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目的:了解甘肃地区健康妇女宫颈人乳头瘤病毒(human papillomavirus,HPV)感染的流行病学特征,探讨人乳头瘤病毒HPV的型别与病理分级的关系。方法:选择2009年5~8月在甘肃省妇幼保健院妇科门诊行宫颈HPV分型检测的576例患者为研究对象,采用核酸分子快速导流杂交基因芯片技术(Hybrimax)对所有患者宫颈脱落细胞进行HPV分型,随后进行阴道镜检查、宫颈多点活检和宫颈管诊刮术,以病理学诊断为金标准。结果:576例患者中,HPV阳性率19.44%,高危型占73.21%。不同宫颈病变中常见的HPV亚型(检出率>10.0%)从高到低依次为HPV16(26.12%)、HPV58(15.67%)、HPV52(10.45%)。不同病理分级中HPV型别不同,宫颈癌中依次为HPV16、18、31;CINⅡ及CINⅢ中依次为HPV16、58、31、33、66;CINⅠ中依次为HPV16、58、52、33、39、6、11、68、cp8304。对于病理诊断≥CINⅡ者,HPV分型检测的敏感度为79.31%,特异度为87.26%,阳性预测值为41.07%,阴性预测值为97.41%。结论:HPV基因分型检测,可1次检测多种亚型,了解HPV型别分布的地域性差异,对于研制适宜甘肃省妇女的特异性HPV疫苗有指导意义,且有利于宫颈病变的分级、分型及指导个体化治疗。
Objective: To understand the epidemiological characteristics of cervical papillomavirus (HPV) infection in healthy women in Gansu province and to explore the relationship between HPV types and pathological grade of HPV in healthy subjects. Methods: From May to August in 2009, 576 cases of HPV genotyping in gynecology clinic of Gansu Provincial Maternal and Child Health Hospital were selected as research objects. Hybrimax was used to detect all the exfoliated cells HPV typing, followed by colposcopy, cervical biopsy and cervical canal curettage to pathological diagnosis as the gold standard. Results: Among 576 patients, the positive rate of HPV was 19.44% and the high risk type was 73.21%. The HPV subtypes (detection rate> 10.0%) common in different cervical lesions were HPV16 (26.12%), HPV58 (15.67%) and HPV52 (10.45%) in descending order. HPV types in different pathological grades are different, followed by HPV16,18,31 in cervical cancer, followed by HPV16,58,31,33,66 in CINⅡ and CINⅢ, followed by HPV16,58,52,33,39 in CINⅠ, 6,11,68, cp8304. For pathological diagnosis of CINII, the sensitivity of HPV typing was 79.31%, the specificity was 87.26%, the positive predictive value was 41.07% and the negative predictive value was 97.41%. CONCLUSION: HPV genotyping test can detect multiple subtypes in one test. It is of great significance to study the regional differences of HPV type distribution in order to develop a specific HPV vaccine suitable for women in Gansu Province. It is also beneficial to the classification of cervical lesions, Type and guide the individual treatment.