Research Of The Relationship Of Human Papillomavirus Infection And Cervical Lesions And Its Related Risk Factors

Objectives:In this research, we intended to study the prevalence of HPV infection and distribution characteristics of HPV subtypes in our hospital. And we analyzed distribution of HPV subtypes in cervical disease spectrum, which range from normal cervix (including chronic cervicitis) to cervical intraepithelial neoplasia (CIN I, CIN II, CIN III) and cervical cancer. Then we investigated the relationship of persistent HPV infection and cervical lesions. Moreover, we tried to explore the related risk factors of HPV infection.Methods:1. From January2009to December2013, clinical data of16320patients received by gynecology clinic of the Third Xiangya Hospital were collected. A retrospective analysis was carried out to analyze the overall prevalence of HPV infection. And the prevalence of HPV infection in different ages and subtypes were compared.2. According to pathological diagnosis,160normal cases and508cervical abnormalities were selected. The prevalence of HPV infection in the normal cases and cervical abnormalities were compared. And the prevalence of HPV infection and the distribution of HPV types in different pathological grade of cervical lesions were analyzed.3.1065patients who undertook twice or more HPV genotyping and TCT over one year interval were selected. They were divided into persistent negative group, non-persistent negative group, non-persistent positive group and persistent positive group. The prevalence of HPV infection and the results of TCT in four groups were compared.4.222patients who undertook HPV genotyping in our hospital received questionnaire by voluntary principles. The risk factors of HPV infection were analyzed by multivariate non-conditional Logistic analysis. Results: 1. Among the16320patients,4332cases were infected with HPV, the overall HPV prevalence was26.54%. The single subtype infection rate was18.82%, the multiple subtypes infection rate was7.72%, the high-risk HPV infection rate was22.87%, and the low-risk HPV infection was3.67%. The most common genotypes were HPV52(6.31%), HPV16(5.93%), HPV58(4.16%), CP8304(3.92%) and HPV53(2.63%). The overall and high-risk HPV prevalence was found to be lowest in women at the age of30-39years old (P<0.05), and to be highest at the age of over60years old (P<0.05). There was no significant difference in low-risk HPV prevalence between any age groups (P=0.693).2. The prevalence of HPV infection in normal, CIN I, CIN II-III, squamous cell carcinoma (SCC), adenocarcinoma and other pathological tumors were14.37%,72.72%,83.02%,94.17%,79.17%and87.50%, respectively. There was significant difference in HPV prevalence between normal cases and cervical abnormalities (P<0.05). There was significant difference in HPV prevalence between five cervical lesion groups (P<0.05). In CIN I, the most common genotypes were HPV58,52,53, CP8304. In CIN II-III and SCC, the most common genotypes were HPV16,58,52. In adenocarcinoma and other pathological tumors, the most common genotypes were HPV16,18.3.12.17percent of patients who were negative in their first HPV genotyping, got infected one year later.12.35percent of patients who were positive in their first HPV genotyping, got infected one year later. There was no significant difference between them (P=0.935). For HPV positive patients, the clearance rate of HPV was87.65%one year later. There was no significant difference in high-risk and low-risk HPV infection between non-persistent positive group and persistent positive group (P=0.545), but there was significant difference in single and multiple subtypes infection between two groups (P<0.05). In persistent positive group, the most common genotypes were HPV16,52,58, CP8304,33. There was no significant difference in incidence of ASC-H and LSIL among persistent negative group, non-persistent negative group, non-persistent positive group and persistent positive group (P>0.05). There was significant difference in incidence of ASC-US, HSIL and SCC among four groups (P<0.05).4. Menopause, numbers of pregnancy, numbers of delivery and numbers of abortion are not associated with HPV infection (P>0.05). Age, educational level, age at first intercourse, condom use and knowledge about HPV are associated with HPV infection (P<0.05). The risk factors of HPV infection included aging, lower educational level and younger than20years old at first intercourse (OR>1). The protective factors of HPV infection included condom use and knowledge about HPV (OR<1).Conclusions:1. The prevalence of HPV infection and the distribution of HPV types have regional differences. In our region, it is necessary to focus on the prevention of HPV16,52and58types.2. The prevalence of high-risk HPV has age differences, while the prevalence of low-risk HPV has not age differences. The prevalence of HPV positively correlated with the upgrading of cervical lesion.3. Persistent HPV infection is mainly consisted of multiple and high-risk HPV infection which can increase the incidence of ASC-US, HSIL and SCC.4. The risk factors of HPV infection included aging, lower educational level and younger than20years old at first intercourse. The protective factors of HPV infection included condom use and knowledge about HPV.