人乳头瘤病毒感染模式对宫颈癌及其癌前病变的影响：研究进展与争议
Influence of Human Papillomavirus Infection Patterns on Cervical Cancer and Its Precancerous Lesions: Research Advances and Controversies
DOI: 10.12677/jcpm.2026.52146, PDF,   
作者: 李 骋：济宁医学院临床医学院，山东 济宁；冯彦丽*：济宁医学院附属医院妇科，山东 济宁
关键词: 人乳头瘤病毒；多重感染；鳞状上皮内病变；宫颈癌；基因型；Human Papillomavirus (HPV)； Multiple Infections； Squamous Intraepithelial Lesions (SILs)； Cervical Cancer； Genotype
摘要: 人乳头瘤病毒(Human Papillomavirus, HPV)是导致宫颈癌及其癌前病变的主要病原体，90%以上的宫颈癌归因于HPV持续感染。HPV感染依据其型别构成可分为单一感染(single infection)和多重感染(multiple infection)两种模式，其中多重感染对宫颈鳞状上皮内病变(squamous intraepithelial lesions, SILs)发生风险的独立影响存在显著争议。本文系统综述了HPV多重感染与宫颈癌及癌前病变风险的关联性，深入分析了多重感染对宫颈病变进展、持续存在和自然消退的影响，探讨了潜在的生物学机制，并评估了其临床意义与现有争议。当前循证医学证据提示，含高危型HPV (high-risk HPV, hrHPV)尤其HPV16/18的多重感染可能与高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia grade 2 or worse, CIN2+)风险增加相关，但其独立于主导高危型别(predominant high-risk type)的风险贡献程度仍需进一步研究阐明。现有临床管理策略主要依据最高风险型别及组织学诊断结果，而未将多重感染状态纳入决策。未来需结合更精准的检测技术和设计严谨的纵向临床队列研究，以明确HPV多重感染的生物学本质和临床价值，为优化宫颈癌预防、筛查和管理策略提供循证依据。
Abstract: Human papillomavirus (HPV) represents the primary etiological agent responsible for cervical cancer and its precancerous lesions, with over 90% of cervical cancers attributable to persistent HPV infection. HPV infections can be categorized into two distinct patterns based on genotype composition: single infection and multiple infection. The independent impact of multiple infections on the risk of cervical squamous intraepithelial lesions (SILs) remains a subject of considerable controversy. This comprehensive review systematically examines the association between HPV multiple infections and the risk of cervical cancer and precancerous lesions, critically analyzes the influence of multiple infections on lesion progression, persistence, and spontaneous regression, explores potential molecular mechanisms, and evaluates their clinical significance and ongoing controversies. Current evidence suggests that multiple infections involving high-risk HPV types, particularly HPV16/18, may be associated with an increased risk of high-grade cervical intraepithelial neoplasia (CIN2+); however, the extent to which this risk contribution is independent of the predominant high-risk type requires further investigation. Current clinical management strategies primarily rely on the highest-risk HPV type and histological diagnosis, without incorporating the status of multiple infections into decision-making. Future efforts should integrate more precise detection technologies and design rigorous longitudinal clinical cohort studies to elucidate the biological nature and clinical value of HPV co-infections. This will provide evidence-based support for optimizing cervical cancer prevention, screening, and management strategies.
文章引用：李骋, 冯彦丽. 人乳头瘤病毒感染模式对宫颈癌及其癌前病变的影响：研究进展与争议[J]. 临床个性化医学, 2026, 5(2): 453-462. https://doi.org/10.12677/jcpm.2026.52146

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