Preventive Gynecology Unit, European Institute of Oncology IRCCS, Milan, Italy.
Division of Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy.
J Low Genit Tract Dis. 2019 Oct;23(4):259-264. doi: 10.1097/LGT.0000000000000487.
The aim of the study was to investigate the distribution of high-risk (HR) human papillomavirus (HPV) genotypes and the role of multiple infection in preneoplastic and neoplastic cervical lesions, according to histology, age, and the number of genotypes per infection.
Nine hundred eighty-eight women affected by known HPV-related cervical lesions and attending the European Institute of Oncology, Milan, Italy, from December 2006 to December 2014, were selected for a cross-sectional study. Prevalence of HPV genotypes was calculated by histology and the number of genotypes per infection. Univariate and multivariable cervical intraepithelial neoplasia (CIN) 2-3 versus CIN 1 risks were estimated by logistic regression models.
Overall, HPV 16 (53.1%), HPV 31 (15.1%), and HPV 58 (6.4%) were the most frequent genotypes in precancerous lesions. At multivariable analysis, HPV 16 (p = .02), 18 (p = .013), and 56 (p = .01) were significantly associated to worsen histology, whereas HPV 39 (p = .03) and 45 (p = .03) were statistically correlated only to the increasing number of genotypes per infections. Human papillomavirus 33 was the only genotype significantly related to both the number of genotypes per infection (p = .005) and age (p = .03). Infections by HR-HPV (odds ratio [OR] = 9.48, 95% CI = 3.77-23.8, p < .001), HPV genotypes covered by current vaccines (OR = 6.28, 95% CI = 4.05-9.75, p < .001), single HPV genotype (OR = 8.13, 95% CI = 4.12-16.0, p < .001), as well as age (OR = 1.13, 95% CI = 1.07-1.19, p < .001) were significantly associated to higher risk of CIN 2-3.
The most of CIN 2+ lesions are sustained by HR-HPV genotypes, especially the ones covered by 9-valent vaccine; therefore, the widespread use of prophylactic HPV vaccines could significantly reduce the incidence of preneoplastic and neoplastic cervical lesions.
本研究旨在根据组织学、年龄和每种感染的 HPV 基因型数量，调查高危（HR）型人乳头瘤病毒（HPV）基因型的分布以及多重感染在癌前和肿瘤性宫颈病变中的作用。
选择 2006 年 12 月至 2014 年 12 月期间在意大利米兰欧洲肿瘤研究所就诊的 988 名已知 HPV 相关宫颈病变的女性进行横断面研究。通过组织学和每种感染的 HPV 基因型数量计算 HPV 基因型的流行率。通过 logistic 回归模型估计单变量和多变量宫颈上皮内瘤变（CIN）2-3 与 CIN 1 的风险。
总体而言，HPV 16（53.1%）、HPV 31（15.1%）和 HPV 58（6.4%）是癌前病变中最常见的基因型。多变量分析显示，HPV 16（p=0.02）、18（p=0.013）和 56（p=0.01）与组织学恶化显著相关，而 HPV 39（p=0.03）和 45（p=0.03）仅与每种感染的 HPV 基因型数量增加相关。HPV 33 是唯一与每种感染的 HPV 基因型数量（p=0.005）和年龄（p=0.03）均相关的基因型。高危型 HPV（HR-HPV）感染（比值比[OR] = 9.48，95%置信区间[CI] = 3.77-23.8，p<0.001）、当前疫苗涵盖的 HPV 基因型（OR = 6.28，95%CI = 4.05-9.75，p<0.001）、单一 HPV 基因型（OR = 8.13，95%CI = 4.12-16.0，p<0.001）以及年龄（OR = 1.13，95%CI = 1.07-1.19，p<0.001）与 CIN 2-3 的风险显著相关。
大多数 CIN 2+病变由 HR-HPV 基因型引起，尤其是由 9 价疫苗涵盖的 HPV 基因型引起；因此，广泛使用预防性 HPV 疫苗可显著降低癌前和肿瘤性宫颈病变的发生率。
