{"id":31081,"date":"2025-12-29T13:08:18","date_gmt":"2025-12-29T10:08:18","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=31081"},"modified":"2026-01-15T11:57:09","modified_gmt":"2026-01-15T08:57:09","slug":"servikal-orneklerde-hpv-sikligi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2025\/12\/29\/servikal-orneklerde-hpv-sikligi\/","title":{"rendered":"Servikal \u00d6rneklerde Y\u00fcksek Riskli Human Papilloma Virusu (HPV) Yayg\u0131nl\u0131\u011f\u0131 ve Genotip Da\u011f\u0131l\u0131m\u0131"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/b><\/h2>\n

\u0130nsan papilloma virusu (human papillomavirus, HPV), cinsel yolla bula\u015fan yayg\u0131n bir infeksiyon etkenidir. Cinsel olarak aktif bireylerin b\u00fcy\u00fck \u00e7o\u011funlu\u011fu, ya\u015famlar\u0131n\u0131n bir d\u00f6neminde genellikle semptom g\u00f6stermeden bu virusla infekte olurlar (1). \u0130nfeksiyonlar\u0131n \u00e7o\u011fu asemptomatik seyretmekte ve kendili\u011finden iyile\u015fmektedir; ancak kal\u0131c\u0131 HPV infeksiyonlar\u0131 hem kad\u0131nlarda hem de erkeklerde anogenital si\u011fillere, prekanser\u00f6z lezyonlara ve servikal, anogenital veya orofaringeal kanserlere yol a\u00e7abilir (2). Serviks kanseri, d\u00fcnya genelinde kad\u0131nlarda en s\u0131k g\u00f6r\u00fclen d\u00f6rd\u00fcnc\u00fc kanser olup olgular\u0131n b\u00fcy\u00fck bir k\u0131sm\u0131 geli\u015fmekte olan \u00fclkelerde saptanmaktad\u0131r; her y\u0131l yakla\u015f\u0131k 260 000 kad\u0131n\u0131n \u00f6l\u00fcm\u00fcne neden olmaktad\u0131r. Serviks kanserlerinin %99.7\u2019sinde y\u00fcksek riskli HPV genotipleri tan\u0131mlanm\u0131\u015ft\u0131r (3).<\/p>\n

Bug\u00fcne kadar 444 HPV tipinin tam genom dizisi a\u00e7\u0131klanm\u0131\u015ft\u0131r; HPV\u2019ler, n\u00fckleotid dizilerindeki farkl\u0131l\u0131klara g\u00f6re Alfa-, Beta-, Gamma-, Mu- ve Nupapillomavirus olmak \u00fczere be\u015f cinse ayr\u0131l\u0131r. Mupapillomavirus ve Nupapillomavirus t\u00fcrleri el ve ayaklardaki si\u011fillerle ili\u015fkiliyken, Betapapillomavirus ve Gammapapillomavirus t\u00fcrleri daha \u00e7ok deri infeksiyonlar\u0131na neden olur. Alfapapillomaviruslar ise mukozal, kutan\u00f6z ve mukokutan\u00f6z b\u00f6lgelere tropizm g\u00f6sterir; onkojenik HPV\u2019ler bu cinsin bir alt k\u00fcmesini olu\u015fturur (4). Malign lezyonlardaki rolleri temelinde HPV\u2019ler onkojenik (y\u00fcksek riskli) ve non-onkojenik (d\u00fc\u015f\u00fck riskli) \u015feklinde s\u0131n\u0131fland\u0131r\u0131l\u0131r. Displazi ve kansere yol a\u00e7abilen 15 tip (HPV-16, -18, -31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -68, -73 ve -82) y\u00fcksek riskli; genital si\u011fillere, d\u00fc\u015f\u00fck dereceli displaziye ve solunum yolu papillomatozuna neden olan 12 tip (HPV-6, -11, -40, -42, -43, -44, -54, -61, -70, -72, -81 ve CP6108) ise d\u00fc\u015f\u00fck riskli olarak tan\u0131mlanm\u0131\u015ft\u0131r. Geriye kalan HPV-26, -53 ve -66 genotipleri ise olas\u0131 y\u00fcksek riskli tipler aras\u0131nda kabul edilir (5). Serviks kanseri hastalar\u0131n\u0131n %99.7\u2019sinde y\u00fcksek riskli HPV DNA\u2019s\u0131 g\u00f6r\u00fclmektedir; bunlar\u0131n aras\u0131nda yer alan HPV-16 ve -18 genotiplerinin d\u00fcnya genelinde servikal kanser olgular\u0131n\u0131n %70\u2019inden fazlas\u0131ndan sorumlu oldu\u011fu bilinmektedir (6,7). Y\u00fcksek riskli HPV infeksiyonu sonras\u0131nda invazif kanser geli\u015fimi %1\u20133 oran\u0131nda ger\u00e7ekle\u015fmekte olup bu s\u00fcre\u00e7 yakla\u015f\u0131k 25\u201340 y\u0131l s\u00fcrmektedir (8).<\/p>\n

