上海市长宁区人乳头瘤病毒与解脲脲原体、沙眼衣原体、淋病奈瑟菌混合感染情况分析

doi:10.3969/j.issn.1673-8640.2020.09.001

摘要/Abstract

摘要：

目的分析上海市长宁区女性人乳头瘤病毒（HPV）与解脲脲原体（UU）、沙眼衣原体（CT）和淋病奈瑟菌（NG）的混合感染状况以及相关性。方法收集2018年6月1日—2019年5月31日上海交通大学医学院附属同仁医院4 496例女性宫颈脱落细胞和宫颈拭子样本,另收集113名体检健康者女性同类样本作为正常对照组。采用聚合酶链反应（PCR）-反向点杂交法检测HPV DNA亚型,PCR-荧光探针法检测CT DNA、UU DNA和NG DNA,分析这些病原体的核酸检出率及阳性分布。根据HPV的阴性、阳性及感染型别进行分组,分析各组CT DNA、UU DNA和NG DNA检出率差异。结果 4 496例样本中,UU DNA检出率最高（65.9%）,其次是HPV DNA（23.9%）,最低是NG DNA（0.9%）。正常对照样本UU DNA、CT DNA、NG DNA、HPV的阳性检出率分别为62.8%、3.6%、0.9%、22.1%。HPV DNA中检出率最高的型别为高危型HPV52,与其他型别相比,其CT、NG和UU的检出率也最高,分别为23.2%、2.9%和20.9%。在HPV阳性组中,UU、CT、NG的检出率均明显高于HPV阴性组（P<0.001）。随着HPV DNA亚型检出的增加,CT、NG和UU的阳性率也有所升高;四重及以上HPV感染的患者CT和UU的阳性率（20.0%和87.7%）明显高于单一HPV感染患者（10.8%和76.9%）（P<0.05）。结论上海市长宁区女性宫颈样本UU的检出率远高于HPV、NG、CT。随着HPV不同亚型多重感染的发生,其CT、UU及NG感染率也有所上升,并出现混合感染。建议出现HPV多重感染时,高度关注并发其他感染的可能性。

关键词: 人乳头瘤病毒, 沙眼衣原体, 解脲脲原体, 淋病奈瑟菌, 混合感染

Abstract:

Objective To investigate the mixed infection status and correlations of human papillomavirus（HPV） with Ureaplasma urealyticum（UU）,Chlamydia trachomatis（CT） and Neisseria gonorrhoeae（NG） among female patients in Changning district of Shanghai. Methods Totally,4 496 samples,including cervical exudate cell and cervical swab samples,of female patients from Shanghai Jiao Tong University School of Medicine Tongren Hospital were collected from June 1st 2018 to May 31st 2019. A total of 113 healthy subjects were enrolled as healthy control group. CT DNA,UU DNA and NG DNA were determined by fluorescence probe-polymerase chain reaction（PCR）,and PCR-reverse dot blot was used to determine HPV DNA subtypes. The positive rate and subtype distribution characteristics were analyzed and compared with those of healthy control group. The determination rates of CT DNA,UU DNA and NG DNA were investigated by classification according to the negativity or positivity and infection types of HPV. Results The determination rate of UU DNA was the highest（65.9%）,followed by HPV DNA（23.9%）,and the determination rate of NG DNA was the lowest（0.9%）. Compared with healthy control group,the determination rates of UU DNA,CT DNA and NG DNA were 62.8%（71/113）,3.6%（4/113）and 0.9%（1/113）,and the determination rate of HPV was 22.1%. The subtype with the highest determination rate of HPV DNA was high-risk HPV52. Compared with the other types,the determination rates of CT,NG and UU were also high（23.2%,2.9% and 20.9%,respectively）. The determination rates of UU,CT and NG in HPV positive group were higher than those in HPV negative group（P<0.001）. With the increasing number of HPV DNA subtypes,the positive rates of CT,NG and UU were increased. The positive rates of CT and UU in patients with 4 or more subtypes of HPV infections（20.00% and 87.7%） were higher than those in patients with single subtype of HPV infection（10.8% and 76.9%）（P<0.05）. Conclusions The determination rate of UU is higher than those of HPV,NG and CT. With the occurrence of multiple infection of different subtypes of HPV,the infection rates of CT,UU and NG increase,and mixed infection occurs. It should pay attention to the occurrence of multiple infection of HPV.

