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背景与目的:目前全世界公认HPV感染是子宫颈癌的病因。本研究旨在了解深圳市不同职业女性人群的生殖道高危型人乳头瘤病毒(human papillomavirus,HPV)感染现状及子宫颈上皮内瘤样病变(cervical intra-epithelial neoplasia,CIN)的现患率,探讨职业因素在子宫颈癌发病中的作用。方法:2004年11月至12月,在深圳市华侨城对15～59岁1137名有性生活女性居民及辖区工厂和服务业从业妇女进行以人群为基础的流行病学调查。对所有接受筛查的妇女均行电子阴道镜检查、液基细胞薄层涂片技术(liquid-based cytology test,LCT)子宫颈脱落细胞学检查及第二代杂交捕获技术(hybrid captureⅡ,HC-Ⅱ)宫颈脱落细胞中高危型HPV检测。对HPV阳性并且LCT≥未明确诊断意义的不典型鳞状上皮细胞(atypical squamous cells of undetetemined sign,ASCUS)和/或LCT≥低度鳞状上皮内瘤样病变(low grade squamous intraepithelial lesion,LSIL)的妇女行阴道镜下活组织病理学检查,以病理结果作为诊断子宫颈上皮内瘤样病变的金标准。资料采用VFP软件录入和整理,利用χ2检验和非条件Lo-gistic回归分析危险因素和CIN的关系。结果:该人群高危HPV-DNA总检出率为14.0%,社区居民、工厂工人、服务业妇女三种人群的HPV检出率分别为14.1%、9.2%、18.9%,工厂工人HPV感染率明显低于服务业妇女和社区居民(P<0.01和P<0.05)。社区居民和工厂工人各年龄组间HPV感染率差异无显著性(P>0.05),服务业妇女15～24岁和25～29岁HPV感染率分别为23.0%和28.2%,较30～34岁和35岁以上组HPV感染率明显增高(P<0.01)。本组妇女CIN现患率为4.4%,CINⅠ现患率明显高于CINⅡ和CINⅢ(P<0.05)。社区居民、工厂工人和服务业妇女CIN现患率分别为3.8%、2.8%和7.4%,服务业妇女CIN现患率明显高于社区居民和工厂工人CIN(P<0.05)。随病变级别升高HPV感染率呈趋势性增加,CINⅡ以上HPV感染率为100%。工人CINⅠ和慢性宫颈炎的HPV感染率为40.0%和47.8%,而服务业CINⅠ的感染率是85.7%,慢性宫颈炎亦有66.7%HPV阳性。单因素和多因素非条件Logistic回归分析,HPV感染是CIN的唯一高危因素(χ2=133.751,P=0.000,OR=43.431);妇女职业、性伙伴≥3个和最经常性伙伴维持时间在1年以内等者是HPV感染的显著危险因素。结论:高危型HPV感染是本组CIN的主要原因,服务业30岁以下妇女HPV感染和CIN现患率均较高,应做重点监测。
Background and purpose: HPV infection is recognized worldwide as the etiology of cervical cancer. The purpose of this study was to investigate the prevalence of genital tract high-risk human papillomavirus (HPV) infection and cervical intra-epithelial neoplasia (CIN) in different occupational groups in Shenzhen. Occupational factors in the pathogenesis of cervical cancer. METHODS: From November to December 2004, a population-based epidemiological survey was conducted in 1137 live-in women aged 15-59 and factories and service-employed women in OCT in Shenzhen OCT. All the women undergoing screening were examined by electronic colposcopy, liquid-based cytology (LCT) cervical cytology and hybrid captureⅡ (HC- Ⅱ) high-risk type HPV in cervical exfoliated cells. Atypical squamous cells of undetected sign (ASCUS) and / or LCT ≥ low grade squamous intraepithelial lesion (LSIL) positive for HPV and LCT ≧ undefined diagnostic significance Of women underwent colposcopic biopsy, with pathological findings as the gold standard for the diagnosis of cervical intraepithelial neoplasia. The data were entered and sorted by VFP software. The relationship between risk factors and CIN was analyzed by Chi-square test and non-conditional Lo-gistic regression. Results: The total detection rate of high-risk HPV-DNA in this population was 14.0%. The detection rates of HPV among community residents, factory workers and service women were 14.1%, 9.2% and 18.9% respectively. The HPV infection rate among factory workers was significantly Lower than those of service women and community residents (P <0.01 and P <0.05). There were no significant differences in HPV infection rates between community residents and factory workers in all age groups (P> 0.05). The prevalence of HPV infection among service workers aged 15-24 and 25-29 was 23.0% and 28.2% respectively, which was 30-34 years And HPV infection rate in the group of 35 years old was significantly higher (P <0.01). The prevalence of CIN in this group of women was 4.4%. The prevalence of CINⅠ was significantly higher than that of CINⅡ and CINⅢ (P <0.05). The prevalence of CIN among community residents, factory workers and service women was 3.8%, 2.8% and 7.4% respectively. The prevalence of CIN in service women was significantly higher than that of community residents and factory workers (P <0.05). With the increase of lesion level, the prevalence of HPV infection tended to increase, and the infection rate of HPV above CIN II was 100%. The prevalence of HPV infection in workers CINⅠ and chronic cervicitis was 40.0% and 47.8% respectively, while the infection rate of CINⅠ in service industry was 85.7%. Chronic cervicitis was also positive in 66.7% of HPV. Univariate and multivariate non-conditional Logistic regression analysis showed that HPV infection was the only risk factor for CIN (χ2 = 133.751, P = 0.000, OR = 43.431). Women occupation, sexual partner≥3 and the most frequent partner maintained at 1 Within a year and others are significant risk factors for HPV infection. Conclusion: High-risk HPV infection is the main cause of CIN in this group. The prevalence of HPV infection and CIN in service workers under 30 years of age is high, and should be monitored.