HPV infeksiyonlar\u0131n\u0131n yayg\u0131nl\u0131\u011f\u0131 ve genotip da\u011f\u0131l\u0131m\u0131, farkl\u0131 pop\u00fclasyonlar aras\u0131nda b\u00fcy\u00fck de\u011fi\u015fiklikler g\u00f6stermektedir. \u00d6rne\u011fin, HPV-31 ve -33 Avrupa ve Amerika Birle\u015fik Devletleri (ABD)\u2019nde daha yayg\u0131nken, HPV-35 ve -45 Afrika\u2019da, HPV-52 ve -58 Asya \u00fclkelerinde daha yayg\u0131nd\u0131r (9). HPV-16 ve -18\u2019in onkojenik potansiyeli, erken viral gen \u00fcr\u00fcnleri olan E6 ve E7 proteinleri ile ili\u015fkilidir. Bu proteinler, t\u00fcm\u00f6r bask\u0131lay\u0131c\u0131 proteinler p53 ve retinoblastomay\u0131 inhibe ederek hasarl\u0131 h\u00fccrelerin \u00f6l\u00fcms\u00fczle\u015fmesine yol a\u00e7an mekanizmalar\u0131 tetikler (10). \u00c7o\u011fu kad\u0131nda HPV infeksiyonu asemptomatiktir ve kanser geli\u015ftirmez. \u0130ki y\u0131l i\u00e7inde, bu infeksiyonlar\u0131n %91\u2019i kendili\u011finden iyile\u015fmektedir. Cinsel y\u00f6nden aktif gen\u00e7 kad\u0131nlarda HPV infeksiyonu daha yayg\u0131nd\u0131r (3).\u00a0<\/span><\/p>\n

G\u00fcn\u00fcm\u00fczde HPV\u2019ye kar\u015f\u0131 etkili \u00fc\u00e7 lisansl\u0131 a\u015f\u0131 bulunmaktad\u0131r:\u00a0<\/span><\/p>\n

Cervarix:<\/strong> HPV-16 ve -18 genotiplerinin L1 virus benzeri par\u00e7ac\u0131klar\u0131n\u0131 (virus-like particle, VLP) i\u00e7erir.\u00a0<\/span><\/p>\n

Gardasil:<\/strong> HPV-6, -11, -16 ve -18 genotiplerinin L1 VLP\u2019lerini i\u00e7erir.<\/p>\n

Gardasil 9:<\/strong> HPV-6, -11, -16, -18, -31, -33, -45, -52 ve -58 genotiplerinin L1 VLP\u2019lerini i\u00e7erir.<\/p>\n

D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), iki veya d\u00f6rt de\u011ferlikli a\u015f\u0131lar\u0131n iki doz olarak uygulanmas\u0131n\u0131 \u00f6nermektedir (5).\u00a0<\/span><\/p>\n

