Status Of Multiple Infection With 16,18HR-HPV In Qinghai And Its Relationship With Different Cervical Lesions

Objective:1.The objective is to understand the status of multiple infections of women with high-risk human papillomavirus(HR-HPV)type 16 or 18 in Qinghai Province,their distribution characteristics in age and ethnic groups,and the composition ratio of each subtype;2.Through investigating the relationship between multiple infections with HR-HPV type 16 or 18 and different cervical lesions,the thesis aims to provide baseline data for the multiple infection characteristics of human papilloma virus(HPV)in women from Qinghai Province,and to provide relevant theoretical basis for vaccination and risk assessment of cervical lesions in clinical work.Methods:The method is to collect 16,311 cases diagnosed at Qinghai University Affiliated Hospital or two other Grade A Tertiary Hospitals due to physical examination or related discomfort from September,2015 to September,2019.It is confirmed the patients contain 16 or 18 HPV infection after human papillomavirus test was performed,and a total of 1470 patients were diagnosed through Thin Prep Cytology Test(TCT)and cervical biopsy,including 1227 single infections and 243 multiple infections.The cervical lesions were divided into the following four group by using biopsy as the gold standard: chronic cervicitis(707 cases),low-grade squamous intraepithelial lesion(LSIL)(193 cases),high-grade squamous intraepithelial lesion(HSIL)(300 cases),cervical squamous Cancer(246 cases)in four groups.As there are few cervical adenocarcinoma cases,it will not be discussed hereby,which means 24 cases of cervical adenocarcinoma are excluded.Statistical method is adopted to analyze the data obtained this time.Results:1.A total of 1,470 cases with HPV 16 or 18 infection were collected in the research,among which 1,227(83.47%)cases were single infection and 243(16.53%)cases were multiple infections.In multiple HR-HPV infections in women from Qinghai,the most common infection of HPV16 co-infected with other types were respectively HPV58,52,39,18,31,33,68,51,66,56,59,35,and 45,HPV18 co-infected with other types of infection were 16,52,31,39,68,58,59,56,51,33,66,35,and 45.Double-type infections are the most common,and it is up to five-type infections in maximum.As the types of mixed infections increases,the number of infected patients gradually decreases.The most common type of multiple infection in the region is HPV16 co-infected with 58,52 infections.2.Patients with multiple infections of type 16 or 18 HR-HPV were between 18 and 78 years old,with an average age of 42.29 ± 12.79.It reached the peak at the age of 40?49,and reached nadir at the age of more than 60,and all showed a unimodal distribution.3.For the most common infection types,it is HPV 16 or 18 co-infected with HPV52,58,or 66 in chronic cervicitis;in LSIL,it is HPV 16 or 18 co-infected with HPV39,58,or 31;in HSIL,it is HPV 16 or 18 co-infected with HPV52,58,or 39;and in cervical squamous carcinoma,it is HPV 16 or 18 co-infected with HPV52,33,or 39.Apparently,under condition of HPV 16 or 18 infection,the most common three types of co-infection in various cervical lesions are different,but HPV 16 or 18 co-infected with HPV52 infection is more universal.4.In patients of Han,Tibetan and Hui ethic groups with multiple infections of type 16 or 18 HR-HPV,statistical analysis performed on the data of three ethnic groups turns out that P> 0.05.The above data shows that in the case of multiple infections of type 16 or 18 HR-HPV,cervical lesions are not significantly different among different ethnic groups.5.Chronic cervicitis,LSIL,HSIL,and cervical squamous carcinoma accounted for 32.90%,26.00%,35.30%,and 5.80% in double-type infections;43.40%,26.40%,20.80%,and 9.40% in triple-type infections;In quadruplex-type infections,the percentages are respectively 33.30%,33.30%,13.30%,and 20.00%;in five-type infections,the percentages are respectively 50.00%,0.00%,50.00%,and 0.00%.After statistical analysis,the result is p> 0.05,the difference was not statistically significant,indicating that there was no obvious difference in the types of cervical lesions in the above multiple infections.6.The research calculated the OR values and 95% confidence intervals for HPV16 and 18 types.The results are as follows:(1)In HPV16 infection,taking chronic cervicitis as reference,for LSIL and HSIL,P <0.05,OR(95% CI)were respectively 3.299(2.145,5.074)and 2.817(1.930,4.113),indicating that multiple infections with HPV16 has higher risk to cause LSIL and HSIL compared with single infection;for cervical squamous carcinoma,p> 0.05,proving that HPV16 multiple infection does not increase the risk of cervical squamous carcinoma.(2)In HPV18 infection,for LSIL,P <0.05,OR(95% CI)= 4.875(2.189,10.858),which means that patients with multiple HPV18 infections are at higher risk of suffering from LSIL;for HSIL and cervical squamous carcinoma,p>0.05,demonstrating that HPV18 multiple infections do not increase risk of suffering from HSIL +.Conclusion:1.Multiple infections with HR-HPV type 16 or 18 increase the risk of cervical lesions.There may be a synergy between multiple infections.Attention should be paid to the multiple infection of HPV16 co-infected with HPV 52 or 58 in the region,and the vaccination of nine-valent vaccine shall be highly emphasized.2.Double-type infections are the most common in Qinghai Province,with up to five-type infections in maximum.There were no significant differences in the types of cervical lesions in double-type and more-type infections.3.It shall pay close attention to multiple infections of HR-HPV type 16 or 18 in women aged 40?49 in Qinghai Province,and the types of cervical lesions have no significant difference among the three major ethnic groups.