一项关于中国东圭31,942名妇女的高风险人乳头瘤病毒基因型分布的现实世界，横截面和纵向研究
A real-world, cross-sectional, and longitudinal study on high-risk human papillomavirus genotype distribution in 31,942 women in Dongguan, China
影响因子:3.40000
分区:医学3区 / 公共卫生3区
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
摘要
持续的人乳头瘤病毒（HPV）感染仍然是宫颈癌的关键危险因素。与细胞学相比，在临床指南中广泛建议基于HPV的主要筛查，需要进一步的纵向研究来优化检测高级宫颈病变的策略。从2015年11月到2023年12月，31,942名参与者包括在现实世界观测研究中。其中，有4,219名参与者至少接受了两轮HPV测试，而397个参与者完成了三轮HPV测试。对所有参与者进行了高危HPV的测试16/18/31/33/35/39/45/51/52/56/56/58/59/59/66/68（HRHPV）和低RSK类型的HPV6/11 Genotyping。一些参与者还接受了病理学的细胞学或阴道镜检查。在横截面队列中，HRHPV的患病率和所有HPV亚型的患病率分别为6.6％（2,108/31,942）和6.8％（2,177/31,942）。三个顶部HRHPV基因型为HPV52（1.9％），HPV58（0.9％）和HPV16（0.9％）。年龄分布显示为45-49和60 - 65年的两个峰。对于初级筛查队列，HRHPV的患病率从2015年至2017年的4.8％增加到2020 - 2020年的7.0％，最终达到2023年的7.2％。对于纵向同伴研究，HRHPV的患病率在重复的人群中比重复率（3.9、5.3和6.0％）较低（3.9、5.3，6.0％）的率（6. 6％）均低于PV。可能会降低患病率。从方法上讲，HRHPV（89.5％）和16个亚型（92.3％）的筛选组比细胞学组表现出更高的敏感性（54.4％）。此外，纵向研究表明，持续的HRHPV亚组的高度鳞状上皮内病变的发病率明显高于（P = 0.04）的发生率（7/17 vs. 0/5）比重新感染组更高。这些发现支持基于HPV的初级筛查，并可能指导中国南部的HPV疫苗接种和宫颈癌预防。
Abstract
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.