Co\u011frafi konum, sosyoekonomik durum, k\u00fclt\u00fcrel uygulamalar ve viral genomun genetik de\u011fi\u015fkenli\u011fi gibi bir\u00e7ok fakt\u00f6rden dolay\u0131 HPV infeksiyonunun ve ili\u015fkili genotiplerin epidemiyolojik yay\u0131l\u0131m\u0131 belirgin farkl\u0131l\u0131klar g\u00f6stermektedir (11). Ya\u015f, hastal\u0131\u011f\u0131n ilerlemesinde \u00f6nemli bir etkendir. Kad\u0131nlar\u0131n %80\u2019i 50 ya\u015f\u0131na kadar HPV ile infekte olurken, servikal kanser \u00f6l\u00fcmlerinin %35\u2019i 65 ya\u015f \u00fcst\u00fc kad\u0131nlarda g\u00f6r\u00fclmektedir (3).\u00a0<\/span><\/p>\n

Bu \u00e7al\u0131\u015fmada, servikal s\u00fcr\u00fcnt\u00fc \u00f6rneklerinde HPV\u2019nin yayg\u0131nl\u0131\u011f\u0131n\u0131n ve dinamik genotip da\u011f\u0131l\u0131m\u0131ndaki de\u011fi\u015fimlerin belirlenmesi ama\u00e7land\u0131.<\/p>\n

Y\u00d6NTEMLER<\/b><\/h2>\n

Retrospektif olarak ger\u00e7ekle\u015ftirilen \u00e7al\u0131\u015fmaya, Ocak 2019 ile Aral\u0131k 2024 tarihleri aras\u0131nda hastanemiz Molek\u00fcler Viroloji Laboratuvar\u0131\u2019nda multipleks ger\u00e7ek zamanl\u0131 PCR testi ile HPV DNA\u2019s\u0131 ara\u015ft\u0131r\u0131lan 8825 kad\u0131na ait servikal s\u00fcr\u00fcnt\u00fc \u00f6rnekleri dahil edildi. \u00c7al\u0131\u015fma grubundaki 8825 ki\u015fiden 1271\u2019inde (%14.4) HPV DNA pozitifli\u011fi saptand\u0131; HPV DNA tespit edilen 1271 ki\u015finin ya\u015f ortalamas\u0131 40.10 \u00b1 11.61 y\u0131l olup 20\u2019si (%1.6) yabanc\u0131 uyruklu idi.<\/p>\n

\u00c7al\u0131\u015fma i\u00e7in Mu\u011fla S\u0131tk\u0131 Ko\u00e7man \u00dcniversitesi T\u0131p Fak\u00fcltesi Etik Kurulu\u2019ndan 21 Ocak 2025 tarihinde, 18 karar numaras\u0131yla onay al\u0131nd\u0131.<\/p>\n

