A total of 2224 females were included in this study, with a mean age of 37.6 years (±9.2 SD), ranging from 21 to 77 years. Patients were admitted for post-coital bleeding, postmenopausal bleeding, last abnormal LCT, abnormal menstruation, irregular bleeding, and uterine prolapse (Table 1). All of the women were tested for liquid-based cytology and for the HPV genotype examination. Cytological abnormalities were found in 479 subjects. ASC-US (264, 11.9%) was found to be the most common cytological abnormalities, followed by LSIL (152, 6.8%). Women with the cytological results of SCC were older than those with other cytological findings. In addition, the mean age of patients with HSIL and ASC-H is higher than that of normal cytology patients (Table 1). HPV infection was detected in 688(30.9%) patients (including HR-HPV infection and LR-HPV infection). The HR-HPV infection rate was 27.8% (619/2224), and the LR-HPV infection rate was 5.0% (112/2224). Forty-three women were detected to have both HR-HPV and LR-HPV infections, and 135 women were detected with multiple HR-HPV infections. Furthermore, patients with cytological findings of ASC-US, LSIL, HSIL and SCC showed higher HPV positive rates and higher multiple HR-HPV positive rates than the normal and AGC results (Table 1).
The prevalence of HPV genotype was shown in Table 2. HPV-52(4.9%) was found to be the most common genotype in total, followed by HPV-16(4.2%), HPV-58(2.9%)and HPV-53(1.9%). The HPV infection rate in patients with different cytological examination results was different. As shown in Tables 3 & 4, HPV infection rate was significantly higher in cytology with ASC-US or worse patients (LCT+) than that of negative patients, except for HPV-35, HPV-43 and HPV-44. In patients with cytological results of HSIL and higher lesions (HSIL+), the infection rates of HPV-16, HPV-31, HPV-33, and HPV-58 were significantly higher than that of those patients with cytological results of LSIL and lower lesions (LSIL-).
Multivariate logistic regression was used to explore the relationship between different HPV subtypes of infection and cytological abnormalities, and to adjust the effect of age on cell lesions. As shown in Table 5, multivariate logistic regression shows HPV-16, 18, 33, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 11, 42 and CP8304 were significantly associated with positive correlation LCT results. In addition, we used multivariate regression to analyze the relationship between different HPV subtypes and HSIL+ lesions, HPV-16, 31, 33, and 58 were shown independent predictors for HSIL and above cytological abnormalities.
On the basis of the above results, we established a prediction model to predict cervical cytology, and calculated the corresponding risk indicators. A Receiver Operating Characteristic curve (ROC) was used to evaluate the prediction efficiency. The results show that the model has a good predictive effect on cell lesions, and the area under the ROC curve (AUC) is equal to 0.73 (Fig. 1A). Additionally, the prediction efficiency for HSIL+ shows an AUC of 0.82 (Fig. 1B).