| Background and ObjectiveHuman papillomavirus infects epithelial cells and widely distributes in humans and animals.HPV exclusively invades stratified squamous epithelium and takes it as only host.HPV infection can induce squamous proliferative lesions of skin and mucosa,including papilloma and tumor-like lesion.The lesions mainly have the following aspects:first,malignant disease including cervical cancer,vulvar cancer,penile cancer,anal cancer,prostate cancer,bladder cancer,colorectal cancer,oral cancer and tonsil cancer;second,benign disease including common warts,flat warts and genital warts;third,recurrent respiratory papillomatosis which may occur in immunocompromised children.HPV causes sexually transmitted infection of the lower genital tract,as well as contact transmission,vertical transmission and hospital infection.The incubation period of HPV infection varied from several weeks to several years.The patients have no clinical symptoms in the early stages of infection and these people are the main source of infection.Different genotypes of HPV can induce the different kind of diseases.There are over 200 different HPV genotypes.Of these,over 40 HPV genotypes are associated with infection of the lower genital tract.At present,it is widely acknowledged that the prolonged HPV infection is the greatest risk of cervical carcinogenesis.The cervical cancer is one of the malignant tumors which the women are susceptible to,and its mortality is second in the women cancer.Studies revealed that over 500000 new cases of cervical cancer were diagnosed each year worldwide,and 380000 new cases were in Asia.In China,over 150000 new cases of cervical cancer were diagnosed each year,resulting in 80000 deaths.Recent years,the morbidity of cervical cancer increased by 3%to 5%,and the ages of the patients were younger year by year.Thecervical cancer has become the public health problem which seriously threatened the women's health.The pathological process of cervical cancer undergoes the HPV prolonged infection,low-grade premalignant lesions,high-grade premalignant lesions and cervical cancer.The precancerous lesions of cervical cancer continued for a long time,and the disease could be reversible through treatment and prevention in this period.Therefore,the screening and preventing of HPV prolonged infection can fundamentally reduce the incidence and mortality of cervical cancer.Recent years,several studies have conduct for the epidemiology about the HPV infection and cervical cancer in China,such as Shanxi,Guangxi,Shanghai,Beijing and Taiwan.Until now,there were no similar studies about the women of flowing population in Pearl River Delta region in Guangdong Province.The aim of this study is to evaluate the HPV infection of women in Pearl River Delta region in Guangdong Province through population screening.We have surveyed distribution characteristics of different genotypes of HPV infection in different population groups and different regions.The relationship between age,occupation,education,sexual life and the status of HPV infection were analyzed.The results should reveal the size and characteristics of the high-risk groups of HPV infection in flowing population in various cities of the Pearl River Delta region in Guangdong Province.According to the data,we can predict the prevalence of HPV infection,establish the database about the characteristics of HPV genotyping and the cervical cancer screening,and then prevent the cervical cancer finally.Samples and Methods1.MethodsThe method used in this study for the HPV detection is the high-throughput gene sequencing provided by clinical laboratory center of Beijing Genomic Institute in Shenzhen,China.The technical processes are as follows:first,HPV-DNA in the cervical cells is amplified and enriched by multiplex-index-PCR technology;second,the HPV-DNA is genotyped based on the high-throughput gene sequencing platform;third,the sequencing results are compared with the HPV genotype information from the standard database,and then the status of the subjects infected with HPV and the HPV genotypes can be accurately determined.2.Subjects in the studyA large flowing population gathers in Guangdong province,and the number is 1/3 of the Chinese flowing population.The flowing population is easy to become the high-risk population with various types of infectious disease because of the low education,poor living conditions,bad hygiene practices and limited knowledge about the diseases.The subjects in our study are women of the five cities(Dongguan,Shenzhen,Zhaoqing,Zhongshan and Huizhou)in Pearl River Delta region in Guangdong Province.The subjects should meet the following standards:18 years to 72 years old,no hysterectomy,no cervical surgery,no pregnancy,no abnormal vaginal discharge,no contact bleeding history,no chronic cervicitis and no suspected cervical lesions.Screening locations were medical institutions or family planning service stations from each city,and 45634 cases were screened.3.SamplesThe gynecologist and specifically trained medical staff examined the subjects and recorded the status of the cervix.According to the "Sampling HPV manual",the medical staff collected the cervical cell sample using the disposable cervical sampling swabs,and then sent them to be detected.4.Statistical analysesAccording to the screening data of the five cities,the HPV infection rate and genotype were analyzed based on the SPSS 13.0 software.Several aspects were analyzed for the association with HPV infection:1)age and HPV infection;2)genotype distribution in the different age group;3)occupation and HPV infection;4)education and HPV infection;5)sexual life and HPV infection.Results1.Situation of HPV infection in five citiesA total of 45634 samples were detected,and the infection rate was 6.95%.Of these,the samples in Dongguan city were 10734,and the percentage was 23.52.Our study revealed that the infection rate of