Molek\u00fcler Analiz<\/strong><\/p>\n

\u00c7al\u0131\u015fmaya dahil edilen olgulara ait servikal \u00f6rneklerden elde edilen HPV genotip PCR sonu\u00e7lar\u0131 analiz edildi. Servikal s\u00fcr\u00fcnt\u00fc \u00f6rnekleri PreservCyt (Hologic Inc., Marlborough, MA, ABD) ta\u015f\u0131ma ortam\u0131 kullan\u0131larak al\u0131nm\u0131\u015ft\u0131r. \u00d6rnekler laboratuvara ula\u015ft\u0131ktan sonra, DNA ekstraksiyonu yap\u0131l\u0131ncaya kadar 2\u20138\u00b0C\u2019de en fazla 2 hafta s\u00fcreyle saklanm\u0131\u015ft\u0131r. Viral DNA ekstraksiyonu, \u00fcretici firman\u0131n talimatlar\u0131na uygun \u015fekilde QIAsymphony DSP Virus\/Pathogen Kit (Qiagen, Venlo, Hollanda) kullan\u0131larak ger\u00e7ekle\u015ftirilmi\u015f; izolasyon ve safla\u015ft\u0131rma s\u00fcre\u00e7leri manyetik boncuklar arac\u0131l\u0131\u011f\u0131yla yap\u0131lm\u0131\u015ft\u0131r. Elde edilen viral n\u00fckleik asit \u00fcr\u00fcnleri, Rotor-Gene Q MDx cihaz\u0131nda (Qiagen, Almanya) QIAscreen HPV PCR test kiti (Qiagen, Hollanda) kullan\u0131larak amplifiye edilmi\u015ftir. Her bir t\u00fcp \u015feridine 15 \u03bcl QIAscreen master mix da\u011f\u0131t\u0131lm\u0131\u015ft\u0131r (\u00f6rnek ba\u015f\u0131na 5 \u03bcl). Amplifikasyon i\u015flemlerinde pozitif kontrol (\u03b2-globin) ve negatif kontrol \u00f6rnekleri kullan\u0131larak deneysel s\u00fcre\u00e7lerin g\u00fcvenilirli\u011fi de\u011ferlendirilmi\u015f; \u00f6rnekleme ve cihaz kaynakl\u0131 hatalar\u0131n en aza indirilmesi ama\u00e7lanm\u0131\u015ft\u0131r. QIAscreen HPV PCR test kiti, y\u00fcksek riskli (HR) HPV tiplerinin E7 geninde korunan bir b\u00f6lgeyi hedefleyen, floresan problar arac\u0131l\u0131\u011f\u0131yla bir veya birden fazla PCR \u00fcr\u00fcn\u00fcn\u00fc saptayan multipleks ve ger\u00e7ek zamanl\u0131 PCR temelli bir analiz sistemidir.\u00a0<\/span><\/p>\n

Test sonu\u00e7lar\u0131 yaz\u0131l\u0131m deste\u011fiyle nitel olarak de\u011ferlendirilmi\u015f olup HPV-16, -18, -31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, -67 ve -68 dahil olmak \u00fczere en yayg\u0131n ve onkojenik 15 HR-HPV genotipi ara\u015ft\u0131r\u0131ld\u0131. \u201cDi\u011fer HPV\u201d kategorisi, HPV-31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, -67 ve -68 genotiplerini i\u00e7ermektedir. HPV genotip da\u011f\u0131l\u0131m\u0131; ya\u015f gruplar\u0131na g\u00f6re (\u226425, 26\u201335, 36\u201345, 46\u201355, 56\u201365 ve \u226566) ayr\u0131 ayr\u0131 de\u011ferlendirildi.<\/p>\n

Sonu\u00e7lar\u0131n Yorumlanmas\u0131<\/strong><\/p>\n

HPV pozitif: <\/strong>HPV-16 ve\/veya HPV-18 i\u00e7in \u201ccycle threshold\u201d (Ct) <36 ve\/veya \u201cdi\u011fer HPV\u201d i\u00e7in Ct <33.5 oldu\u011funda (\u03b2-globin Ct de\u011feri dikkate al\u0131nmaks\u0131z\u0131n) \u00f6rnek HPV pozitif kabul edildi. \u0130lgili kanal mevcut HPV tiplerini g\u00f6sterdi.<\/p>\n

HPV negatif:<\/strong> \u03b2-globin i\u00e7in CT \u226430 ve HPV-16 ile HPV-18 i\u00e7in CT \u226536 veya sinyal yoksa, ayr\u0131ca \u201cdi\u011fer HPV\u201d i\u00e7in CT \u226533.5 veya sinyal yoksa \u00f6rnek HPV negatif olarak de\u011ferlendirildi.<\/p>\n

Ge\u00e7ersiz:<\/strong> \u03b2-globinin Ct de\u011feri >30 ve HPV-16 ile HPV-18 i\u00e7in Ct \u226536 veya sinyal yoksa; ayr\u0131ca \u201cDi\u011fer HPV\u201d i\u00e7in Ct \u226533.5 veya sinyal yoksa sonu\u00e7 ge\u00e7ersiz olarak tan\u0131mland\u0131.<\/p>\n

