자궁경부 상피내 종양과 인유두종 바이러스Viral load와의 상관관계
The association of the cervical intraepithelial neoplasia and human papillomavirus viral load
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목적: HPV viral load가 자궁경부 상피내 종양과 어떠한 상관관계가 있는지와 병변의 중증도를 예측하는 인자로서의 유용성을 알아보고자 하였다. 연구 방법: 2003년 8월부터 2004년 10월까지 자궁경부 세포검사와 HPV DNA test를 함께 시행받은 총 2411명 중 질확대경 하 조직생검 및 수술을 통해 최종 병리조직학적 진단이 내려진 군 (n=259)을 대상으로 viral load 값과 병변의 정도를 비교하였다. Viral load의 측정은 Hybrid Capture II system을 이용하여 검체와 대조군의 상대적인 빛 단위의 비율로 표현하였다. 결과: 대조군과 CIN 1, CIN 2, CIN 3, SCC인 각각의 군 사이에 임상적 특성에는 유의한 차이를 보이지 않았으나 CIN 등급이 높아질수록 viral load가 증가하는 양상을 보였으며 통계적으로 유의하였다. HPV viral load가 자궁경부 상피내 종양 유무를 진단하는데 대한 민감도, 특이도, 양성예측도, 음성예측도는 각각 82.9%, 37.7%, 60.0%, 66.2%로 나타난 반면에 저등급 병변과 고등급 병변을 감별하는데는 각각 94.4%, 34.3%, 67.5%, 80.8%로 더 높은 민감도를 나타냈다. 또한 viral load를 negative, low, intermediate, high의 4군으로 나누어 자궁경부 상피내 종양 유무를 비교하였을 때, 각 군의 odds ratio는 negative 군을 기준으로 하여 1.8, 3.4, 3.5로 확인되었고, 특히 고등급 병변 여부와 유의한 상관관계가 있어 6.7, 9.0, 9.6로 증가된 odds ratio를 보였다. 결론: 자궁경부 상피내 종양에서 고등급 병변일수록 높은 HPV viral load를 가지는 것으로 나타났으며 이는 viral load의 측정이 병변의 중증도를 예측하고 추가 검사 및 치료 여부를 결정하는 데 도움이 될 수 있으리라 생각된다.
Abstract
Objective: The purpose of this study was to determine the relationship between the cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) DNA load and to evaluate the efficacy of viral load in prediction of histologic severity. Methods: The cervical cytology and Hybrid Capture II tests for HPV detection were performed in 2411 women visited our hospital, from August 2003 to October 2004. A total of 259 consecutive women underwent cervical colposcopy directed biopsy and operations with confirmed final histologic diagnoses were included. Viral load was measured by Hybrid Capture II system expressed as relative lights unit (RLU) ratio of specimens and controls. Results: There was no significant difference of CIN 1, CIN 2, CIN 3, SCC group and control group in the clinical characteristics. The higher the viral load, the higher stage of CIN was shown. HPV viral load test showed sensitivity of 82.9%, specificity of 37.7%, positive predictability of 60.0%, negative predictability of 66.2% in detecting CIN, while 94.4%, 34.3%, 67.5%, 80.8% in detecting HGSIL. The viral loads were categorized into four groups (negative, low, intermediate, high) for analysis and it was shown that higher viral load group tended to exist CIN more frequently (odds ratio=1, 1.8, 3.4, 3.5). In addition, viral load was more strongly associated with the risk of HGSIL than that of LGSIL (odds ratio=1, 6.7, 9.0, 9.6). Conclusion: We found that the higher HPV viral load is significantly associated with the higher stage of CIN. The measurement of HPV DNA load is useful for predicting the severity of lesions of the uterine cervix and making decision of treatment plans.
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