一、HR-HPV持续感染的疾病风险高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)持续感染是引起子宫颈癌及癌前病变的主要病因。通常不到10%新发HPV感染会在5~10年内持续阳性,并进一步进展为子宫颈癌前病变[1]。2021年,WHO发布的子宫颈癌筛查及癌前病变治疗指南(第二版)[2]以及我国国家卫生健康委子宫颈癌筛查项目推荐方法中建议对14种HR-HPV型别(HPV 16、18、31、33、35、39、45、51、52、56、58、59、66、68)进行核酸检测。值得注意的是,国际癌症研究机构(IARC)对致癌类型的分类随着更多循证医学证据可能会发生了变化,例如HPV 66可能不再被纳入1类致癌型别[3]。
宫颈癌(Cervical Cancer)是我国最常见的妇科肿瘤,目前认为宫颈癌的发生发展,是因为宫颈上皮内病变继续发展,突破上皮下基底膜,浸润间质,形成了宫颈浸润癌。宫颈低级别鳞状上皮内病变大部分患者可以自然消退,在极少数个体中,长期的高危型HPV感染可能促使宫颈发展至高级别鳞状上皮内病变,并有可能最终演变为宫颈癌。针对合并高危型HPV感染的宫颈低级别鳞状上皮内病变,当前的治疗方案包括药物治疗、物理疗法和手术切除等多种方法。临床可根据患者年龄、生育诉求及实际病情和经济状况,选择合适的治疗方案。本文对宫颈低级别鳞状上皮内病变合并高危型HPV感染的治疗策略进行综述,对于临床指导实践具有重要意义。Cervical cancer is the most common gynecological tumor in our country. It is currently believed that the occurrence and development of cervical cancer are a process where cervical intraepithelial neoplasia progresses, breaks through the basement membrane under the epithelium, infiltrates the stroma, and forms invasive cervical cancer. Most patients with low-grade squamous intraepithelial lesions (LSIL) of the cervix can naturally regress. In a very small number of individuals, long-term high-risk HPV infection may promote the progression of the cervix to high-grade squamous intraepithelial lesions (HSIL) and potentially evolve into cervical cancer. For low-grade squamous intraepithelial lesions of the cervix associated with high-risk HPV infection, current treatment options include drug therapy, physical therapy, and surgical excision, among various methods. Clinically, appropriate treatment plans can be selected based on the patient’s age, fertility desires, actual condition, and economic status. This article reviews the treatment strategies for low-grade squamous intraepithelial lesions of the cervix combined with high-risk HPV infection, which is of significant importance for guiding clinical practice
高危型人乳头瘤病毒(HPV)感染是宫颈癌发生的主要致病因素,尤其是HPV16和HPV18型与宫颈癌的发生密切相关。本文综述了高危型HPV的流行病学特征,分析了不同地区和人群中HPV基因型的分布及其易感性差异。HPV疫苗接种和宫颈癌筛查是预防HPV感染、减少宫颈癌发生的主要策略。全球范围内HPV疫苗的推广显著降低了高危型HPV感染的流行率,对宫颈癌防治具有重要意义。此外,本文还强调了在高危人群中开展早期筛查和定期干预的重要性,突出了这些措施在促进早期诊断和减少疾病负担方面的积极作用。High-risk human papillomavirus (HPV) infection is the main cause of cervical cancer, with HPV types 16 and 18 being particularly closely linked to its development. This review explores the epidemiology of high-risk HPV, focusing on the distribution of HPV genotypes and variations in susceptibility across different regions and populations. HPV vaccination and cervical cancer screening are the primary strategies for preventing HPV infections and reducing the incidence of cervical cancer. The global expansion of HPV vaccination has significantly reduced the prevalence of high-risk HPV infections, with important implications for cervical cancer prevention and control. Furthermore, this review emphasizes the critical role of early screening and regular interventions in high-risk groups, highlighting their impact on improving early diagnosis and reducing the overall disease burden.