\u0130statistiksel Analiz<\/strong><\/p>\n

\u0130statistiksel analiz, SPSS s\u00fcr\u00fcm 22.0 (IBM Corp., Armonk, NY, ABD) yaz\u0131l\u0131m\u0131 kullan\u0131larak ger\u00e7ekle\u015ftirildi. De\u011fi\u015fkenlerin normal da\u011f\u0131l\u0131ma uygunlu\u011fu g\u00f6rsel y\u00f6ntemler (histogram ve olas\u0131l\u0131k grafikleri) ve Kolmogorov-Smirnov testi ile incelendi. Kantitatif de\u011fi\u015fkenler Mann-Whitney U testi, kalitatif de\u011fi\u015fkenler ise Pearson \u03c7\u00b2 testi kullan\u0131larak kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. De\u011fi\u015fkenler aras\u0131ndaki ili\u015fkiler Spearman s\u0131ral\u0131 korelasyon katsay\u0131s\u0131 ile analiz edildi; p<\/i><0.05 de\u011feri istatistiksel olarak anlaml\u0131 kabul edildi.<\/p>\n

BULGULAR\u00a0<\/span><\/b><\/h2>\n

Bu \u00e7al\u0131\u015fmaya, multipleks ger\u00e7ek zamanl\u0131 PCR testi ile HPV DNA\u2019s\u0131 ara\u015ft\u0131r\u0131lan 8825 kad\u0131na ait servikal s\u00fcr\u00fcnt\u00fc \u00f6rnekleri dahil edildi. \u00c7al\u0131\u015fma grubundaki 8825 ki\u015fiden 1271\u2019inde (%14.4) HPV DNA pozitifli\u011fi saptand\u0131; HPV DNA tespit edilen 1271 ki\u015finin ya\u015f ortalamas\u0131 40.10 \u00b1 11.61 y\u0131l olup 20\u2019si (%1.6) yabanc\u0131 uyruklu idi.\u00a0<\/span><\/p>\n

HPV genotipleri ara\u015ft\u0131r\u0131lan 1271 hastada en yayg\u0131n g\u00f6r\u00fclen genotipler s\u0131ras\u0131yla %50 (n=636) ile \u201cdi\u011fer HPV\u201d ve %36.2 (n=460) ile HPV-16 idi. Bunu %8.5 (n=108) ile HPV-18, %2.8 (n=36) ile HPV-16 + \u201cdi\u011fer HPV\u201d, %1.7 (n=22) ile HPV-18 + \u201cdi\u011fer HPV\u201d ve %0.7 (n=9) ile HPV-16 + HPV-18 izlendi. Ayn\u0131 anda \u00fc\u00e7 veya daha fazla genotipin (HPV-16 + HPV-18 + \u201cdi\u011fer HPV\u201d) spatand\u0131\u011f\u0131 infeksiyon g\u00f6r\u00fclmedi.\u00a0<\/span><\/p>\n

\"\"<\/a>

Tablo 1.<\/strong> HPV DNA Pozitif Olan Kad\u0131nlarda HPV Genotiplerine G\u00f6re Demografik \u00d6zellikler ve Y\u0131llara G\u00f6re Da\u011f\u0131l\u0131m<\/p><\/div>\n

Hastalar\u0131n demografik ve virolojik \u00f6zelliklerine g\u00f6re HPV genotiplerinin da\u011f\u0131l\u0131m\u0131 Tablo 1\u2019de sunuldu. Genotip gruplar\u0131na g\u00f6re ya\u015f da\u011f\u0131l\u0131m\u0131 incelendi\u011finde, en y\u00fcksek ya\u015f ortalamas\u0131 40.78 \u00b1 11.39 y\u0131l ile HPV-16 grubunda, en d\u00fc\u015f\u00fck ya\u015f ortalamas\u0131 ise 31.33 \u00b1 6.89 y\u0131l ile HPV-16 + HPV-18 grubunda saptand\u0131 (Tablo 1).\u00a0<\/span><\/p>\n

