研究目的

本研究旨在分析西藏自治区山南市乃东区女性高危型人乳头状瘤病毒（human papillomavirus, HPV）的感染率现状及其相关影响因素。通过系统性调查和分析，获取当地女性高危型HPV感染率、型别分布以及年龄特异性流行趋势等数据，为评估该地区子宫颈癌防控现状提供科学依据。通过对高危型HPV感染影响因素的分析，有助于识别高危人群，并为制定区域特异性防控策略提供循证支持，对改善低卫生资源地区的子宫颈癌防治工作具有重要指导意义。

研究方法

本研究采用横断面研究设计，于2023年5月至11月在西藏自治区山南市乃东区对25 ~ 64岁女性开展子宫颈癌筛查。采用基于杂交捕获原理的HPV分型技术进行HPV检测，同时通过问卷调查收集参与者的社会人口学信息，包括年龄、民族、婚姻状况、教育水平、职业等；行为因素，如吸烟史、初次性生活年龄、避孕措施使用情况；以及生殖健康相关数据，包括月经初潮年龄、分娩史、绝经状态等。采用SPSS 26.0软件进行统计分析，单因素分析采用c²检验，多因素分析采用logistic回归模型，以评估各因素对高危型HPV感染的影响。

研究结果

1. 本研究共纳入10 530名符合条件的女性，其中高危型HPV感染率为12.4%（1 307/10 530），HPV16/18的感染率为1.9%（203/10 530），其他12种高危型HPV的感染率为10.5%（1 104/10 530）。感染率呈“U”型分布，25 ~ 34岁年龄组（12.3%）和55 ~ 64岁年龄组（14.9%）为感染高峰。

2. 单因素分析发现，年龄（ײ = 17.456）、婚姻状况（ײ = 16.421）、职业（ײ = 34.684）、吸烟史（ײ = 9.303）、初次性生活年龄（ײ = 6.029）、绝经（ײ = 17.070）和避孕套避孕（ײ = 5.649）等因素为高危型HPV感染的影响因素（P < 0.05）。纳入多因素logistic回归分析结果显示，已婚（OR = 0.672, 95%CI = 0.539 ~ 0.838）和公职人员身份（OR = 0.741, 95%CI = 0.612 ~ 0.898）为保护因素，而有吸烟史（OR = 1.638, 95%CI = 1.131 ~ 2.373）和已绝经（OR = 1.251, 95%CI = 1.106 ~ 1.415）则为危险因素。

3. 在25 ~ 34岁年龄组女性中，已婚状态具有保护作用（OR = 0.580, 95%CI = 0.391 ~ 0.861），而吸烟史则是危险因素（OR = 1.981, 95%CI = 1.122 ~ 3.501）；在35 ~ 44岁年龄组女性中，避孕套使用显示出保护作用（OR = 0.467, 95%CI = 0.227 ~ 0.964）；在45 ~ 54岁年龄组女性中，绝经状态为危险因素（OR = 1.263, 95%CI = 1.024 ~ 1.559）；在55 ~ 64岁年龄组女性中，农牧民职业具有保护作用（OR = 0.598, 95%CI = 0.390 ~ 0.916），而初次性行为年龄较小被视为危险因素（OR = 1.463, 95%CI = 1.134 ~ 1.888）。

研究结论

1. 西藏自治区山南市乃东区女性高危型HPV的感染率相对全国水平偏高。该地区HPV16/18型别感染率较低，提示可能存在非16/18型别的显著流行。因此，在制定HPV防控策略时，比如选择疫苗价态，应充分考虑各地区的感染特征。

2. 55 ~ 64岁年龄组、有吸烟史以及已绝经者更易感染高危型HPV。因此，在子宫颈癌筛查中，应特别关注这些高风险群体，以提高筛查的效率和准确性。此外，针对高风险群体普及性健康和子宫颈癌相关知识，倡导健康的生活习惯（如戒烟、使用避孕套等），对于降低高危型HPV感染率及其相关疾病风险至关重要。

