| [Objective]To study the association of HR-HPV genotype with cervical cancer and precancerous lesions, the relation of infections of sexually transmitted pathogenic microbes with cervical cancer, risk factors of cervical cancer in Fujian and the synergistic action of pathogen microbes and behavial factor in etiology of cervicle cancer.[methods]1. A case-control design was applied in this study. A total of 308 patients of cervical cancer diagnosed with histology were enrolled and 336 control subjects consisted of patients of hysterectomy with benign lesions. Each participant was scheduled for a face-to-face interview with the structured questionnaire. Cervical cells were obtained and 6 ml blood was collected from all women. Cervical cells DNA was extracted, and HPV DNA,HCMV,HSV-Ⅱ,CT,UU and NG were detected. TP and HIV were done with blood sample.2. A total of 2338 women were screened for cervical lesions. The correlation of HR-HPV genotypes with the histological results was evaluated. Two hundred and thirty six women with CIN2/3 treated by LEEP conization with negative margins confirmed by pathology examination of the surgical specimen were included. The cervical cells for HPV genotype testing were collected before and 6,12,24 months after treatment respectively. HPV genotype and multiple HPV infection were evaluated as possible predictors of residual/recurrent disease.[Results]1. The OR of each HR-HPV type for cervical cancer showed that HR-HPV-16 (OR=51.55; 95%CI=28.73-61.86), HR-HPV-18 (OR=52.81; 95%CI=22.84-61.27), HR-HPV-31 (OR= 12.41; 95%CI=10.59-16.68), HR-HPV-53 (OR=2.92; 95%CI= 1.03-8.28), HR-HPV-59 (OR= 13.58; 95%CI=10.76-21.07) and multiple HR-HPV infection (OR=1.11; 95%CI=0.81-3.13). HR-HPV-33, HR-HPV-39, HR-HPV-45 were detected in cervicle cancer only.2. The crude OR for infections of sexually transmitted pathogenic microbes associated with cervical cancer showed that HCMV (OR=7.106; 95%CI=3.479-14.512), HSV-Ⅱ(OR=32.489; 95%CI=7.514-40.478), CT (OR=12.315; 95%CI= 5.824-26.039), UU (OR=4.564; 95%CI=3.177-6.556), NG (OR=1.662; 95%CI= 0.427-6.467), TP (OR=21.104; 95%CI=7.324-60.816). There was statistically significant difference between cancer group and control group with respect to the pathogen loading dose of HCMV and UU (P＜0.001). There was no statistically significant difference between cancer group and control group with respect to the pathogen loading dose of HSV-Ⅱ, CT and NG (P>0.05)3. The major risk factors of cervicle cancer included:tuberculosis (OR=4.388; 95%CI=1.846-10.426), sexually transmitted diseases (OR=20.501; 95%CI=7.097-59.226), gravidity, age 16 to 20 of sexual life for the first time, number'of sex partner, HR-HPV,HSV-Ⅱand TP.4. Analysis by OR revealed that HPV-66,-68, and -CP8304 were associated with CIN 1; HPV-52 was CIN 2/3-associated types.5. Preoperative infection with either HPV-16 (P=0.007), HPV-18 (P=0.000), HPV-33 (P=0.001) or HPV-45 (P=0.019) was associated with higher rates of residual /recurrent lesions after conization with negative margins. Preoperative infection with multiple HPV types was associated with the highest rate of residual/recurrent lesions compared with infection with single HPV type and HPV negative cases (P=0.005)[Conclusion]1. HPV-16,-18,-31,-33,-39,-45,-53, and -59 have more dominant oncogenic risk over others in Fujian. HPV-18 and -16 have the highest oncopotency.2. Infection of HCMV, HSV-Ⅱ, CT, UU, TP was closely related to the genesis of cervical cancer. Significant combined effects between HPV and infection of HCMV,HSV-Ⅱ,CT,UU,TP was found. Their combination could strengthen the process of the disease and lead to the pathogenesis of cervical cancer.3. Tuberculosis, sexually transmitted diseases, smoking, gravidity, age 16 to 20 of sexual life for the first time, number of sex partner, HR-HPV, HSV-Ⅱ, TP and so on, were the main risk factors of cervical cancer. 4. The presence of multiple HR-HPV had no increased risk of having cervical carcinoma or precancerous lesion.5. HPV-66,-68, and -CP83:04 were associated with CIN1; HPV-52 was CIN2/3-associated types in Fujian. The presence of HPV-16,-18,-33 and -45, as well as multiple HPV types pre-LEEP are associated with higher rates of residual/recurrent disease after LEEP.
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