건강증진센터를 방문하는 여성의 인유두종바이러스의 유병률 및 유전형의 분포와 자궁이형성증과의 관계
Prevalence and Genotype of Human Papillomavirus Infection and Risk of Cervical Dysplasia among Asymptomatic Korean Women
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배경: 지속적인 인유두종 바이러스(Human papillomavirus, HPV)의 감염이 자궁경부암을 발생시킨다는 것이 밝혀졌고 현재 고위험 HPV 유전형의 존재유무와 자궁경부질세포진검사가 자궁경부암 선별에 중요한 요소로 자리잡고 있다. 이에고위험 HPV를 표적으로 하는 백신이 개발되어 실제 임상에서 쓰이고 있다. 따라서 산부인과적 증상이 없는 여성에서인유두종바이러스의 유병률 및 유전형의 분포, 자궁이형성증과의 관계를 알아보고자 하였다. 방법: 환자의 질 분비물을 HPV genotyping chip을 이용하여 유전형의 분포를 분석하였다. 자궁이형성증은 후향적으로환자의 의무기록 검토를 통하여 ‘no dysplasia 군’, ‘미확정 비정형 편평 상피 세포(atypical squamous cells of undetermined significance, ASCUS) 군’, ‘저등급편평상피내 병변(low-grade squamous intraepithelial lesion, LSIL) 군’, ‘고등급편평상피내병변(high-grade squamous intraepithelial lesion, HSIL) 군’으로 분류하여 HPV 유병률 및 유전형의 분포, 자궁이형성증과HPV 감염과의 관계를 분석하였다. 결과: 전체 HPV 감염 유병률은 17.6% (91/518)였다. HPV-18 (2.3%), HPV-16 (2.1%), HPV-58 (1.2%) 순으로 높은 유전자형의 분포를 보였다. 자궁경부질세포진검사 결과에 따른 HPV genotyping 검사결과 HPV 감염 유병률 및 고위험 HPV 유전형의 유병률은 ‘no dysplasia 군’에 비해 ‘ASCUS 군’, ‘LSIL 군’, ‘HSIL 군’에서 유의하게 높았다(P＜0.05). 결론: 이번 연구에서는 산부인과적 증상이 없는 건강한 한국 여성을 대상으로 HPV 유병률 및 HPV 유전자형의 분포와자궁이형성증과의 연관성에 대한 자료를 구축하였다. 최근 자궁경부암백신 접종이 적극적으로 권장되고 있어 향후 한국여성에서 HPV와 자궁이형성증 유병률의 변화가 있을 것으로 생각되며 저자들은 이 연구가 기본 자료로 역할을 할 것이라 판단된다.
Abstract
Background: The persistence of infection by high-risk human papillomavirus (HPV) may lead to cervical cancer. Recently, the American Society for Colposcopy and Cervical Pathology (ASCCP) announced that oncogenic HPV screening and the PAP smear are the main methods of screening for cervical cancer. The goal of this study was to investigate the prevalence and genotyping of HPV, as well as the risk of cervical dysplasia. Methods: HPV genotyping was conducted by a commercial chip assay. Cervical dysplasia was retrospectively reviewed using electronic medical records. The study participants were grouped together according to cervical dysplasia status: ‘no dysplasia,’ ‘atypical squamous cells of undetermined significance (ASCUS),’ ‘low-grade squamous intraepithelial lesion (LSIL),’ and ‘high-grade squamous intraepithelial lesion (HSIL).’ The HPV prevalence and genotyping were analyzed according to the cervical dysplasia group. Results: The overall prevalence of HPV was 17.6% (91 out of 518 patients). HPV-18 (2.3%), HPV-16 (2.1%), and HPV-58 (1.2%) were the three most frequent genotypes. The prevalence of HPV infection and the high-risk HPV positive rate was higher in the ASCUS, LSIL, and HSIL groups than in the no dysplasia group (P＜0.05). Conclusion: In this study, basic data regarding the prevalence and distribution of HPV genotypes were obtained. Since HPV vaccination has been actively encouraged among Korean women, a change in the prevalence of HPV and cervical dysplasia is expected in the future. This study provided basic data describing the prevalence of HPV and its genotypes in the pre-HPV vaccination era.
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