Hospital-based Study On The Distribution Of HPV Types In Patients With Cervical Intraepithelial Neoplasia And The Applicability Of HPV Vaccines In Xinjiang Region

Purpose:To investigate the distribution and infection rate of subtypes of human papillomavirus(HPV)in patients with cervical intraepithelial neoplasia(CIN),so as to further risk stratification for high-risk women infected with HPV.In order to provide relevant basic data for HPV vaccination in Xinjiang.Methods:In this study,a total of1331 patients diagnosed with CIN and hospitalized for surgical treatment in the Affiliated Cancer Hospital of Xinjiang Medical University from January 2017 to December 2021were retrospectively analyzed the HPV infection rate and genotype distribution.Results:(1)Among the 1331 patients included,the frequency of HPV detection was 1569 times(cases with multiple infections could be counted repeatedly),the positive rate of HPV was 89.86%(1196/1331),and the negative rate was 10.14%(135/1331),among which the frequency of HPV16 was the highest.41.94%(658/1569).The top six following PV16 were PV58,52,33,18 and 31.They accounted for 10.13%(159/1569),8.16%(128/1569),5.86%(92/1569),5.23%(82/1569)and 3.1%(65/1569)respectively.(2)The highest HPV detection rate was 36.01%(163/1569)in the 40-49 age group,followed by27.12%(427/1569)in the 30-39 age group and 20.59%(323/1569)in the 50-59 age group.In all age groups,the most common genotypes were HPV16,58,52,33,18,in slightly different order.HPV16 has the highest infection rate in<30 years old patients,difference was statistically significant(?~2=10.654,P=0.031).HPV58 has high infection rate in 30-39 and(29)60 years old is significantly higher than other age groups,the difference was statistically significant(?~2=9.803,P=0.044).HPV18 infection rate is higher in<30 and(29)60 years old age group,the difference was statistically significant(?~2=354.654,P=0.000).(3)The different level of CIN patients with single infection and multiple infection rate statistically difference(?~2=10.590,P=0.005),the single infection rate was significantly higher multiple infection rate(78.21%vs 21.79%).By comparing two between CIN groups found CIN1 groups with CIN3 HPV infection status of different(?~2=8.188,P=0.004),CIN2 group with CIN3 HPV infection status of different(?~2=5.342,P=0.021),there was no significant difference in HPV infection between CIN1group and CIN2 group(P>0.05),and the single infection rate of CIN3 was higher than that of CIN1 and CIN2 groups(78.9%vs 68.9%,78.9%vs 72.2%).The multiple infection rates were lower than CIN1 and CIN2 groups(21.1%vs 31.1%,21.1%vs27.8%).By comparing the prevalence of different HPV types in patients with single and multiple infections,it was found that whether it was single infection or multiple infection,the infection rate of HPV16,HPV58 and HPV52 increased with the increase of cervical lesions.It can be seen that the unique disease of these HPV genotypes is stronger than that of other types.Among them,HPV16 was the dominant infection.(4)In the cervical cytology of CIN patients,the highest proportion was NILM group(38.54%,513/1331),followed by HSIL+group(20.89%,278/1331)and ASC-US group(17.46%);The detection rates of HPV 16,58,18,52 and 33 were 38.83%,7.95%,6.42%,6.27%and4.27%respectively in NILM group.HPV16 detection rate increased with the severety of abnormal cervical liquid based cytology level,27.52%in LSIL group was,45.55%in the ASC-H group,and 49.11%in HSIL+group(?~2=29.454,P=0.000).(5)The total detection rate of HPV16+18 was 47.17%,HPV6+11+16+18 was 48.57%,and HPV6+11+16+18+31+33+45+52+58 was 77.37%.HPV53+51+39+56+68was not covered by HPV vaccine detected in 16.06%of the CIN patients.The detection rate of HPV16,33,58 increased with the increase of the severity of CIN,while the detection rate of HPV11,18,31,45,51,39,56 decreased with the increase of the severity of CIN.Conclusions:(1)HPV16,18,31,33,39,51,52,56,58 and 68 have high prevalence in the CIN population in this study,suggesting that better effects can be achieved when vaccination covers more than HPV genotypes in the prevention of HPV-related cervical cancer in the local area,especially the nine-valent vaccine can benefit the local population the most.(2)The single infection rate was significantly higher than the multiple infection rate in CIN patients.With the increase of cervical lesions,the single infection rate of HPV increased,while the multiple infection rate decreased.Whether single infection or multiple infection,the infection rates of HPV16,HPV58 and HPV52 increased with the increase of cervical lesions.It can be seen that although there are many HPV types infected by CIN patients,the number of HPV types that can eventually cause lesions is relatively small,which confirms once again that HPV vaccine has a high applicability in Xinjiang.(3)NILM group accounted for the highest proportion of patients with CIN,suggesting that cervical cytology has a high rate of missed diagnosis,and colposcopy referral rate should be improved to avoid missed diagnosis of cervical lesions.HPV 16 infection is dominant in all levels of cytological diagnosis,and cervical lesions caused by HPV infection depend on the pathogenicity of each type of HPV infection.Therefore,HPV bivalent or quadrivalent vaccine is recommended to achieve the purpose of blocking most cervical lesions.