本文選題：人乳頭瘤病毒 + 宮頸病變��； 參考：《新疆大學(xué)》2017年碩士論文

【摘要】：目的:宮頸癌是新疆維吾爾族婦女發(fā)病率極高的惡性腫瘤之一。利用分子生物學(xué)和免疫檢測(cè)法,分析維吾爾族婦女高危型HPV感染的情況及危險(xiǎn)因素;探討維吾爾族婦女高危型HPV感染與多項(xiàng)免疫指標(biāo)的變化及血清抗體水平之間的相關(guān)性,為建立宮頸癌篩查的輔助指標(biāo)體系提供了依據(jù)。方法:2015年12月至2016年12月就診于新疆維吾爾自治區(qū)人民醫(yī)院門診或住院的婦女,自愿接受HCII法檢測(cè)HPV感染聯(lián)合或者未聯(lián)合液基細(xì)胞學(xué)檢查,從中篩選出HPV感染陽(yáng)性或者液基細(xì)胞學(xué)診斷≥非典型鱗狀上皮細(xì)胞(atypical squamous cell of Undetermined signification,ASC-US)患者,進(jìn)一步進(jìn)行陰道鏡下檢查和活檢送病理檢查;同時(shí)抽取靜脈血3~5毫升,分離出2毫升用于流式細(xì)胞儀法檢測(cè)T淋巴細(xì)胞亞群;剩余的血清/血漿利用酶聯(lián)免疫吸附法(ELISA)檢測(cè)人乳頭瘤病毒16型L1-IgG抗體水平。結(jié)果:1.(1)維吾爾族與漢族宮頸癌HPV陽(yáng)性率分別為87.93%、68.04%;兩民族之間有顯著性差異(P0.01)。(2)HPV載量RLU/CO≥1.0為陽(yáng)性,1.0為陰性,根據(jù)HPV載量高低分為1、1~100、100~1000、1000共4個(gè)載量組;宮頸病變與HPV載量(RLU/CO)之間存在正相關(guān)關(guān)系,HPV載量越高,宮頸病變程度越重(P0.01)。(3)維吾爾族和漢族兩組中,HPV陰性(RLU/CO1)組分別與1~100組、100~1000組、1000組;且1~100組和1000組;100~1000組和1000組,各組間有顯著性差異(P0.05)。(4)液基細(xì)胞學(xué)(TCT)檢查結(jié)果分為宮頸上皮內(nèi)病變陰性(NILM)、非典型鱗狀上皮細(xì)胞(ASC-US)、低級(jí)別宮頸鱗狀上皮內(nèi)病變(LSIL)、高級(jí)別宮頸鱗狀上皮內(nèi)病變(HSIL)、宮頸鱗狀細(xì)胞癌和非典型腺細(xì)胞(SCC+AGUS)等5個(gè)組;NILM、ASC-US、LSIL、HSIL、SCC+AGUS組與HPV陽(yáng)性率兩組之間有顯著性差異(P0.01)。(5)在NILM組和SCC+AGUS組,漢族患者所占30.77%(4/13)、而維吾爾族患者所占69.23%(9/13),兩組之間有顯著性差異(P0.01)。(6)年齡和HPV載量也逐步升高,35~45歲和45~55歲之間明顯升高(P0.05)。(7)宮頸病變與年齡有一定的關(guān)系,兩組之間有顯著性差異(P0.05)。2.(1)CD4輔助/誘導(dǎo)T細(xì)胞百分比參考范圍33%~58%,根據(jù)參考范圍高低分為33、33~45、45~58、58等4個(gè)組;隨著宮頸病變程度的加重,CD4輔助/誘導(dǎo)T細(xì)胞百分比在33、33~45范圍內(nèi)明顯下降,各組之間有顯著性差異(P0.01)。(2)CD4/CD8比值參考范圍0.71~2.78,根據(jù)參考范圍高低分為0.71、0.71~1.74、1.74~2.78、2.78等4個(gè)組;隨著宮頸病變程度的加重,CD4/CD8比值在0.71、0.71~1.74范圍內(nèi)明顯下降,各組之間有顯著性差異(P0.01)。(3)CD3總T細(xì)胞百分比參考范圍56%~86%,根據(jù)參考范圍高低分為56、56~71、71~86、86等4個(gè)組;隨著宮頸病變的加重,CD3總T細(xì)胞百分比56~71、71~86范圍有下降趨勢(shì),但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(4)CD8抑制/殺傷T細(xì)胞百分比參考范圍13%~39%,根據(jù)參考范圍高低分為13、13~26、26~39、39等4個(gè)組;隨著宮頸病變的加重,CD8抑制/殺傷T細(xì)胞百分比39范圍有下降趨勢(shì),但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.(1)隨著宮頸病變加重,HPV 16 L1-IgG抗體水平下降趨勢(shì),但各組之間無(wú)顯著差異(P0.05)。(2)HPV載量(RLU/CO)不同的與HPV 16 L1-IgG抗體水平無(wú)顯著性差異(P0.05)。(3)HPV16 L1-IgG抗體水平與不同民族之間沒有相關(guān)性(P0.05)。(4)HPV16 L1-IgG抗體水平與年齡之間沒有相關(guān)性(P0.05)。結(jié)論:1.宮頸病變級(jí)別與HR-HPV感染率呈正相關(guān)。HPV載量增加與高級(jí)別宮頸上皮內(nèi)病變和宮頸癌的患病風(fēng)險(xiǎn)正相關(guān)。隨著細(xì)胞學(xué)及宮頸病變病理學(xué)級(jí)別的升高,HR-HPV載量及HPV的陽(yáng)性率均隨之升高。2.機(jī)體免疫功能低下和免疫功能紊亂均使宮頸病變的危險(xiǎn)度增高。高級(jí)別宮頸病變患者的細(xì)胞免疫功能均有不同程度的降低,其中宮頸癌患者的細(xì)胞免疫功能降低最為顯著。3.血清HPV16 L1-IgG抗體檢測(cè)陽(yáng)性既可代表現(xiàn)存HPV感染,也可表示既往HPV感染。HPV 16 L1-IgG抗體陽(yáng)性率隨宮頸病變級(jí)別增高呈下降趨勢(shì),但血清抗體水平之間無(wú)顯著性差異,試驗(yàn)結(jié)果可能與HPV清除與宮頸病變逆轉(zhuǎn)有關(guān)。
