[不同HPV亚型感染合并细胞学异常状态下CIN2+/CIN3+风险的评估]
[Evaluation of CIN2+ /CIN3+ risk of different HPV subtypes infection combined with abnormal cytology status].
作者信息
Luo H X, Du H, Liu Z H, Zhang L J, Wang C, Wu R F
机构信息
Department of Obstetrics and Gynecology, Shenzhen Key Laboratory of Gynecological Diagnostic Technology Research, Peking University Shenzhen Hospital, Shenzhen 518036, China (Currently address: Department of Obstetrics and Gynecology, Peking University People' Hospital, Beijing 100044, China).
Department of Obstetrics and Gynecology, Shenzhen Key Laboratory of Gynecological Diagnostic Technology Research, Peking University Shenzhen Hospital, Shenzhen 518036, China.
出版信息
Zhonghua Zhong Liu Za Zhi. 2018 Mar 23;40(3):232-238. doi: 10.3760/cma.j.issn.0253-3766.2018.03.015.
To determine the morbidity of cervical intraepithelial neoplasia 2+ (CIN2+ ) and CIN3+ of different human papillomavirus(HPV) subtype infection combined with different cytology status. The Shenzhen Cervical Cancer Screening Trial Ⅰ & Ⅱ (SHENCCASTⅠ&Ⅱ) are population-based cross-sectional cervical cancer screening studis conducted in Shenzhen and surrounding area from 2008 to 2010. A total of 12 097 women who aged 25-59 years were included in the analysis. All of these women were detected by liquid-based cytology test and several high-risk HPV-DNA tests. The ones with HPV positive or atypical squamous cells of undetermined sign (ASC-US) were sequentially conducted by cervical biopsy vaginoscopy. Finally, 10 805 samples with complete data of hybrid capture 2(HC2), the polymerase chain reaction-based matrix-assisted laser desorption/ionization time-of-flight assay (MALDI-TOF), HPV genotyping detection, cytology and pathology results were analyzed. The top 6 infection rates of HR-HPV in CIN2+ and CIN3+ were HPV16, HPV52, HPV58, HPV33, HPV31, HPV18. The highest constituent ratio of cytology in CIN2+ and CIN3+ was high grade squamous intraepithelial lesion(HSIL). The morbidities of CIN2+ of patients infected with HPV16, HPV31, HPV58, HPV33, HPV18, HPV52 were 41.3%, 31.5%, 30.6%, 28.7%, 28.2%, 17.7%, respectively, while the morbidities of CIN3+ of those were 33.5%, 20.5%, 19.4%, 15.7%, 19.2%, 8.3%, respectively.The morbidities of CIN2+ in negative intraepithelial lesion or malignancy (NILM), ASC-US, low grade squamous intraepithelial lesion (LSIL), atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high grade squamous intraepithelial lesion (HSIL), atypical glandular cell (AGC) samples were 0.4%, 6.9%, 11.1%, 36.4%, 82.0%, 16.7%, respectively, while the morbidities of CIN3+ of those were 0.2%, 3.1%, 4.2%, 22.7%, 64.8%, 0.0%, respectively. The morbidities of CIN2+ in NILM combined with HPV16, HPV18, HPV31, HPV33 infection were 12.6%, 13.3%, 15.8% and 11.5%, respectively, while the morbidities of CIN3+ of those were 10.3%, 11.1%, 7.9% and 7.7%, respectively.The morbidities of CIN2+ and CIN3+ in ASC-US combining with hrHPV infection were high, and the top 6 subtypes associated with high risk of CIN2+ were HPV31 (35.7%), HPV33 (26.9%), HPV16 (26.5%), HPV58 (22.4%), HPV52 (18.6%), HPV68 (15.4%), while those associated with high risk of CIN3+ were HPV16 (20.4%), HPV31 (14.3%), HPV33 (11.5%), HPV58 (8.6%), HPV68 (7.7%), HPV52 (5.8%). Cytology combined with HPV genotyping detection can more effectively estimate the morbidity risks of CIN2+ and CIN3+ . Both high prevalence rates and high risks associated with CIN2+ and CIN3+ of HPV31, HPV33, HPV52 and HPV58 are observed. NILM and ASC-US status combined with these subtypes mentioned above are advised to be conducted by colposcopy.
确定不同人乳头瘤病毒（HPV）亚型感染合并不同细胞学状态时宫颈上皮内瘤变2级及以上（CIN2+）和CIN3+的发病率。深圳宫颈癌筛查试验Ⅰ和Ⅱ（SHENCCASTⅠ&Ⅱ）是2008年至2010年在深圳及周边地区开展的基于人群的横断面宫颈癌筛查研究。共有12097名年龄在25 - 59岁的女性纳入分析。所有这些女性均接受了液基细胞学检测和多种高危型HPV - DNA检测。HPV阳性或意义未明的非典型鳞状细胞（ASC - US）者依次接受阴道镜下宫颈活检。最终，对10805份具有杂交捕获2（HC2）、基于聚合酶链反应的基质辅助激光解吸/电离飞行时间分析（MALDI - TOF）、HPV基因分型检测、细胞学及病理结果完整数据的样本进行分析。CIN2+和CIN3+中HR - HPV感染率排名前6的分别是HPV16、HPV52、HPV58、HPV33、HPV31、HPV18。CIN2+和CIN3+中细胞学构成比最高的是高级别鳞状上皮内病变（HSIL）。感染HPV16、HPV31、HPV58、HPV33、HPV18、HPV52的患者CIN2+发病率分别为41.3%、31.5%、30.6%、28.7%、28.2%、17.7%，而CIN3+发病率分别为33.5%、20.5%、19.4%、15.7%、19.2%、8.3%。阴性上皮内病变或恶性肿瘤（NILM）、ASC - US、低级别鳞状上皮内病变（LSIL）、不能排除高级别鳞状上皮内病变的非典型鳞状细胞（ASC - H）、高级别鳞状上皮内病变（HSIL）、非典型腺细胞（AGC）样本中CIN2+发病率分别为0.4%、6.9%、11.1%、36.4%、82.0%、16.7%，而CIN3+发病率分别为0.2%、3.1%、4.2%、22.7%、64.8%、0.0%。NILM合并HPV16、HPV18、HPV31、HPV33感染时CIN2+发病率分别为12.6%、13.3%、15.8%和11.5%，而CIN3+发病率分别为10.3%、11.1%、7.9%和7.7%。ASC - US合并hrHPV感染时CIN2+和CIN3+发病率较高，与CIN2+高风险相关的前6种亚型为HPV31（35.7%）、HPV33（26.9%）、HPV16（26.5%）、HPV58（22.4%）、HPV52（18.6%）、HPV68（15.4%），与CIN3+高风险相关的为HPV16（20.4%）、HPV31（14.3%）、HPV33（11.5%）、HPV58（8.6%）、HPV68（7.7%）、HPV52（5.8%）。细胞学联合HPV基因分型检测能更有效地评估CIN2+和CIN3+的发病风险。观察到HPV31、HPV33、HPV52和HPV58的CIN2+和CIN3+患病率及风险均较高。建议对NILM和ASC - US状态合并上述亚型者进行阴道镜检查。
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