3. 西藏自治区山南市乃东区不同年龄别女性高危型HPV感染的影响因素各不相同，强调根据不同年龄阶段女性的特点制定有针对性干预措施，以更有效地预防和控制HPV感染。

Objectives

This study aims to analyze the prevalence of high-risk human papillomavirus (HPV) infection and its associated factors among women in Naidong District, Shannan City, Tibet Autonomous Region. Through systematic investigation and analysis, data on high-risk HPV infection rates, type distribution, and age-specific trends were obtained to provide a scientific basis for assessing the current status of cervical cancer prevention and control in the region. The analysis of factors influencing high-risk HPV infection helps identify high-risk populations and provides evidence-based support for developing region-specific prevention strategies, which is of significant guiding importance for improving cervical cancer prevention and control in low-resource health areas.

Methods

This cross-sectional study was conducted from May to November 2023 among women aged 25 to 64 in Naidong District, Shannan City, Tibet Autonomous Region. HPV testing was performed using a hybrid capture-based typing technique, and sociodemographic information, behavioral factors, and reproductive health data were collected through questionnaires. Statistical analysis was performed using SPSS 26.0 software, with chi-square tests for univariate analysis and logistic regression models for multivariate analysis to evaluate the impact of various factors on high-risk HPV infection.

Result

1. A total of 10,530 eligible women were included in the study, with an overall high-risk HPV infection rate of 12.4% (1,307/10,530). The infection rates for HPV 16/18 were 1.9% (203/10,530), and for other high-risk HPV types, it was 10.5% (1,104/10,530). The infection rate exhibited a "U"-shaped distribution, with peaks in the 25 - 34 age group (12.3%) and the 55 - 64 age group (14.9%).

2. Univariate analysis revealed that age (ײ = 17.456), marital status (ײ = 16.421), occupation (ײ = 34.684), smoking history (ײ = 9.303), age at first sexual intercourse (ײ = 6.029), menopause (ײ = 17.070), and condom use (ײ = 5.649) were significantly associated with high-risk HPV infection (P < 0.05). Multivariate logistic regression analysis showed that being married (OR = 0.672, 95% CI = 0.539 - 0.838) and having a public sector occupation (OR = 0.741, 95% CI = 0.612 - 0.898) were protective factors, while having a smoking history (OR = 1.638, 95% CI = 1.131 - 2.373) and menopause (OR = 1.251, 95% CI = 1.106 - 1.415) were risk factors.

3. For women aged 25 - 34, being married was protective (OR = 0.580, 95% CI = 0.391 - 0.861), while smoking history was a risk factor (OR = 1.981, 95% CI = 1.122 - 3.501). For those aged 35 - 44, condom use was protective (OR = 0.467, 95% CI = 0.227 - 0.964). For women aged 45 - 54, menopause was a risk factor (OR = 1.263, 95% CI = 1.024 - 1.559). For those aged 55 - 64, being a farmer or herdsman was protective (OR = 0.598, 95% CI = 0.390 - 0.916), while younger age at first sexual intercourse was a risk factor (OR = 1.463, 95% CI = 1.134 - 1.888).

Conclusions

1. The prevalence of high-risk HPV infection among women in Naidong District, Shannan City, Tibet Autonomous Region, is relatively higher than the national level. The lower infection rate of HPV 16/18 suggests a significant circulation of non-16/18 types in the region. Therefore, region-specific infection characteristics should be fully considered when developing HPV prevention strategies, such as the selection of vaccine valency.

2. Women aged 55 - 64, those with a smoking history, and those who have undergone menopause are more susceptible to high-risk HPV infection. Thus, these high-risk groups should be prioritized in cervical cancer screening to enhance screening efficiency and accuracy. Additionally, disseminating sexual health and cervical cancer - related knowledge and promoting healthy lifestyle habits (such as smoking cessation and condom use) are crucial for reducing the incidence of high-risk HPV infection and associated diseases.

3. The factors influencing high-risk HPV infection vary among different age groups of women in Naidong District, Shannan City, Tibet Autonomous Region. This highlights the need to develop targeted interventions based on the characteristics of women at different age stages to more effectively prevent and control HPV infection.