Key words: Human papillomavirus, Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrhoeae, Mixed infection

中图分类号:

R373.9

宣彬彬, 谭美玉, 孙寒晓, 盛慧明. 上海市长宁区人乳头瘤病毒与解脲脲原体、沙眼衣原体、淋病奈瑟菌混合感染情况分析[J]. 检验医学, 2020, 35(9): 859-863.

XUAN Binbin, TAN Meiyu, SUN Hanxiao, SHENG Huiming. Mixed infection status of human papillomavirus,Ureaplasma urealyticum,Chlamydia trachomatis and Neisseria gonorrhoeae in Changning district of Shanghai[J]. Laboratory Medicine, 2020, 35(9): 859-863.

图/表 3

参考文献 13

[1]	SILVA J,CERQUEIRA F,MEDEIROS R.Chlamydia trachomatis infection:implications for HPV status and cervical cancer[J]. Arch Gynecol Obstet,2014,289(4):715-723.
[2]	VAN DYNE E A,HENLEY S J,SARAIYA M,et a1. Trends in human papillomavirus-associated cancers-United States,1999-2015[J]. MMWR Morb Mortal Wkly Rep,2018,67(33):918-924.
[3]	孙永梅,陈兆武,张扬,等. 安徽地区宫颈癌患者HPV 感染状况及其在放疗疗效监测中的应用[J]. 检验医学,2019,34(10):897-900.
[4]	武利涛,郭楠,李宝萍,等. 北京2 183例女性高危型HPV 感染状况分析[J]. 中国实验诊断学,2019,23(10):1711-1714.
[5]	张静,王海滨,时字. STD门诊患者沙眼衣原体、解脲支原体、淋球菌与人乳头瘤病毒感染情况分析[J]. 标记免疫分析与临床,2015,22(8):725-728.
[6]	YE H,SONG T,ZENG X,et a1. Association between genital mycoplasmas infection and human papillomavirus infection,abnormal cervical cytopathology,and cervical cancer:a systematic review and meta-analysis[J]. Arch Gynecol Obstet,2018,297(6):1377-1387.
[7]	BERNARD H U,BURK RD,CHEN Z,et a1. Classification of papillomaviruses(PVs) based on 189 PV types and proposal of taxonomic amendments[J]. Virology,2010,401(1):70-79.
[8]	SUN B,HE J,CHEN X,et al.Prevalence and genotype distribution of human papillomavirus infection in Harbin,Northeast China[J]. Arch Virol,2014,159(5):1027-1032.
[9]	ZHOU H L,ZHANG W,ZHANG C J,et al.Prevalence and distribution of human papillomavirus genotypes in Chinese women between 1991 and 2016:a systematic review[J]. J Infect,2018,76(6):522-528.
[10]	BELLAMINUTTI S,SERACENI S,DE SETA F,et al.HPV and Chlamydia trachomatis co-dection in young asymptomatic women from high incidence area for cervical cancer[J]. J Med Virol,2014,86(11):1920-1925.
[11]	PANATTO D,AMICIZIA D,BIANCHI S,et al. Chlamydia trachomatis prevalence and chlamydial/HPV co-infection among HPV-unvaccinated young Italian females with normal cytology[J]. Hum Vaccin Immunother,2015,11(1):270-276.
[12]	KORHONEN S,HOKYNAR K,ERIKSSON T,et al. The prevalence of HSV,HHV-6,HPV and Mycoplasma genitalium in Chlamydia trachomatis positive and Chlamydia trachomatis negative urogenital samples among young women in Finland[J]. Pathogens,2019,8(4):276.
[13]	杨家宏. 女性生殖道解脲脲支原体感染及耐药性[J]. 中华医院感染学杂志,2013,23(15):3795-3796.

