探讨山东省门诊女性就诊者人乳头状瘤病毒(human papillomavirus，HPV)感染及其亚型分布状况。

收集2014年3月至2015年6月期间，山东省171家医院和社区卫生服务站妇科门诊4161例女性门诊就诊者宫颈拭子标本，送济南金域医学检验中心用导流杂交与基因芯片结合技术进行21种HPV基因型检测后，分析6个年龄组(≤20岁组101例、21~30岁组953例、31~40岁组1368例、41~50岁组1262例、51~60岁组330例、>61岁组56例)的阳性率和亚型分布。

4161例女性中，检出HPV阳性1325例，总阳性率31.8%，其中：高危型HPV(high-risk HPV，hrHPV)和低危型HPV(low-risk HPV，lrHPV)阳性检出率分别为27.3%和10.4%。hrHPV(46.5%)和lrHPV(45.5%)阳性率均以≤20岁年龄组阳性率最高，后随年龄增加而逐渐下降，而hrHPV阳性率在51~60岁组略有升高(26.1%)。此外，随着年龄的增加，各年龄组单一性感染构成比(依次为37.1%、55.9%、67.2%、67.4%、72.3%、73.4%)和单一性hrHPV感染构成比(依次为25.8%、57.2%、72.9%、76.8%、78.7%、73.3%)所占比例逐渐增加，而各年龄组多重感染构成比(依次为63.9%、44.1%、32.8%、32.6%、27.7%、26.7%)、单一性lrHPV感染构成比(依次为24.2%、16.9%、13.0%、12.2%、8.5%、20.0%)和高低危HPV混合感染构成比(依次为50.0%、25.9%、14.1%、11.0%、12.8%、6.7%)所占比例逐渐减少。21种HPV亚型均有检出(范围为0.1%~18.3%)，hrHPV前5位的分别为HPV16(13.6%)、HPV52(11.1%)、HPV58(7.7%)、HPV53(6.9%)和HPV51(4.7%)；lrHPV前3位分别为HPV6(6.8%)、HPV11(5.5%)和HPV81(5.4%)。多重感染中HPV16所占比率明显低于单重感染(10.7%比18.3%)，而HPV53(8.1%比4.9%)和HPV33(4.0%比2.3%)则相反。在多重感染病例中，随着感染不同亚型HPV数量的增多，高低危混合感染例数所占比例明显增加(287例二重感染中检出高低危HPV亚型混合感染病例占35.9%、125例三重感染中占61.6%、80例四重及以上感染中占78.7%)。

山东省门诊女性HPV感染率和不同亚型分布受年龄、感染重数和感染模式的影响。山东省门诊女性的这些HPV感染特征，可为宫颈癌筛查和HPV疫苗接种及推广提供科学依据。

To investigate the prevalence and genotype distribution of human papillomavirus (HPV) infection among female outpatients in Shandong Province.

Cervical swabs of 4161 females from 171 local community hospitals and health stations from March 2014 to June 2015 were referred to Jinan KingMed Diagnostics and tested by a HPV genotyping chip, which can detect 21 HPV types using flow-through hybridization. The prevalence and genotype distribution in six age groups (101 cases in ≤20 age group, 953 cases in 21-30 age group, 1368 cases in 31-40 age group, 1262 cases in 41-50 age group, 330 cases in 51-60 age group and 56 cases in >61 age group) were documented and analyzed.

A total of 1325 cases were HPV-positive and the positive rate was 31.8%. The positive rates of high-risk HPV (hrHPV) and low-risk HPV (lrHPV) were 27.3% and 10.4% respectively. Both the prevalence of hrHPV (46.5%) and lrHPV (45.5%) was highest in ≤20-year age group, and gradually declined as age increased. The hrHPV-positive rate slightly increased in 50~60-year age group (26.1%). Similar age-specific prevalence was observed in multiple HPV infection(double or more subtype, the age-specific constituent rates were 63.9%, 44.1%, 32.8%, 32.6%, 27.7% and 26.7%, respectively), pure lrHPV infection(the age-specific constituent rates were 24.2%, 16.9%, 13.0%, 12.2%, 8.5% and 20.0%, respectively), hrHPV and lrHPV mixed infections(the age-specific constituent rates were 50.0%, 25.9%, 14.1%, 11.0%, 12.8% and 6.7%, respectively). In contrast, the percentages of single HPV(the age-specific constituent rates were 37.1%, 55.9%, 67.2%, 67.4%, 72.3% and 73.4%, respectively)and pure hrHPV infections(the age-specific constituent rates were 25.8%, 57.2%, 72.9%, 76.8%, 78.7% and 73.3%, respectively)showed an upward trend as age increased. All 21 HPV genotypes were detected (ranging from 0.1% to 18.3%). HPV16 (13.6%), HPV52 (11.1%), HPV58 (7.7%), HPV53 (6.9%) and HPV51 (4.7%) were the most common hrHPV genotypes. HPV6 (6.8%), HPV11 (5.5%) and HPV81 (5.4%) were the most common lrHPV genotypes. HPV16 was more common in single infection than in multiple infection (18.3% vs 10.7%), while HPV53 and HPV33 showed opposite distributions that they were more common in multiple infection than in single infection (4.9% vs 8.1% and 2.3% vs 4.0% respectively). The proportion of hrHPV and lrHPV mixed infection increased when the number of HPV subtype in the infection increased in these cases. 35.9% hrHPV and lrHPV mixed infections were detected in 287 two subtype infection cases, 61.6% hrHPV and lrHPV mixed infections were detected in 125 three subtype infection cases and 78.7% hrHPV and lrHPV mixed infections were detected in 80 four or more subtype infection cases.

The prevalence and genotype distribution of HPV infection are influenced by ages, number of HPV subtypes that co-infect the patients and infection modalities in Shandong Province. The characteristics of HPV infection among these female outpatients can serve as valuable reference to guide cervical cancer screening and HPV vaccination programs.