CINI, CINII-CINIII and cervical cancer were 53.79%, 61.9%, 77.5%, 93.02% respectively. The high risk HPV infection rate in each group was statistically significant (X2=38.752, P0.05). (2) 16 subtypes were detected in chronic cervicitis and CINI, CINII+CINIII and cervical cancer. In all subtypes, the difference of the detection rate in different cervical lesions was statistically significant (P0.05), indicating that high risk type 16 affects the degree of cervical lesions. With the increase of cervical lesions, the detection rate of 16 subtypes also increases the detection rate of.15 subtypes in different uterine cervix lesions (P0.0 5) (5) (3) the five subtypes of 300 cases with the highest detection rate were: the detection rate of HPV16 in cervical cancer was 62.5%, and the difference between HPV16 and HPV53 in different cervical lesions was statistically significant (P0.05), and the difference in the proportion of HPV16,18,33,39,52,53 and 58 subtypes in the same cervical disease was statistically significant (P0.05); 1 The difference of the negative rate of the 6,58 subtype after the treatment of different cervical lesions was statistically significant (P0.05) the difference in the negative rate of the.58 subtypes was statistically significant (P0.05) (P0.05) there was a statistically significant difference between the different treatment modes of the single high-risk HPV infection (P0.05), and the double and multiple infection after different treatment methods. There was no significant difference in the negative rate (P0.05). The negative rate of single infection in different cervical lesions was statistically significant (P0.05). The negative rate in chronic inflammation and CINI, CINII and CINIIII and cervical cancer were 50.75% (67/132), 62.96% (51/81) and 78.12% (25/32) respectively. The negative rate of the infection was also increased after treatment. 5, the 16 subtype negative rate was 36.67%, 62.07%, 75%, 72% after four treatments, the negative rate was statistically significant (P0.05), 39 subtype without radical treatment, and the other three treatment methods were respectively: 0,71.43%, 50%, and the difference was statistically significant (P0.05), four therapeutic parties. The total conversion rate of the type was 43.65%, 63.53%, 69.39%, 72.50%, and the difference was statistically significant (P0.05). It indicated that the conversion rate of HPV was related to the treatment mode. The difference of the negative rate of the simple interferon treatment and the other three treatments were statistically significant (P0.05). (6) < 35 years old, 36~50 years, or 50 years old and three groups, and their HPV conversion rate was 66.7% (26/39 ), 58.9% (112/190), 40.8% (29/71), three were statistically significant (P0.05), and type 58 HPV negative rate was statistically significant in all age groups (P0.05). (P0.05) high risk HPV negative rate in different groups of cervical lesions and cervical cancer were compared with the multiple sample rate X2 test, the difference was statistically significant (P0.05) and four treatment methods. The differences were statistically significant (P0.05) in the X2 test of each sample rate at different follow-up times, indicating that the four treatments would increase the negative rate over time. In the follow-up period, 3 patients were reinfected and 2 were infected with the same subtype.
Conclusion: 1. high risk HPV infection is the occurrence and development of cervical lesions at all levels, and with the increase of cervical lesions, the probability of infection of high risk type HPV also increases the most common subtype of.2.16 subtype in all levels of cervical lesions, especially in cervical cancer, followed by the 58 subtype. And the 16 subtype with cervical disease. The rate of change in the level of infection also increased. Again, it was confirmed that the 16 subtype of the 16 subtype was the most likely to lead to the prognosis of the patients with cervical lesions before the treatment of the 58 subtypes of cervical cancer, but the 16 subtype was not related to the load. The persistent infection of the high risk subtypes indicated the existence of cervical lesions or the recurrence of the.4. cervix lesion level only after treatment. In the 16 subtype, the negative rate of the patients was affected, the other subtypes had no difference in the different cervical lesions, so it was not possible to determine whether the severity of the cervical lesions affected the negative factors of high risk HPV..5. could effectively remove the high risk HPV infection. The effect of the same surgical treatment was obviously better than that of interferon. In the 16 subtype, the effect of each treatment on the prognosis was most obvious. The negative rate of.6. single subtype infection was significantly higher than that of double and multiple infection. The clearance rate of the single subtype of vagina was significantly higher than that of the multisubtype.7.. The older the patient was, the lower the negative rate was. It shows that the age is also a factor that affects the negative rate of.8.. After different treatment, the rate of changing the negative rate of the cervix is gradually increased after different treatment. The risk of infection with high-risk HPV may also be repeated infection or re infection of new subtypes.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33
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相關(guān)期刊論文 前5條
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