Liu Z H, Lin W, Wang Y Y, Wu B, Yuan S X, Yao J L, Zhao X S, Chen B, Qiao Y L, Zhao F H, Chen W, Hu S Y
Department of Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen 518028, China.
Department of Healthcare, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen 518028, China.
Zhonghua Zhong Liu Za Zhi. 2018 Oct 23;40(10):757-763. doi: 10.3760/cma.j.issn.0253-3766.2018.10.007.
To analyze the epidemiological genotype features of human papillomavirus (HPV) in cervical infection and their risks for cervical precancers among women in Shenzhen area. A total of 2 717 individuals ranging in age from 30~59 years were recruited in 18 community health centers of Shenzhen city from March 1 to June 15, 2015 by a cluster sampling method. The results of genotype of HPV, liquid-based cytology (LBC), colposcopy and pathology were analyzed. The clinical sensitivity and specificity as well as positive (PPV) and negative (NPV) predictive values of the combination of different HPV genotype in screening the cervical intraepithelial neoplasia (CIN) 2 and above were estimated. The HPV infection rate in Shenzhen area was 15.9% (432/2 717). The most common HPV genotype was HPV52 (22.9%), followed by HPV16 (12.7%), HPV53 (10.0%), HPV51 (8.6%) and HPV58 (8.1%). Compared with HPV16/18 genotyping, HPV33/16 genotyping had a higher sensitivity (57.1% vs. 42.9%, <0.05) and an analogous specificity (87.3% vs. 86.9%, >0.05) in predicting CIN2+ . The sensitivity of combination of HPV33/16 genotyping and low grade squamous intraepithelial lesion (LSIL) positive tested by LBC in predicting CIN2+ was 75.0%, significantly higher than 64.3% of atypical squamous cells of undetermined significance (ASC-US) positive tested by LBC alone (<0.05). The specificities of these two methods mentioned above in predicting CIN2+ were 83.5% and 89.2%, respectively, without statistical difference (>0.05). Women infected by HPV have distinct risks for CIN2+ according to different high-risk HPV genotypes. The top five risks were HPV 33, 16, 58, 56, and 68. HPV-positive women triaged by LBC LSIL+ combined with HPV33/16 genotyping may be a potential strategy for cervical cancer screening in developed urban area.
分析深圳地区女性宫颈感染中人乳头瘤病毒(HPV)的流行病学基因型特征及其发生宫颈上皮内瘤变的风险。2015年3月1日至6月15日,采用整群抽样方法,在深圳市18个社区卫生服务中心招募了2717名年龄在30至59岁之间的个体。分析HPV基因型、液基细胞学(LBC)、阴道镜检查及病理结果。评估不同HPV基因型组合筛查宫颈上皮内瘤变(CIN)2及以上病变的临床敏感性、特异性以及阳性预测值(PPV)和阴性预测值(NPV)。深圳地区HPV感染率为15.9%(432/2717)。最常见的HPV基因型为HPV52(22.9%),其次为HPV16(12.7%)、HPV53(10.0%)、HPV(8.各基因型在预测CIN2+方面具有较高的敏感性(57.1%对42.9%,<0.05)和相似的特异性(87.3%对86.9%,>0.05)。HPV33/16基因分型与LBC检测低级别鳞状上皮内病变(LSIL)阳性联合预测CIN2+的敏感性为75.0%,显著高于LBC单独检测意义不明确的非典型鳞状细胞(ASC-US)阳性时的64.3%(<0.05)。上述两种方法预测CIN2+的特异性分别为83.5%和89.2%,无统计学差异(>0.05)。根据不同的高危HPV基因型,HPV感染女性发生CIN2+的风险各异。风险最高的前五种基因型为HPV 33、16、58、56和68。LBC检测LSIL+联合HPV33/16基因分型对HPV阳性女性进行分流,可能是发达城市地区宫颈癌筛查的一种潜在策略。