Study On HPV Infection Status And Risk Factors Of Cervical Cancer Or Precancerous Lesions In Women Over 30 Years Old In Research Area Of Hubei

Objective:To analyze the status and epidemiological characteristics of high-risk HPV infection in a natural female population in research area,Hubei Province,and to explore the risk factors of precancerous lesions in women with high-risk HPV16 or 18infection.Methods:The data from the study are derived from the cervical cancer screening project in the"two cancers"screening of female natural population in research area,Hubei Province.A natural population of women aged 30 and over who were screened for cervical cancer in research area of Hubei from January 2017 to February 2018 was selected,and 311,382 cases were finally included,with an average age of 48.53±8.33 years.The cervical cancer screening method based on high-risk HPV screening was adopted to screen for HPV infection and cervical cancer and precancerous lesions in the population through HPV testing,cervical cytosis and colposcopy biopsies,and relevant epidemiological survey data were collected through questionnaires.Describe the HPV positive rate and cervical cancer or precancerous lesions in various regions by urban area;Explore the correlation between HPV infection and cervical cancer or precancerous lesions with age;And analyze the demographic characteristics,previous medical history,common gynecological diseases and other related epidemiological factors and the relationship between HPV infection type（especially single infection and multiple infection）and cervical cancer or precancerous lesions of the female population infected with high-risk HPV16 or 18（all single or multiple infections related to HPV16or 18）through univariate analysis and three classification multivariate logistic regression model.Results:（1）A total of 24,274 HPV-positive cases were detected among 311,382screened subjects,with an HPV infection rate of 7.80%,of which 6,086 were women infected with HPV 16 or 18（all single or multiple infections related to HPV 16 or 18）,and 18188 were infected with other high-risk HPV（excluding HPV 16 or 18）.According to the screening process specifications,6681 women with high-risk HPV infection were finally subjected to colposcopy biopsy.Based on the results of the pathological biopsy,the final diagnosis of cervical cancer screening was divided into four categories:normal cervical,CIN1,CIN2 and CIN3+（CIN3 and above lesions）,1746 cases of cervical cancer or precancerous lesions（CIN1 and above lesions）were finally detected.The prevalence of the total population was 0.56%,including 855 cases of CIN1,0.27%of prevalence,and 377 cases of CIN2.The prevalence rate was 0.12%,CIN3+（CIN3 and above lesions）514 cases,the prevalence rate was 0.17%.Among them,there were 855cases of CIN1,the prevalence rate was 0.27%,377 cases of CIN2,the prevalence rate was 0.12%,514 cases of CIN3+（CIN3 and above lesions）,the prevalence rate was0.17%.（2）The top three regions with HPV positive rate are H,G and I in order,with13.16%,11.49%and 9.30%respectively.The lowest HPV positive rate is 5.95%in J;The prevalence of CIN1+（CIN1 and above lesions）in the top three areas are E（1.02%）,G（0.79%）and D（0.67%）;The top three areas of CIN2+（CIN2 and above lesions）prevalence are D（0.43%）,G（0.37%）and C（0.33%）;The top three areas of CIN3+（CIN3 and above diseases）prevalence:D（0.29%）,C（0.24%）and G（0.18%）.The prevalence of cervical cancer or precancerous lesions was higher in E,D,G and C.