Brismar-Wendel S, Froberg M, Hjerpe A, Andersson S, Johansson B
Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynaecology, Karolinska University Hospital Huddinge, Karolinska Institutet, 141 86 Stockholm, Sweden.
Br J Cancer. 2009 Aug 4;101(3):511-7. doi: 10.1038/sj.bjc.6605165. Epub 2009 Jul 21.
To define the spectrum of human papillomavirus (HPV) types and establish an age limit for triage HPV testing in atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL).
343 liquid-based cytological samples from the population-based screening programme with minor abnormalities were subjected to HPV genotyping (Linear Array, Roche, Basel, Switzerland).
High-risk human papillomavirus (HR-HPV) was found in 71% of LSIL and 49% of ASCUS cases (P<0.001). High-risk human papillomavirus prevalence was age-dependent in LSIL (P=0.01), with decreasing prevalence until the age of 50 years, followed by a slight increase. Human papillomavirus type 16 was the most common HR-HPV, found in 23% of HPV-positive women. Human papillomavirus type 18 was the sixth most common, found in 9.9% (P<0.001). An age-dependent quadratic trend was observed for multiple infections (P=0.01) with a trough at about 42 years. The most common HR-HPV types to show a coinfection with HPV16 (clade 9) were HPV39 (28%), 45 (38%), and 59 (46%), belonging to HPV18 clade 7. The frequency of low-risk (LR) vs probable HR and HR-HPV also followed an age-dependent quadratic trend.
After the age of 25 years, HR-HPV prevalence is similar in LSIL and ASCUS cases, motivating a low age limit for triage HPV testing. Multiple infections and LR/HR-HPV dominance are age-dependent. Genotyping in longitudinal design is needed to elucidate the importance of multiple infections in cancer progression and in cross-protection from vaccination.
明确人乳头瘤病毒（HPV）类型谱，并确定非典型鳞状细胞意义不明确（ASCUS）和低级别鳞状上皮内病变（LSIL）患者进行HPV分流检测的年龄界限。
从基于人群的筛查项目中选取343份存在轻微异常的液基细胞学样本进行HPV基因分型（线性阵列，罗氏公司，瑞士巴塞尔）。
71%的LSIL病例和49%的ASCUS病例中检测到高危型人乳头瘤病毒（HR-HPV）（P<0.001）。LSIL病例中HR-HPV感染率与年龄相关（P=0.01），50岁之前感染率逐渐下降，之后略有上升。HPV16型是最常见的HR-HPV，在23%的HPV阳性女性中被发现。HPV18型是第六常见的，占9.9%（P<0.001）。多重感染呈现年龄相关的二次趋势（P=0.01），在约42岁时出现低谷。与HPV16（9型分支）共同感染的最常见HR-HPV类型为HPV39（28%）、45（38%）和59（46%），属于HPV18 7型分支。低危（LR）与可能的HR及HR-HPV的频率也呈现年龄相关的二次趋势。
25岁之后，LSIL和ASCUS病例中HR-HPV感染率相似，这促使HPV分流检测的年龄界限降低。多重感染以及LR/HR-HPV优势与年龄相关。需要进行纵向设计的基因分型以阐明多重感染在癌症进展和疫苗交叉保护中的重要性。
