The Correlation Between Human Papillomavirus Viral Load And The Degree Of Cervical Lesions

Objective: 1.To explore the relationship between single and multiple human papillomavirus(HPV)infections and cervical pathological grade;2.The distribution of HPV types in different cervical pathological grades,the relationship between viral load and different cervical pathological grade and the predictive value of HPV viral load on cervical intraepithelial neoplasia(CIN)Ⅱ+ under single HPV infection;3.The changes of viral load in patients with HPV infection before and after treatment.Methods: This study retrospectively enrolled 4783 cases of HPV-DNA positive for cervical exfoliated cells detection in Shanxi Provincial People’s Hospital between May 2017 and March 2019.3728 cases of them were selected according to the inclusion and exclusion criteria.The genotypes and viral loads of HPV were determined by real-time fluorescence quantitative PCR.At the same time,TCT and histopathological diagnosis under colposcope were performed.According to the pathologic results,the grades of cervical lesions were grouped into 3 categories: chronic cervicitis/CINⅠ,CINⅡ/CINⅢ and cervical cancer.ROC curve was used to predict the sensitivity and specificityof HPV viral load on the diagnosis of CINⅡ+.Results: 1.There were 3364 cases of HPV single infection,including 78.3% of chronic cervicitis /CINⅠ,18.7% of CINⅡ/CINⅢ,and 3.0% of cervical cancer;364 cases of HPV multiple infections,including 51.6% of chronic cervicitis/CINⅠ,42.6% of CINⅡ/CIN Ⅲ,and 5.8% of cervical cancer.There were significant differences in the proportion of single infection and multiple infections in different cervical pathological grades,X2=127.21,P<0.001.2.HPV infection genotypes in chronic cervicitis/CINⅠ,CINⅡ/CINⅢ were HPV16,52,58 and 53.The proportion of HPV16,52,58 and 53 infections in chronic cervicitis/CINⅠ were 17.05%,12.91%,9.08% and 8.89%,respectively.And the proportion of HPV16,52,58 and 53 infections in CINⅡ/CINⅢ were 32.22%,10.32%,8.41% and 5.87%,respectively.The most common genotypes of HPV infection in cervical cancer were HPV16 and HPV18,and their ratios were 81.19% and 6.93%,respectively.3.When HPV16,18,31,33,51,52,53 and 58 were infected,there were significant differences in viral load between different cervical pathological grades(P <0.05),and there was a positive correlation between viral load and cervical pathological grade.There were no significant differences in viral load among different cervical pathological grades when other types(HPV6,11,26,35,39,45,56,59,66,68,73,81,82)were infected(P>0.05).4.When HPV31,18,33 and 16 were infected and their viral loads were higher than the critical value,the sensitivity of predicting CINⅡ + were 98%,92.1%,77.8% and 70.5%,respectively,and the specificity were 66.20%,34.40%,57.00% and 65.50%,respectively.5.The data of 120 patients with HPV infection before and after treatment were collected.The viral loads after treatment were significantly lower than that before treatment,t = 13.260,P<0.001.Conclusion: 1.Multiple HPV infections are more likely to aggravate the degree of cervical pathological grade than single infection;2.HPV viral load is type-dependent with cervical pathological grade;3.By obtaining the appropriate thresholds of HPV viral loads,we can make risk cues and best prediction for CINⅡ+;4.After treatment,the prognosis of patients with HPV infection can be evaluated by monitoring the viral load of HPV.