（3）311382 screening subjects were divided into 7 groups by age（30～35,36～40,41～45,46～50,51～55,56～60,and>60）.The HPV infection rate increased with the increase of the age group.The HPV positive rate was the highest in the>60 age group（9.85%）.The difference of HPV infection rate among women of different ages was statistically significant（χ²=334.80,P<0.0001）.HPV16 or 18（all single or multiple infections related to HPV16 or 18）infection rate（r₁=0.96,P=0.0005）,and other high-risk HPV（excluding HPV16 and 18）infection rate（r₂=0.90,P=0.0055）were positively correlated with age,and the infection rate of HPV16 or 18 and other high-risk HPV in women over 60 years old was higher than that in women under 60 years old（χ²=157.11,P<0.0001）.With the increase of age group,the prevalence of CIN1+（CIN1and above lesions）,CIN2+（CIN2 and above lesions）,and CIN3+（CIN3 and above lesions）increased first and then decreased in 6681 women who underwent colposcopy biopsy.The prevalence of CIN1+reached a peak of 30.94%in 36-40 age group,while the prevalence of CIN2+and CIN3+reached a peak of 17.15%and 10.02%in the41～45 age group,respectively.（4）Of the 6086 women with HPV16 or 18 infection（all single or multiple infections associated with HPV16 or 18）,4933 received colposcopy biopsy.The types of HPV infection were divided into 6 groups:single HPV16 infection group,HPV16+other high-risk HPV infection group,HPV18+other high-risk HPV infection group,HPV16+18 infection group and HPV16+18+other high-risk HPV infection group.Single factor analysis showed that the risk of CIN3+in HPV16+other high-risk groups was significantly lower than that in single HPV16 group（OR=0.594,95%CI:0.0464,0.762）;Compared with single HPV18 group,the risk of CIN2 in HPV16+18 infection group（OR=4.661,95%CI:1.636,13.276）and HPV16+18+other high-risk HPV infection group（OR=6.667,95%CI:2.612,17.016）increased significantly.The single factor analysis of demographic characteristics,previous medical history and common gynecological diseases showed that age,education level,menopause,family cancer history,sexual hemorrhage and vaginal cleanliness were the possible influencing factors of cervical cancer or precancerous lesions.（4）The influencing factors and HPV types selected from the above single factor analysis were included in the three classification multivariate Logistic regression model.The results showed that The risk of CIN2（OR=0.757,95%CI:0.586,0.978）and CIN3+（OR=0.775,95%CI:0.632,0.952）was lower in patients over 45 years old;The risk of CIN3+（OR=1.488,95%CI:1.173,1.888）was higher in junior high school and below;Postmenopausal women had lower risk of CIN2（OR=0.733,95%CI:0.554,0.971）and CIN3+（OR=0.590,95%CI:0.472,0.737）;The risk of CIN3+was higher in patients with family tumor history（OR=2.386,95%CI:1.291,4.411）,sexual hemorrhage（OR=2.293,95%CI:1.162,4.525）,vaginal cleanlinessⅢorⅣ(OR=1.769,95%CI:1.437,2.176;The risk of CIN3+（OR=0.636,95%CI:0.493,0.821）was lower in single HPV16 infectious group than in HPV16+other high risk HPV infection groups;The risk of CIN2（OR=0.288,95%CI:0.168,0.493）and CIN3+（OR=0.200,95%CI:0.127,0.315）was lower in single HPV18 group;The risk of CIN2（OR=0.254,95%CI:0.111,0.581）and CIN3+（OR=0.085,95%CI:0.031,0.229）was lower in HPV18+other HPV infection group;Compared with the single HPV18 infection group,HPV16+other high-risk HPV infection groups had a higher risk of CIN2（OR=3.565,95%CI:2.021,6.288）and CIN3+（OR=3.179,95%CI:1.946,5.192）,HPV16+18 group（OR=4.822,95%CI:1.676,13.872）and HPV16+18+other high-risk HPV infection group（OR=5.559,95%CI:1.924,16.060）have a higher risk of CIN2.Conclusions:The HPV infection rate of 311382 women aged 30 and over in research area of Hubei Province is 7.80%.The older the age is,the higher the HPV infection rate is.The prevalence of CIN2+（17.15%）and CIN3+（10.02%）was the highest in the 41～45 age group of 6681 women who had to undergo colposcopy biopsy.The cervical cancer screening in women with high-risk HPV infection in that age group should be focused on.The risk factors of cervical cancer or precancerous lesions are low education level,menopause,family cancer history,sexual intercourse bleeding symptoms and poor cleanliness of vagina（gradeⅢorⅣ）.The risk of cervical cancer or precancerous lesions is higher in HPV16 plus other high-risk infection than in single HPV16infection.