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目的 了解上海地区宫颈脱落细胞学正常女性人乳头瘤病毒(human papillomavirus, HPV)型别分布特征及其相关影响因素.方法 选取上海地区已婚女性3372人进行问卷调查;用PCR反向斑点杂交法(PCR-RDB)对3206名妇女的宫颈脱落细胞样本进行HPV感染型别鉴定;采用Logistic回归对资料进行分析.结果 3206名妇女中HPV感染者为669例,阳性检出率为20.87%.阳性检出率前3位的年龄段为55~59岁、50~54岁和45~49岁,阳性检出率分别为27.67%%、21.65%和21.55%.在HPV感染中一重感染占70.4%;多重感染占29.6%.在多重感染中以二重感染为主(20.63%).中高危基因型HPV感染的前5位型别是HPV52型3.65%,HPV53型2.71%,HPV51型2.03%、HPV58型1.87%和HPV16型1.40%;低危型前3位型别是HPV81型2.03%,HPV42型1.43%和HPV55型1.31%.HPV感染患者中中高危HPV感染者483例,中高危HPV阳性受试者与HPV阴性受试者在年龄、初次性生活年龄、周性生活次数、学历和饮酒等方面差异有统计学意义(P<0.05).其中,经年龄分层发现55~59岁年龄段感染率明显高于其他年龄段(χ2=15.349,P=0.000).单因素分析,中高危基因型HPV感染的保护因素为高学历和较晚的初次性生活年龄,而危险因素为55~59岁年龄段、更年期月经状况、≥3次/周的性生活次数和饮酒.经多因素非条件Logistic回归分析,高学历和较晚的初次性生活年龄仍然是中高危基因型HPV感染的保护因素,其回归系数分别为-0.165和-0.08(P<0.01);55~59岁年龄段、≥3次/周性生活次数和饮酒是中高危HPV感染的风险因子,其OR值分别为1.558、1.275和1.678(P<0.01).进一步分析,55~59岁年龄段和饮酒是中高危HPV感染的独立风险因素.结论 上海地区女性中高危HPV感染的常见型别是HPV52型、HPV53型、HPV51型、HPV58型和HPV16型;55~59岁年龄段是中高危HPV感染的高风险人群,55~59岁年龄段和饮酒是独立风险因素;适度性生活,推迟初次性生活年龄能降低中高危HPV的感染风险.

Objective To understand the various HPV types and the factors influencing their distribution among women with normal cervical cytology in the Shanghai area, to provide basic data for cervical cancer prevention and vaccine use.Methods A questionnaire-based survey was conducted among 3 372 married women in the Shanghai area. A PCR reverse dot blot (PCR-RDB) method was adopted for HPV genotyping of cervical exfoliated cell samples from 3 206 women. Odds ratio (OR) for HPV infection were analyzed using logistic regression. Results Of the 3 206 women investigated, 669 (20.87%) were positive for HPV infection. The highest incidence of HPV infections was seen in the age groups of 55-59 years, 50-54 years and 45-49 years, with the rates of positive detection being 27.67%, 21.65%, and 21.55%, respectively. While 70.4% of the positive cases had a single infection, 29.6% showed multiple infections. In cases with multiple infections, double infection was predominant (20.63%). The top five high-risk gene types were HPV52(3.65%),HPV53(2.71%),HPV51(2.03%),HPV58(1.87%),and HPV16 (1.40%). The top three low-risk gene types were HPV81 (2.03%), HPV42 (1.43%), and HPV55 (1.31%). Among the women with HPV infections,there were 483 having medium-high-risk HPV infection.There were significant differences in the age,the age at first sexual activity,sexual activities per week,education,and alcohol consumption between HPV positive and HPV negative patients. Age stratification showed that the infection rates in the 55-59 years old group were significantly higher than that in the other age groups(χ2=15.349, P=0.000). Both single factor and multivariate non-conditional logistic regression analyses showed that higher education and the start of sexual activity at a later age were protective factors for medium-high-risk HPV infection,with regression coefficients of-0.165 and-0.08,respectively (P<0.01) in the multivariate analysis. The risk factors included age between 55- 59 years, menstrual status (menopause), sexual activity (≥3 times per week) and alcohol consumption. High-risk HPV infections also had the same risk factors,and the odds ratios were 1.558,1.275,and 1.678,respectively(P<0.01).However, 55-59 years of age and alcohol consumption are independent risk factors for medium-high risk HPV infection. Conclusions High-risk HPV in women of Shanghai is commonly caused by HPV52, HPV53, HPV51,HPV58,and HPV16.The high-risk group includes women who are 55-59 years old.While drinking is an independent risk factor for medium-high risk HPV infection, a moderate sex life and delayed age at first sex can reduce the risk of high-risk HPV infections.