[Abstract]:Objective: cervical cancer is one of the malignant tumors of Uygur women in Xinjiang. Using molecular biology and immunoassay, the situation and risk factors of high risk HPV infection in Uygur women are analyzed, and the correlation between high risk HPV infection of Uygur women and the changes of multiple immune markers and the level of serum antibody are discussed. To establish a basis for establishing an auxiliary index system for screening for cervical cancer. Methods: from December 2015 to December 2016, women who were hospitalized at the the Xinjiang Uygur Autonomous Region people's hospital were admitted to the the Xinjiang Uygur Autonomous Region people's hospital. The HPV infection combined with or without the combined liquid based cytological examination was tested voluntarily, and the positive or liquid based cytological diagnosis of HPV infection was screened out. Patients with atypical squamous cells (atypical squamous cell of Undetermined signification, ASC-US) were further examined under colposcopy and biopsy, and 3~5 milliliters of venous blood were extracted at the same time, and 2 ml was isolated for the detection of T lymphatic subsets by flow cytometry; the remaining serum / plasma was used for enzyme linked immunosorbent assay. Method (ELISA) detection of human papillomavirus type 16 L1-IgG antibody level. Results: 1. (1) the Uygur and Han cervical cancer HPV positive rate is 87.93%, 68.04%; two ethnic groups have significant difference (P0.01). (2) HPV load RLU/CO > 1 as positive, 1 as negative, according to the HPV load level is divided into 1,1~100100~10001000, 4 load groups; cervical disease There was a positive correlation between change and HPV load (RLU/CO), the higher the load of HPV, the higher the degree of cervical lesions (P0.01). (3) in two groups of Uygur and Han, HPV negative (RLU/CO1) group was respectively with 1~100 group, 100~1000 group and 1000 groups, and 1~100 group and 1000 group, 100~1000 group and 1000 groups, there were significant differences (P0.05). (4) liquid based cytology (TCT) examination The results were divided into 5 groups: negative cervical intraepithelial lesion (NILM), atypical squamous epithelial cell (ASC-US), low grade cervical squamous intraepithelial lesion (LSIL), high grade cervical squamous intraepithelial lesion (HSIL), cervical squamous cell carcinoma and atypical gland cell (SCC+AGUS), and NILM, ASC-US, LSIL, HSIL, SCC+AGUS group and HPV positive rate two groups Significant difference (P0.01). (5) in group NILM and group SCC+AGUS, 30.77% (4/13) of Han patients and 69.23% (9/13) of Uygur patients (9/13), there was a significant difference between two groups (P0.01). (6) age and HPV load increased gradually, 35~45 and 45~55 (P0.05). (7) there was a certain relationship between cervical lesions and age, two groups between the two groups. There were significant differences (P0.05).2. (1) CD4 auxiliary / inducement of T cell percentage reference range 33%~58%, according to the reference range of 33,33~45,45~58,58 and other groups, with the severity of cervical lesions, the