中文摘要：

目的通过人群调查，分析口腔HPV携带者中宫颈病变[包括宫颈上皮内瘤变（CIN）和宫颈癌]的发病风险。方法选取2009年1月至2011年12月在上海地区3个临床中心（包括上海交通大学医学院附属仁济医院、上海市第一妇婴保健院和上海市奉贤区中心医院）诊治的1200例门诊患者（包括行年度体检和门诊就诊患者）和50例术前诊断为CINⅢ、宫颈癌的住院患者，以荧光定量PCR技术检测其口腔HPV感染情况。对其中1200例门诊患者进行横断面队列分析，比较口腔HPV阳性和阴性者之间宫颈病变发生率的差异，并分析口腔HPV感染患者的人口一行为学特征；另对1250例门诊和住院患者进行病例一对照分析，比较宫颈正常者与宫颈病变患者口腔HPV感染的差异，分析宫颈病变发病的主要危险因素。结果荧光定量PCR技术检测显示，1200例门诊患者中，口腔HPV阳性71例，占5．9％（71／1200）；50例住院患者中，口腔HPV阳性16例，占32．0％（16／50）。横断面队列分析显示，1200例门诊患者中，共发现宫颈病变患者（包括CINI和CINⅡ）18例，口腔HPV阳性（71例）和阴性（1129例）患者的宫颈病变发生率分别为4．2％（3／71）和1．3％（15／1129），两者比较，差异有统计学意义（P〈0．05）；口腔HPV阳性者发生CINI和CINⅡ的相对危险度分别为2．9和4．0；口腔HPV阳性者口交频繁（包括口交频度为经常和一直者）及性伴侣数〉3个者显著多于口腔HPV阴性者（P〈0．01）。病例一对照分析显示，1250例门诊和住院患者中，宫颈正常者（1182例）口腔HPV阳性率为5．8％（68／1182），宫颈病变者（68例）口腔HPV阳性率为27．9％（19／68），其中CINI、CINⅡ、CINⅢ、宫颈癌患者口腔HPV阳性率分别为2／13、1／5、31．4％（11／35）和5／15，CINI、cINⅡ、CINⅢ、宫颈癌患者口腔HPV阳性率分剐与宫颈正常者比较，?

英文摘要：

Objective To evaluate the risk of the occun＇enee of cervical intraepithelial neoplasia （CIN） and invasive cervical cancer in the oral HPV carriers through a population-based investigation in Shanghai. Methods A total of 1200 cases of outpatients who attended the annual cervical examination and 50 preoperational cases of inpatients with CIN Ⅲ or invasive cervical cancer were enrolled from three clinical centers in Shanghai. The oral HPV infection was determined by real-time PCR. In 1200-case cross-sectional study, the incidence rate of CIN was compared between the oral HPV positive and negative cohort. In 1250-case case-control study, the positive rate of oral HPV DNA test was compared among normal control group, CIN I - II[, and invasive cancer case groups, and all odds ratio （OR） values were calculated, respectively. The HPV transmission-related demographic and behavioral characters of the oral HPV carriers were also analyzed. Results The oral HPV carriers accounted for 5.9% （71/1200） of the investigated outpatients. The oral HPV DNA positive rates were gradually increased with the cervical disease grades, which were 5.8% （68/1182, normal） ,2/13 （ CIN I ）, 1/5 （ CIN Ⅱ ）, 31.4% （ 11/35, CIN m ） and 5/15 （ invasive cancer）. In cross-sectional cohort studies, the relative risks （RR） of CIN I , 11 were 2. 9 and 4.0 for oral HPV carriers, respectively. In case-control study, the OR values for CIN I - IU and invasive cervical cancer were 3.1（95% CI： 1.6 - 10. 1） , 4. 2（95% CI： 1.7 -28.4）, 7.1 （95% CI： 4.8 - 19.8） and 10. 1 （95% CI： 3.2 -32. 1 ） , respectively. The oral sex and multi-sexual partner were two major risk factors for the oral and cervical HPV co-infection, HPV-related cervical cancer and precancerous diseases according to behavioral analysis. Conclusions There are complicated transmission pathways between oral and cervical HPV. Oral HPV carriers should be intensively followed up and their oral HPV infection and HPV-related cervical diseases