Dongguan,Shenzhen,Zhaoqing,Zhongshan and Huizhou were 6.53%,7.54%,6.73%,6.65%and 7.34%respectively.The highest infection rate was in Shenzhen city,and the lowest infection rate was in Dongguan city.The infection rates of the five cities had significant difference(P<0.05)according to the nonparametric chi-square test.2.Distribution of HPV genotype in five citiesAccording to the statistical analyses,the main HPV genotypes were HPV 16,18.31,51,52,58,6,and 66.The most common genotype was HPV 16,and its infection rate was 1.18%,and then followed by HPV 52,58,18,66.The first eight HPV infection genotypes,except HPV 6,seven other genotypes were high-risk type.The HPV infection type distribution among the five cities was similar.According to the nonparametric chi-square test,the infection rates among the different districts had no significant difference in Dongguan,Zhaoqing and Huizhou,and the infection rates among the different districts had significant difference in Shenzhen and Zhongshan.3.HPV infection and demographic characteristics in five citiesThe ages of the study subjects were 18 years to 72 years.The HPV infection genotypes were different among the different age groups.The elder than 65 years subjects had the highest infection rate.And the infection rate was 10.71%.The infection rates had significant difference(P<0.05)among the different age groups.The HPV infection rates increased with age in the subjects elder than 24 years old.The first five HPV genotypes in each age group were HPV 16,52,58,18,66,followed by HPV 31,51.The infection rates had no significant difference(P>0.05)among the different occupation group.The occupation of commerce and service had the highest infection rate,and the rate was 7.92%.The infection rates had no significant difference(P>0.05)among the different education group.The primary school group had the highest infection rate,and the rate was 7.69%.The infection rates had significant difference(P<0.05)among the different sexual life group.The sexual life during 26 years to 30 years had the highest infection rate,and the rate was 9.54%.The infection rates increased with sexual life from 6 years to 30 years.Although the infection rate of the sexual life more than 30 years was lower than the sexual life from 26 years to 30 years,the rate of the sexual life more than 30 years was higher than the other groups.ConclusionsThis study investigated HPV infection status and the epidemiological characteristics of floating women in the five cities in the Pearl River Delta region in Guangdong Province.The descending order of infection rate of the five cities is Shenzhen,Huizhou,Zhaoqing,Zhongshan and Dongguan City,and there was statistical difference between the infection rates in different cities.This result illustrated that the HPV infection rates is not the same as the regional difference,and the influence reason mainly includes education,economy,environment,health services and health awareness and other factors.The survey object of this study is the floating women,who have poorly educated and lower cultural qualities,lack of awareness of the disease,worse living conditions and health habits.At the same time,they were difficult to manage as the mobility of them is large.The distribution of HPV infection type of these cities is similar to multiple regions of our country and other Asian countries.Although there are some differences results from the characteristics of the geographical distribution and the development among different cities,the main types of HPV infection are still high-risk HPV 16,52,58.After worldwide screening,the World Health Organization reported that the highest types of HPV infection are HPV16,18,58.So this survey proved that HPV 16 is the main type of HPV infection in the world once again,and the distribution of other type is different among different countries or different regions.The highest infection rates of high-risk HPV in the analysis correlation between HPV infection and population distribution of different groups in five cities are as followed:The subjects elder than 65 years group had the highest infection rate in age groups,although there is a deviation because of too little number of subjects,the result display obviously positive correlation of the age growth and HPV infection.The possible reason is that as the growth of the age,the body's immunity to HPV reduces gradually.The commerce and service group had the highest infection rate in occupation groups possibly because of the particularity of occupation that the irregular living habits and complex work environment.The primary school group had the highest infection rate in education group and the reason may be that people with low level of disease recognition and prevention of low education degree.The sexual life during 26 to 30 years had the highest infection rate in sexual life groups.The HPV infection rates are rising with the increase of sexual life,although the infection rate of the sexual life more than 30 years was only the second high group because of too small number of subjects.This result was consistent with the analysis of relative factors between HPV infection and multiple sexual partners and premature sexual behavior.In summary,the study found that the HPV infection rate of floating women in the Pearl River Delta region in Guangdong Province was positively correlated with age and years of sexual life,and it can be impacted by the special nature of the occupation and level of education.The HPV screening database has been established by this study which can enrich the epidemiological data of women HPV infection in China.And it provides scientific basis for the HPV vaccine research and prevention of cervical cancer.At the same time,the HPV screening model by the application of sequencing chip technique also provides a reference model for other reproductive tract infection detection. |
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