HPV genotip da\u011f\u0131l\u0131m\u0131 analiz edilen 1271 hastan\u0131n %98.4 (n=1251)\u2019\u00fc T\u00fcrk vatanda\u015f\u0131, %1.6 (n=20)\u2019s\u0131 ise yabanc\u0131 uyrukluydu. T\u00fcrk vatanda\u015flar\u0131 ile yabanc\u0131 uyruklular aras\u0131nda HPV genotip da\u011f\u0131l\u0131m\u0131 a\u00e7\u0131s\u0131ndan istatistiksel olarak anlaml\u0131 bir fark saptanmad\u0131 (p<\/i>=0.083). T\u00fcrklerde en s\u0131k g\u00f6r\u00fclen genotipler, %50.1 ile \u201cdi\u011fer HPV\u201d ve %36.2 ile HPV-16 iken yabanc\u0131larda en s\u0131k g\u00f6r\u00fclen genotipler %45 ile \u201cdi\u011fer HPV\u201d ve %1.5 ile HPV-16 idi. Genotiplerin da\u011f\u0131l\u0131m\u0131n\u0131 y\u0131llara g\u00f6re de\u011ferlendirdi\u011fimizde; 2019, 2021, 2022, 2023 ve 2024 y\u0131llar\u0131nda \u201cdi\u011fer HPV\u201d genotipleri en y\u00fcksek oranlarda saptan\u0131rken, yaln\u0131zca 2020 y\u0131l\u0131nda HPV-16 en s\u0131k izlenen genotip oldu. Y\u0131llara g\u00f6re genotip da\u011f\u0131l\u0131mlar\u0131 aras\u0131nda istatistiksel olarak anlaml\u0131 d\u00fczeyde fark g\u00f6r\u00fcld\u00fc (p<\/i><0.001) (Tablo 1).\u00a0<\/span><\/p>\n

\"\"<\/a>

\u015eekil 1.<\/strong> Ya\u015f Gruplar\u0131na G\u00f6re HPV Genotip Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

HPV genotipleri ya\u015f gruplar\u0131na g\u00f6re incelendi\u011finde, en y\u00fcksek pozitiflik oran\u0131 %31.2 (n=397) ile 36\u201345 ya\u015f grubunda, en d\u00fc\u015f\u00fck oran ise %1.0 (n=13) ile 56\u201365 ya\u015f grubunda g\u00f6r\u00fcld\u00fc. Ya\u015f grubu analizinde, \u226425, 26\u201335, 36\u201345, 46\u201355 ve 56\u201365 ya\u015f gruplar\u0131nda en s\u0131k \u201cdi\u011fer HPV\u201d, ikinci s\u0131kl\u0131kta HPV-16 g\u00f6r\u00fcl\u00fcrken; 66 ya\u015f ve \u00fczerindeki olgularda en s\u0131k HPV-16, ikinci s\u0131kl\u0131kta \u201cdi\u011fer HPV\u201d izlendi. Ya\u015f gruplar\u0131na aras\u0131nda genotip da\u011f\u0131l\u0131mlar\u0131 a\u00e7\u0131s\u0131ndan istatistiksel olarak anlaml\u0131 d\u00fczeyde bir fark saptanmad\u0131 (p<\/i>=0.154) (\u015eekil 1).\u00a0<\/span><\/p>\n

