川西高原地区妇女人乳头瘤病毒感染现状及其与阴道微环境改变的关系

Human papillomavirus (HPV) infection in women of Western Sichuan Plateau and its relationship with changed vaginal microenvironment

摘要:

【背景】人乳头瘤病毒(human papillomavirus，HPV)感染与宫颈癌及癌前病变的发生密切相关，HPV疫苗是预防感染的重要手段，但HPV亚型分布具有明显的区域差异。【目的】了解川西高原地区妇女宫颈HPV感染现状，探讨其与阴道微环境改变之间的关系，为该人群HPV疫苗使用和宫颈癌预防工作提供指导。【方法】选取2017年11月至2019年5月在成都三六三医院体检和就诊的3 816例川西高原地区妇女，进行HPV基因分型、薄层液基细胞学检测(thinprep cytologic test，TCT)和阴道微环境检查，分析HPV感染率和基因型分布，并探讨高危型HPV (high risk HPV，hrHPV)感染与阴道微环境改变之间的关系。【结果】3 816例妇女的HPV总感染率为19.81% (756/3 816)，hrHPV感染率为16.48% (629/3 816)，HPV52在hrHPV感染中占比最高，达17.20% (135/785)，后面依次为HPV58 (92/11.72%)、HPV16 (89/11.34%)、HPV53 (88/11.21%)、HPV18 (55/7.01%)；415例宫颈细胞病变中有101例(24.3%)感染了hrHPV，基因分型排名前5位的亚型为HPV52/58/16/18/31，高度细胞病变hrHPV感染前5位是HPV52/58/18/31/16，低度细胞病变hrHPV感染前7位是HPV58/16/56/53/52/68/51。1 696例阴道微环境改变中，hrHPV感染率为19.16% (325/1 696)，比阴道微环境正常者高(P<0.05)，其中细菌性阴道炎(bacterial vaginitis，BV)与hrHPV感染有关联(P<0.05)，单纯白细胞增高、真菌性阴道炎(vulvovaginal candidiasis，VVC)、滴虫性阴道炎(trichomonal vaginitis，TV)及混合感染与hrHPV感染无关联性(P>0.05)。【结论】预防川西高原地区妇女HPV感染及宫颈癌选择九价疫苗可能更加适宜，HPV53可作为国内HPV疫苗研制对象之一。另外，可把BV患者作为宫颈癌防控重点之一。

Abstract:

[Background] human papillomavirus (HPV) infection is closely related to cervical cancer and precancerous lesions. HPV vaccine is an important means to prevent infection, but the distribution of HPV subtypes has obvious regional differences. [Objective] To acquaint with the current situation of cervical HPV infection in women in Western Sichuan Plateau, and to explore the relationship between HPV infection and vaginal microenvironment changes, which could provide guidance for the use of HPV vaccine and the prevention of cervical cancer to them. [Methods] A total of 3 816 women in plateau area of Western Sichuan in 363 Hospital between November 2017 to May 2019, were selected for HPV genotyping, thinprep cytologic test (TCT) and vaginal microenvironment examination at the same time. The infection rate and genotype distribution of HPV were analyzed, and the relationship between high risk HPV (hrHPV) infection and vaginal microenvironment was discussed. [Results] Among 3 816 women in Western Sichuan Plateau, the total infection rate of HPV was 19.81% (756/3 816), and the infection rate of hrHPV was 16.48% (629/3 816). The highest proportion of hrHPV was HPV52, which was 17.20% (135/785), followed by HPV58 (92/11.72%), HPV16 (89/11.34%), HPV53 (88/11.21%) and HPV18 (55/7.01%). Among 415 cases of cervical cytopathy, 101 cases (24.3%) were infected with hrHPV. The top five subtypes were HPV52/58/16/18/31. The top five of high cytopathic hrHPV infections were HPV52/58/18/31/16, and the top seven of low cytopathic hrHPV infections were HPV58/16/56/53/52/68/51 . Among 1 696 cases of vaginal microenvironment changes, the infection rate of hrHPV was 19.16% (325/1 696), which was higher than that of normal vaginal microenvironment (P<0.05). Bacterial vaginitis (BV) was associated with hrHPV infection (P<0.05), while leukocytosis alone, vulvovaginal candidiasis (VVC), trichomonal vaginitis (TV) and mixed infection were not associated with hrHPV infection (P>0.05). [Conclusion] The infection rate of HPV and hrHPV in women living in Western Sichuan Plateau are higher. The top five subtypes of hrHPV are HPV52/58/16/53/18, and the top five subtypes of hrHPV with cervical cytopathy are HPV52/58/16/18/31. 9-Valent Human Papillomavirus Vaccine may be more suitable for the prevention of HPV infection and cervical cancer in this area. HPV53, which is common in this area, may cause cervical cytopathy, but there is no vaccine available. Therefore, HPV53 may be one of the domestic HPV vaccine development targets. Moreover, BV may be associated with hrHPV infection, so BV infection patients might be one of the key points of cervical cancer prevention and control.