目的本研究探讨在中国一个宫颈癌发病率明显较高的县,围绝经期(40-59岁)和老年(60-65岁)妇女中,高危型人乳头瘤病毒(HR-HPV)感染的流行病学及其与癌前病变的联系。通过独特地关注欠发达地区的这些年龄组,这项研究旨在为宫颈癌的管理和预防提供新的策略。它旨在为有针对性的干预措施和公共卫生政策提供信息,这些措施和政策可以使HPV风险增加的妇女大大受益。解决当前经济弱势社区预防工作中的一个关键差距。方法本观察性研究在略阳县妇幼保健计划生育服务中心进行,从2021年9月到2022年1月。它评估了2008年40-65岁的女性进行HPV筛查,342人接受进一步的细胞学检查。该研究评估了不同年龄段和风险类别的HPV感染患病率。它利用问卷收集参与者的基本信息,健康行为,等相关数据分析HR-HPV感染的影响因素。统计分析包括卡方检验,趋势分析,逻辑回归,和多种插补技术来解决丢失的数据。结果略阳县40~65岁女性HR-HPV感染率为18.43%。老年妇女表现出更高的HPV感染发生率,ThinPrep细胞学检查(TCT)结果异常(陕西福安生物科技有限公司。,宝鸡市,中国),低/高级别鳞状上皮内病变(LSIL/HSIL)(P<0.05)。总体上最普遍的HR-HPV基因型,围绝经期,和老年组分别为HPV-52,-53和-58;HPV-52,-53和-16;和HPV-58,-52和-53。异常的Bethesda系统(TBS)结果中流行的HR-HPV基因型为HPV-16,-52,-33,-58;-16,-52,-58;和-16,-33和-52。HPV-16、-18、-33的患病率随病变严重程度的增加而增加(P<0.05)。在这项研究中,3个年龄组影响HR-HPV的因素主要与性行为和文化程度有关,包括下生殖道疾病史,多胎妊娠,不结扎输卵管的避孕方法,初婚年龄超过18岁,做爱后从不洗外阴,性禁欲,初中以上文化程度,和配偶的高中以上文化程度。结论这些发现表明,老年人群异常TBS的发生率升高可能归因于持续性感染易发HR-HPV基因型(HPV-58、-52和-53)的患病率较高。多重感染,和有效的致癌HR-HPV基因型(HPV-16和-33)。此外,老年患者HR-HPV患病率较高可能与受教育程度较低有关,降低筛查率,和有限的避孕套使用。因此,针对围绝经期和老年妇女的策略应优先提高健康意识,提高筛查率,并鼓励使用避孕套。
Purpose This study delves into the epidemiology of high-risk human papillomavirus (HR-HPV) infection and its link to precancerous lesions among perimenopausal (40-59 years) and elderly (60-65 years) women in a Chinese county with a notably high incidence of cervical cancer. By uniquely focusing on these age groups in underdeveloped regions, the research aims to offer novel strategies for the management and prevention of cervical cancer. It seeks to inform targeted interventions and public health policies that could significantly benefit women at heightened risk for HPV, addressing a critical gap in current prevention efforts in economically disadvantaged communities. Methods This observational study was conducted at the Maternal and Child Health and Family Planning Service Centre in Lueyang County, from September 2021 to January 2022. It assessed 2008 women aged 40-65 for HPV screening, with 342 undergoing further cytological examination. The study evaluated the prevalence of HPV infection across different age groups and risk categories. It utilized a questionnaire to collect participants\' basic information, health behaviors, and other relevant data to analyze factors influencing HR-HPV infection. Statistical analyses comprised chi-square tests, trend analysis, logistic regression, and multiple imputation techniques to address missing data. Results The prevalence of HR-HPV infection among women aged 40-65 years in Lueyang County was 18.43%. Older women exhibited a higher incidence of HPV infection, abnormal ThinPrep Cytology Test (TCT) results (Shaanxi Fu\'an Biotechnology Co. Ltd., Baoji City, China), and low/high-grade squamous intraepithelial lesions (LSIL/HSIL) (P<0.05). The most prevalent HR-HPV genotypes in the overall, perimenopausal, and elderly groups were HPV-52, -53, and -58; HPV-52, -53, and -16; and HPV-58, -52, and -53, respectively. The prevalent HR-HPV genotypes in the abnormal The Bethesda System (TBS) results were HPV-16, -52, -33, -58; -16, -52, -58; and-16, -33, and -52. HPV-16, -18, -33 prevalence increased with increasing lesion severity (P<0.05). In this study, factors affecting HR-HPV in the three age groups were found to be mainly related to sexual behavior and education level, including history of lower genital tract diseases, multiple pregnancies, contraceptive methods without tubal ligation, age at first marriage greater than 18 years, never washing the vulva after sex, abstinence from sex, education level of junior high school or above, and spouse\'s education level of high school or above. Conclusions These findings suggest that the elevated rate of abnormal TBS in the older age group may be attributed to the higher prevalence of persistent infection-prone HR-HPV genotypes (HPV-58, -52, and-53), multiple infections, and potent oncogenic HR-HPV genotypes (HPV-16 and -33). Additionally, the higher HR-HPV prevalence in older patients may be related to lower education attainment, reduced screening rate, and limited condom usage. Therefore, strategies targeting perimenopausal and older women should prioritize enhancing health awareness, increasing screening rates, and encouraging condom utilization.