\u0130RDELEME<\/b><\/h2>\n

\u0130nsan papilloma virusu, cinsel yolla bula\u015fan en \u00f6nemli infeksiyon etkenlerinden biri olup asemptomatik infeksiyondan kansere kadar geni\u015f bir klinik spektruma neden olabilir. Yap\u0131lan \u00e7al\u0131\u015fmalarda HPV varl\u0131\u011f\u0131n\u0131n servikal kanser geli\u015fiminde ba\u015fl\u0131ca risk fakt\u00f6r\u00fc oldu\u011fu; di\u011fer risk fakt\u00f6rlerinin ise ya virusla kar\u015f\u0131la\u015fma oran\u0131n\u0131 art\u0131rd\u0131\u011f\u0131 ya da karsinojenik s\u00fcreci h\u0131zland\u0131rd\u0131\u011f\u0131 bildirilmi\u015ftir (12). Tan\u0131mlanan ba\u015fl\u0131ca risk fakt\u00f6rleri cinsiyet, ya\u015f, cinsel aktivite ve cinsel partner say\u0131s\u0131d\u0131r; en y\u00fcksek risk 25 ya\u015f alt\u0131 cinsel olarak aktif kad\u0131nlarda g\u00f6r\u00fclmektedir. Di\u011fer risk fakt\u00f6rleri aras\u0131nda sigara i\u00e7mek ve ba\u011f\u0131\u015f\u0131kl\u0131k durumu yer almaktad\u0131r (3). D\u00fcnya genelinde, serviks kanseri kad\u0131nlarda en s\u0131k g\u00f6r\u00fclen ikinci malignite olup her 100 000 kad\u0131ndan yakla\u015f\u0131k 35\u2019ini etkiler. T\u00fcrkiye Kanser Kontrol Program\u0131\u2019na g\u00f6re, serviks kanseri kad\u0131nlarda en s\u0131k g\u00f6r\u00fclen 10. kanserdir (13). Serviks kanserinde HPV genotiplerinin da\u011f\u0131l\u0131m\u0131 \u0131rk ve co\u011frafi b\u00f6lgeye g\u00f6re de\u011fi\u015fiklik g\u00f6stermektedir (14). Bu nedenle, her \u00fclkedeki HPV genotiplerine ili\u015fkin epidemiyolojik veriler, serviks kanserini \u00f6nlemek i\u00e7in uygun stratejilerin geli\u015ftirilmesinde b\u00fcy\u00fck \u00f6nem ta\u015f\u0131r. Bu \u00e7al\u0131\u015fman\u0131n amac\u0131, T\u00fcrkiye\u2019nin Mu\u011fla ilinde kad\u0131nlar aras\u0131nda HPV genotip da\u011f\u0131l\u0131m\u0131na ili\u015fkin g\u00fcncel epidemiyolojik verileri sunmakt\u0131r.<\/p>\n

