对中国东莞 31,942 名女性的高危人乳头瘤病毒基因型分布进行的真实世界横断面纵向研究。
A real-world, cross-sectional, and longitudinal study on high-risk human papillomavirus genotype distribution in 31,942 women in Dongguan, China.
发表日期:2024
作者:
Huanxia Zhong, Wenwei Pan, Binbin Chen, Jiamin Gu, Yu Liang, Guoli Sun, Xinghua Huang, Huitao Yuan, Haina Guo, Ling Zhong, Zhuanfen Li, Ping Zhou, Siliang Zeng, Li Tang
来源:
FRONTIERS IN PUBLIC HEALTH
摘要:
持续的人乳头瘤病毒(HPV)感染仍然是宫颈癌的一个关键危险因素。基于HPV的初步筛查在临床指南中被广泛推荐,与细胞学相比,需要进一步的纵向研究来优化检测高级别宫颈病变的策略。从2015年11月到2023年12月,真实世界观察性研究纳入了31,942名参与者。其中,4,219 名参与者接受了至少两轮 HPV 检测,397 名参与者完成了三轮 HPV 检测。所有参与者均接受了高危型 HPV 16/18/31/33/35/39/45/51/52/56/58/59/66/68 (hrHPV) 和低危型 HPV6/11 检测基因分型。一些参与者还接受了细胞学或阴道镜检查和病理学检查。 在横断面队列中,hrHPV 和所有 HPV 亚型的患病率分别为 6.6% (2,108/31,942) 和 6.8% (2,177/31,942)。排名前三位的 hrHPV 基因型是 HPV52 (1.9%)、HPV58 (0.9%) 和 HPV16 (0.9%)。年龄分布在 45-49 岁和 60-65 岁出现两个峰值。对于初筛队列,hrHPV患病率从2015-2017年的4.8%上升到2020-2020年的7.0%,最终在2023年达到7.2%。对于纵向队列研究,重复人群中的hrHPV患病率(3.9, 5.3%、6.0%)均低于初次hrHPV筛查率(6.6%),表明重复筛查可能会降低患病率。从方法学角度来看,hrHPV(89.5%)和16种亚型筛查组(92.3%)表现出优于细胞学组(54.4%)的敏感性。此外,纵向研究表明,持续性hrHPV亚组的高级鳞状上皮内病变发生率显着高于再次感染组(p = 0.04),组织学进展事件也较多(7/17 vs. 0/5)。表明东莞高危型HPV患病率呈上升趋势,经过多次筛查后这一趋势有所下降。研究结果支持基于 HPV 的初步筛查,并可能指导华南地区的 HPV 疫苗接种和宫颈癌预防。版权所有 © 2024 钟、潘、陈、顾、梁、孙、黄、袁、郭、钟、李、周、曾和唐.
Persistent human papillomavirus (HPV) infection remains a key risk factor for cervical cancer. HPV-based primary screening is widely recommended in clinical guidelines, and further longitudinal studies are needed to optimize strategies for detecting high-grade cervical lesions compared to cytology.From November 2015 to December 2023, 31,942 participants were included in the real-world observational study. Among those, 4,219 participants underwent at least two rounds of HPV tests, and 397 completed three rounds of HPV tests. All participants were tested for high-risk types of HPV 16/18/31/33/35/39/45/51/52/56/58/59/66/68 (hrHPV) and low-risk types of HPV6/11 genotyping. Some participants also received cytology or colposcopy with pathology.In the cross-sectional cohort, the prevalence of hrHPV and all HPV subtypes was 6.6% (2,108/31,942) and 6.8% (2,177/31,942), respectively. The three top hrHPV genotypes were HPV52 (1.9%), HPV58 (0.9%), and HPV16 (0.9%). Age distributions showed two peaks at 45-49 and 60-65 years. For the primary screening cohort, the hrHPV prevalence rate increased from 4.8% in 2015-2017 to 7.0% in 2020-2020 and finally reached 7.2% in 2023. For the longitudinal cohort study, the hrHPV prevalence rates in the repeated population (3.9, 5.3, and 6.0%) were lower than the primary hrHPV screening rates (6.6%), which indicated that repeated screening might decrease the prevalence rate. Methodologically, the hrHPV (89.5%) and the screening group of 16 subtypes (92.3%) demonstrated superior sensitivity than the cytology group (54.4%). Moreover, the longitudinal study indicated that the persistent hrHPV subgroup had a significantly higher (p = 0.04) incidence of high-grade squamous intraepithelial lesions and more histology progression events (7/17 vs. 0/5) than the reinfection group.The study indicates a rising high-risk HPV prevalence in Dongguan, with repeated screening reducing this trend. The findings support HPV-based primary screening and might guide HPV vaccination and cervical cancer prevention in South China.Copyright © 2024 Zhong, Pan, Chen, Gu, Liang, Sun, Huang, Yuan, Guo, Zhong, Li, Zhou, Zeng and Tang.