HPV亚型	HPV（1 073例）		HPV合并UU（832例）		HPV合并CT（138例）		HPV合并NG（22例）
HPV亚型	例数	百分比/%	例数	百分比/%	例数	百分比/%	例数	百分比/%
52	233	21.7	174	20.9	32	23.2	4	2.9
16	161	15.0	123	14.8	25	18.1	3	2.2
53	127	11.8	104	12.5	17	12.3	4	2.9
58	127	11.8	99	11.9	16	11.6	4	2.9
81（低危型）	121	11.3	100	12.0	18	13.0	1	0.7
51	113	10.5	91	10.9	15	10.9	3	2.2
43（低危型）	99	9.2	80	9.6	20	14.5	0	0.0
18	86	8.0	67	8.1	17	12.3	1	0.7
42（低危型）	86	8.0	68	8.2	11	8.0	1	0.7
68	83	7.7	67	8.1	13	9.4	4	2.9
59	76	7.1	61	7.3	20	14.5	3	2.2
56	56	5.2	47	5.6	6	4.3	1	0.7
6（低危型）	51	4.8	40	4.8	9	6.5	2	1.4
66	50	4.7	43	5.2	2	1.4	0	0.0
39	45	4.2	37	4.4	5	3.6	1	0.7
33	43	4.0	27	3.2	9	6.5	1	0.7
35	37	3.5	24	2.9	1	0.7	0	0.0
11（低危型）	36	3.4	31	3.7	7	5.1	2	1.4
31	34	3.2	26	3.1	4	2.9	1	0.7
73	25	2.3	15	1.8	6	4.3	0	0.0
45	24	2.2	22	2.6	1	0.7	1	0.7
82	14	1.3	13	1.6	1	0.7	1	0.7
83（低危型）	8	0.8	8	1.0	1	0.7	0	0.0

HPV亚型	HPV（1 073例）		HPV合并UU（832例）		HPV合并CT（138例）		HPV合并NG（22例）
HPV亚型	例数	百分比/%	例数	百分比/%	例数	百分比/%	例数	百分比/%
52	233	21.7	174	20.9	32	23.2	4	2.9
16	161	15.0	123	14.8	25	18.1	3	2.2
53	127	11.8	104	12.5	17	12.3	4	2.9
58	127	11.8	99	11.9	16	11.6	4	2.9
81（低危型）	121	11.3	100	12.0	18	13.0	1	0.7
51	113	10.5	91	10.9	15	10.9	3	2.2
43（低危型）	99	9.2	80	9.6	20	14.5	0	0.0
18	86	8.0	67	8.1	17	12.3	1	0.7
42（低危型）	86	8.0	68	8.2	11	8.0	1	0.7
68	83	7.7	67	8.1	13	9.4	4	2.9
59	76	7.1	61	7.3	20	14.5	3	2.2
56	56	5.2	47	5.6	6	4.3	1	0.7
6（低危型）	51	4.8	40	4.8	9	6.5	2	1.4
66	50	4.7	43	5.2	2	1.4	0	0.0
39	45	4.2	37	4.4	5	3.6	1	0.7
33	43	4.0	27	3.2	9	6.5	1	0.7
35	37	3.5	24	2.9	1	0.7	0	0.0
11（低危型）	36	3.4	31	3.7	7	5.1	2	1.4
31	34	3.2	26	3.1	4	2.9	1	0.7
73	25	2.3	15	1.8	6	4.3	0	0.0
45	24	2.2	22	2.6	1	0.7	1	0.7
82	14	1.3	13	1.6	1	0.7	1	0.7
83（低危型）	8	0.8	8	1.0	1	0.7	0	0.0

组别	CT		NG		UU		CT/NG/UU
组别	阳性例数	阳性率/%	阳性例数	阳性率/%	阳性例数	阳性率/%	阳性例数	阳性率/%
HPV阳性组	138	12.9^*#	22	2.1^*#	832	77.5^*#	857	79.9^*#
HPV阴性组	172	5.0	20	0.6	2 133	62.3	2 185	63.8
正常对照组	71	3.5	1	0.9	71	62.8	71	62.8

组别	CT		NG		UU		CT/NG/UU
组别	阳性例数	阳性率/%	阳性例数	阳性率/%	阳性例数	阳性率/%	阳性例数	阳性率/%
HPV阳性组	138	12.9^*#	22	2.1^*#	832	77.5^*#	857	79.9^*#
HPV阴性组	172	5.0	20	0.6	2 133	62.3	2 185	63.8
正常对照组	71	3.5	1	0.9	71	62.8	71	62.8

组别	CT		NG		UU		CT/NG/UU
组别	阳性例数	阳性率/%	阳性例数	阳性率/%	阳性例数	阳性率/%	阳性例数	阳性率/%
单一感染	73	10.8	11	1.6	518	76.9	530	78.6
双重感染	39	15.1	6	2.3	199	77.1	209	81.0
三重感染	13	17.1	5	6.6^*	58	76.3	60	78.9
四重及以上感染	13	20.0^*	0	0	57	87.7^*	57	87.7