percentage of CD4 assisted / induced T cells decreased significantly in the 33,33~45 range, there was a significant difference between each group (P0.01). (2) CD4/CD8 ratio reference. The range of 0.71~2.78 was divided into 4 groups according to the reference range of 0.71,0.71~1.74,1.74~2.78,2.78. With the aggravation of the degree of cervical lesions, the CD4/CD8 ratio decreased significantly within the range of 0.71,0.71~1.74. There was a significant difference between each group (P0.01). (3) the reference range of the total CD3 T cell percentage was 56%~86%, according to the reference range, 56,56~71,71 was divided into 56,56~71,71 ~86,86 and other 4 groups, with the aggravation of cervical lesions, the percentage of CD3 T cell percentage 56~71,71~86 decreased, but the difference was not statistically significant (P0.05). (4) the reference range of CD8 inhibition / killing T cell percentage was 13%~39%, according to the reference range, 4 groups were divided into 13,13~26,26~39,39 and so on. With the aggravation of cervical lesions, CD8 inhibition / killing T cells There was a downward trend in the percentage 39 range, but the difference was not statistically significant (P0.05).3. (1) with the aggravation of cervical lesions, HPV 16 L1-IgG antibody level decreased, but there was no significant difference between each group (P0.05). (2) there was no significant difference between HPV load (RLU/CO) and HPV 16 L1-IgG antibody water level (P0.05). (3) HPV16 L1-IgG antibody level and different ethnic groups. There is no correlation between (P0.05). (4) there is no correlation between HPV16 L1-IgG antibody level and age (P0.05). Conclusion: the level of cervical lesions and HR-HPV infection rate is positively correlated with the increase of.HPV load and high level cervical intraepithelial lesion and the risk of cervical cancer. With the increase of cytology and the pathological grade of cervical lesions, HR-HPV The positive rate of load and HPV increased with the immune function of.2. and the disorder of immune function, the risk of cervical lesions increased. The cellular immune function of patients with high grade cervical lesions decreased in varying degrees, and the most significant reduction of cellular immune function in cervical cancer patients was.3. serum HPV16 L1-IgG antibody test positive It can not only represent the existing HPV infection, but also indicate that the positive rate of.HPV 16 L1-IgG antibody in the previous HPV infection is decreasing with the increase of cervical lesions, but there is no significant difference between the serum antibody level and the results of the test may be related to the clearance of HPV and the reversal of cervical lesions.

【學(xué)位授予單位】：新疆大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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