| Cervical cancer is the second largest malignant tumor threating to the health of women in. The occurrence rates are increasing constantly in recent years, especially in developing countries. There are about 460,000 new cases each year, among which about 274,000 patients die from cervical cancer and the trend goes to the younger generation.The incidence of cervical cancer is a process that evolutions gradually from the precancerous lesions to the long-term and continuous pathological cancer. Some studies show that the cervical low-grade squamous intraepithelial lesions are mostly infected by the low-risk type of HPV, and few evolution to the cervical cancer; but the high-risk type of HVP-positive will result in the cervical high-grade squamous intraepithelial lesions. A growing number of pathologists and clinicians believe that the high-grade cervical squamous intraepithelial lesions are the real precancerous lesions.The risk factors for cervical cancer have some certain consistency with cervical precancerous lesions. Until now, we have reach to some consensus about the human papillomavirus infection is a necessary condition for cervical cancer. What the epidemiologists and clinicians concern about are the effects of other auxiliary risk factors after the existence of HPV infection and so do the cervical precancerous lesions. These risk factors include living conditions such as sex, marital fertility status, smoking, family history, oral contraceptives, sexually transmitted infections, social and economic factors, educational level, screening and so on.It has some unique practical meanings to know the high-risk factors of cervical high-grade squamous intraepithelial lesions and to develop appropriate screening strategies to better reduce the incidence of cervical cancer. Through the comparative case research of the cervical high-grade intraepithelial lesions, this article investigates the relationship between the cervical high-grade cervical intraepithelial lesions with the high-risk human papillomavirus infection and other possible auxiliary risk factors. To understand the high risk factors of HSIL contributes to the high-risk groups in screening. It attaches great significant to the prevention of cervical carcinoma with early diagnosis and early treatment for cervical precancerous lesions.Objective:To investigate the relationship between the cervical high-grade cervical intraepithelial lesions with the high-risk human papillomavirus infection and other possible auxiliary risk factors. It contributes to the cervical cancer screening for precancerous lesions at high risk, thus to reach the level of a more efficient use of health resources with the aim to reduce the incidence of cervical cancer and mortality.Methods:To develop the questionnaire:the questionnaire included demographic data, educational level, income level, smoking, reproductive history, high-risk HPV infection in sexually transmitted disease history (syphilis, genital herpes, clothing the original body, genital warts, trichomoniasis, HIV), oral contraceptives, sexual behavior, the cervical screening history (Pap or liquid-based cells) and cervical cancer family history, and to show the results of their cervical cytology, high-risk HPV-DNA values, pathology results.Subjects:the 594 patients who did cervical pathology from May,2008 to August, 2010 in Guangdong Provincial People's Hospital. The pathological results of HSIL (CINII-CINIII) occupy a total number of 376 cases (case group). The 218 patients are normal (normal, chronic inflammation, polyps) under the medical needs in the colposcopic biopsy. The group of subjects are required to complete a specially designed questionnaire.Inspection methods and positive criteria:cytological diagnostic criteria use the TBS (the Besthesda system) classification or the five classification of Pap; applies the second-generation hybrid capture (HCⅡ) detection of 13 HR-HPV (16,18, 31,33,35,45,51,52,56,58,59 and 68) subtypes, positive standards of the HPV-DNA≥1 pg/ml. It uses the conventional methylene blue staining of cervical biopsy.Statistical Methods:All of the analyses are processed on the software of SPSS 13.0. First, to conduct a analysis of single factor to preliminarily screening the influencing factors, using the c2 test with count data, the measurement data using the t test, and the nonparametric test using ranked data. Then we select the factors of the P value less than 0.10 in any single factor analysis for further multivariate Logistic regression analysis, using forced introduction method (enter method). Multivariate analysis showes a significant level according toα=0.05 (bilateral), and all P values≤0.05 are as the factors high-level cervical squamous intraepithelial neoplasia.Result:(1) HSIL single factor analysis:Age:patient group 36.051±6.849 years of age, ranging 20 to 71 years old; the control group Age 38.096±9.762 years of age, ranging 20 to 69 years old. To divide the age of≤31 years old; 32-36 years old; 37-42 years old;> 42 years old. With the different percentage of age of the two groups, there are great differences (P<0.001).Sex factors:the difference age of the first sexual life was significant (P<0.001), the number of sexual partners between the two groups was significant (P<0.001), in control group, the number of sexual partners are 1,2,≥3 and the percentage is 83.9% (183/218),7.8%(17/218),3.2%(7/218), case group were 81.4%(306/374),10.4% (39/374),8.2%(22/374). The number of sexual partners, sexual partners had no significant difference in the percentage (P=0.945).Reproductive history and contraceptive methods:the number of groups of pregnancy, parity, history of oral contraceptives had no significant percentage difference (P> 0.05).Smoking and family history:the family history of smoking and differences between the two groups had no significant (P> 0.05).Sociological factors:the case group and control group in vocational and educational level had no significant difference (P>0.05), but the two groups were significantly different income level, as in Table 2.infection in sexually transmitted diseases other than HR-HPV:the control group rate was 6.4%(14/218), infection rate of 4% in case group (15/374), they had no significant difference (P> 0.05).Cervical cytology screening:the number of the control group divided by cytological screening into 0,1,2,≥3 times, the percentages were 48.2%(105/218),21.1% (46/218),11.9%(26/218),8.8%(41/218).HR-HPV infection:high-risk HPV-DNA value of≥1 pg/ml is defined as a high-risk HPV infection, the control group, high-risk HPV infection rate was 49.1% (117/218), the control group, high-risk HPV infection rate 98.1%(367/374), the difference was significant (P<0.001).(2)HSIL of the logistic multiple regression analysis:There were significant differences between control group and patient group in factors of age of first coritus, number of sex partner,income and high risk HPV infection.was a high risk factor for High-grade squamous intraepithelial lesion (P=0.00).HPV-DNA load was graded in group of< 1pg/ml, 1≤HPV-DNA< 10pg/ml,10≤HPV-DNA< 100pg/ml,100≤HPV-DNA<1000pg/ml,and≥1000pg/ml. In comparison with guoup of<lpg/ml,OR values in other groups were 15.516,38.496,98.33,57.564, respectively, parity was also a high risk factor.And compared with nulliparous women (0),OR values were 2.931,4.067 and 3.870 for parity of 1,2 and≥3 times.number of sexual partners may be a high risk factorwith P value of 0.61.cervical cytology screening times that was divided into four groups of 0,1,2,≥3 times was a protective factor with OR value of 0.897. CONCLUSION:High-risk human papillomavirus(HPV) infection is a high risk factor for High-grade squamous intraepithelial. Cervical cytology screening and later first coitus are protection factors. More deliveriws si also a high risk and sexual partners may be one high riskConclusion:High-risk human papillomavirus(HPV) infection is a high risk factor for High-grade squamous intraepithelial. Cervical cytology screening and later first coitus are protection factors. More deliveriws si also a high risk and sexual partners may be one high risk... |
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