不同女性生殖道部位高危型人乳头瘤病毒感染的特征及其对基于人乳头瘤病毒的宫颈癌筛查的影响。
The features of high-risk human papillomavirus infection in different female genital sites and impacts on HPV-based cervical cancer screening.
机构信息
Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China.
出版信息
Virol J. 2023 Jun 6;20(1):116. doi: 10.1186/s12985-023-02073-4.
BACKGROUND
The causal role of high-risk Human papillomavirus (HR-HPV) in the pathogenesis of anogenital cancers is well established. In contrast, information on HR-HPV distribution of continuous anatomic sites within the female genital tract is limited, and the impact of sample type on the clinical performance in HPV-based cervical cancer screening warrants investigation.
METHODS
A total of 2,646 Chinese women were enrolled in the study from May 2006 to April 2007. We analyzed the infection features by infection status and pathological diagnoses of 489 women with complete HR-HPV type and viral load data on the cervix, upper vagina, lower vagina, and perineum samples. Additionally, we assessed the clinical performance for detecting high-grade cervical intraepithelial neoplasia of grade two or worse (≥ CIN2) among these four types of samples.
RESULTS
HR-HPV positivity rate was lower in the cervix (51.53%) and perineum (55.83%), higher in the upper (65.64%) and lower vagina (64.42%), and increased with the severity of cervical histological lesions (all P<0.001). Single infection was more dominant than multiple infections at each anatomic site of the female genital tract. The proportion of single HR-HPV infection decreased successively from the cervix (67.05%) to the perineum (50.00%) (P=0.019) in cervical intraepithelial neoplasia grade 1 (CIN1) and was higher in samples of the cervix (85.11%) and perineum (72.34%) in ≥ CIN2. In addition, the highest viral load was observed in the cervix compared to the other three sites. The overall agreement of the cervical and perineum samples was 79.35% and increased continuously from normal (76.55%) to ≥ CIN2 (91.49%). As for the detection of ≥ CIN2, the sensitivity was 100.00%, 97.87%, 95.74%, and 91.49% for the cervix, upper vagina, lower vagina, and perineum samples, respectively.
CONCLUSIONS
Single HR-HPV infection predominated throughout the female genital tract, but the viral load was lower compared to multiple HR-HPV infections. Despite the decreasing viral load from cervix to perineum, the clinical performance for detecting ≥ CIN2 of the perineum sample was comparable to that of the cervix.
背景
高危型人乳头瘤病毒（HR-HPV）在肛门生殖器癌发病机制中的因果作用已得到充分证实。相比之下，关于女性生殖道内连续解剖部位的 HR-HPV 分布的信息有限，并且样本类型对 HPV 为基础的宫颈癌筛查中的临床性能的影响仍有待研究。
方法
本研究共纳入 2646 名中国女性，研究时间为 2006 年 5 月至 2007 年 4 月。我们根据 489 名 HR-HPV 型和病毒载量数据完整的宫颈、上阴道、下阴道和会阴样本的感染状况和病理诊断，分析了感染特征。此外，我们评估了这四种类型样本检测高级别宫颈上皮内瘤变二级或更高级别（≥CIN2）的临床性能。
结果
HR-HPV 阳性率在宫颈（51.53%）和会阴（55.83%）较低，在上阴道（65.64%）和下阴道（64.42%）较高，且随宫颈组织学病变严重程度增加而升高（均 P<0.001）。在女性生殖道的每个解剖部位，单一感染比多种感染更为常见。在 CIN1 中，单一 HR-HPV 感染的比例从宫颈（67.05%）到会阴（50.00%）逐渐下降（P=0.019），在≥CIN2 中，宫颈（85.11%）和会阴（72.34%）的样本中比例更高。此外，宫颈的病毒载量最高，与其他三个部位相比。宫颈和会阴样本的总体一致性为 79.35%，从正常（76.55%）到≥CIN2（91.49%）连续增加。至于≥CIN2 的检测，宫颈、上阴道、下阴道和会阴样本的灵敏度分别为 100.00%、97.87%、95.74%和 91.49%。
结论
单一 HR-HPV 感染在整个女性生殖道中占主导地位，但病毒载量低于多种 HR-HPV 感染。尽管从宫颈到会阴的病毒载量逐渐降低，但会阴样本检测≥CIN2 的临床性能与宫颈相当。
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