关于中国东莞地区31,942名女性高危人乳头瘤病毒（HPV）基因型分布的一项真实世界的横断面与纵向研究

A real-world, cross-sectional, and longitudinal study on high-risk human papillomavirus genotype distribution in 31,942 women in Dongguan, China

FRONTIERS IN PUBLIC HEALTH

影响因子:3.4

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

DOI: 10.3389/fpubh.2024.1409030

摘要

持续性人乳头瘤病毒（HPV）感染是宫颈癌的关键风险因素。基于HPV的初筛在临床指南中被广泛推荐，且需要进一步的纵向研究以优化高等级宫颈病变的检测策略，尤其相较于细胞学筛查。从2015年11月至2023年12月，共纳入31,942名参与者。参与者中，4,219人接受了至少两轮HPV检测，397人完成了三轮检测。所有参与者均进行了高危型HPV 16/18/31/33/35/39/45/51/52/56/58/59/66/68的分型检测，以及低危型HPV6/11的分型。一部分参与者还接受了细胞学或阴道镜检查及病理学诊断。在横断面队列中，高危型HPV（hrHPV）和所有HPV亚型的感染率分别为6.6%（2,108/31,942）和6.8%（2,177/31,942）。前三位高危型HPV基因型为HPV52（1.9%）、HPV58（0.9%）和HPV16（0.9%）。年龄分布显示在45-49岁和60-65岁两个高峰。对于初筛队列，hrHPV的感染率从2015-2017年的4.8%上升到2020年的7.0%，2023年达7.2%。在纵向队列中，重复检测中的hrHPV感染率（3.9%、5.3%、6.0%）低于初筛的整体感染率（6.6%），显示重复筛查可降低感染率。从方法学上看，hrHPV（89.5%）和16个亚型筛查组（92.3%）的敏感性优于细胞学筛查组（54.4%）。纵向研究还显示，持续感染高危型HPV的亚组比再感染组的高等级鳞状上皮内病变（HSIL）发生率显著更高（p=0.04），且组织学进展事件更多（7/17对0/5）。研究结果显示东莞地区高危HPV感染率呈上升趋势，重复筛查有助于降低该趋势。研究支持采用HPV为基础的初筛策略，为南中国的HPV疫苗接种和宫颈癌预防提供指导。

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.