D\u00fcnya genelinde HPV prevalans\u0131 %2 ile %44 aras\u0131nda de\u011fi\u015fmektedir. Normal servikal sitolojiye sahip kad\u0131nlarda ise bu oran %11.6\u2013%11.7 civar\u0131ndad\u0131r (3). Servikal HPV prevalans\u0131 Sahra alt\u0131 Afrika\u2019da %24 ile en y\u00fcksek d\u00fczeyde bildirilmi\u015f olup bunu Latin Amerika ve Karayipler (%16), Do\u011fu Avrupa (%14) ve G\u00fcneydo\u011fu Asya (%14) izlemektedir (1). HPV DNA pozitifli\u011fi, Macaristan\u2019da Fogarasi ve arkada\u015flar\u0131 (15) taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada %11.15 oran\u0131nda, Bulgaristan\u2019da Kovachev ve arkada\u015flar\u0131 (16) taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada ise %29.8 oran\u0131nda bildirilmi\u015ftir. \u00c7in\u2019in Pekin kentinde Zhang ve arkada\u015flar\u0131 (17) taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada HPV prevalans\u0131 %21 iken Hindistan\u2019\u0131n bat\u0131s\u0131nda yap\u0131lan bir \u00e7al\u0131\u015fmada servikal lezyonlu kad\u0131nlarda HR-HPV prevalans\u0131 %62.32 (134\/215) olarak tespit edilmi\u015ftir (11).\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, HPV DNA pozitiflik oran\u0131 %14.4 oran\u0131nda saptanm\u0131\u015f olup bu de\u011fer, d\u00fcnya genelinde bildirilen prevalans aral\u0131\u011f\u0131 i\u00e7inde yer almakta ve Do\u011fu Avrupa \u00fclkelerinde bildirilen oranlarla benzerlik g\u00f6stermektedir. Bununla birlikte, s\u00f6z konusu oran nispeten y\u00fcksek kabul edilebilir. T\u00fcrkiye\u2019de yap\u0131lan \u00e7al\u0131\u015fmalara bak\u0131ld\u0131\u011f\u0131nda HPV DNA pozitifli\u011fi oranlar\u0131 Tekkesin ve arkada\u015flar\u0131n\u0131n (9) \u00e7al\u0131\u015fmas\u0131nda %46.4, Taskin ve arkada\u015flar\u0131n\u0131n (18) \u00e7al\u0131\u015fmas\u0131nda %9.17 (18) ve Alacam ve arkada\u015flar\u0131n\u0131n (19) \u0130stanbul\u2019da yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada %36.3 (829\/2285) olarak bildirilmi\u015ftir. \u0130stanbul\u2019da yap\u0131lan bir di\u011fer \u00e7al\u0131\u015fmada ise HR-HPV pozitifli\u011fi oran\u0131 %11.73\u2019t\u00fcr (494\/4212) (20). T\u00fcrkiye\u2019de HPV prevalans\u0131 %2.1 ile %21 aras\u0131nda de\u011fi\u015fmekte olup elde etti\u011fimiz sonu\u00e7 bu aral\u0131kla uyumludur (12). \u00dclkemizde ve d\u00fcnya genelinde bildirilen HPV prevalans\u0131ndaki farkl\u0131l\u0131klar; sosyoekonomik durum, co\u011frafi yap\u0131, k\u00fclt\u00fcrel \u00f6zellikler, kullan\u0131lan tan\u0131 y\u00f6ntemleri ve \u00e7al\u0131\u015fmaya dahil edilen pop\u00fclasyonun karakteristikleri ile a\u00e7\u0131klanabilir.<\/p>\n

HPV genotip da\u011f\u0131l\u0131m\u0131, co\u011frafi b\u00f6lgelere, toplumlar\u0131n sosyoekonomik durumuna, ya\u015fam tarzlar\u0131na ve ba\u011f\u0131\u015f\u0131klama programlar\u0131n\u0131n uygulanma d\u00fczeyine g\u00f6re farkl\u0131l\u0131k g\u00f6stermektedir. D\u00fcnyada ve T\u00fcrkiye\u2019de HPV genotip da\u011f\u0131l\u0131m\u0131 \u00fczerine yap\u0131lan \u00e7al\u0131\u015fmalar, \u00f6zellikle kanserle ili\u015fkilendirilen y\u00fcksek riskli HPV t\u00fcrlerinin yayg\u0131nl\u0131\u011f\u0131na odaklanmaktad\u0131r. HPV genotiplerinin farkl\u0131 onkojenik potansiyele sahip olmas\u0131 nedeniyle, sitoloji temelli yakla\u015f\u0131mlar\u0131n yerini alan molek\u00fcler temelli tarama politikalar\u0131n\u0131n planlanmas\u0131nda genotip da\u011f\u0131l\u0131m\u0131n\u0131n izlenmesi kritik \u00f6neme sahiptir.\u00a0<\/span><\/p>\n

Almanya\u2019da gen\u00e7 kad\u0131nlarda yap\u0131lan bir \u00e7al\u0131\u015fmada HPV-16 prevalans\u0131 %7.0 ve HPV-18 prevalans\u0131 %0.8 oranlar\u0131nda bildirilmi\u015ftir (21). Bulgaristan\u2019da 687 kad\u0131nda yap\u0131lan bir \u00e7al\u0131\u015fmada en s\u0131k saptanan genotip HPV-16 (%13) olup bunu HPV-56 (%6.3) izlemektedir (16). \u00c7in\u2019in Pekin kentinde en s\u0131k rastlanan HPV genotipleri HPV-52 (%5.4) ve HPV-16 (%3.4) olarak bildirilmi\u015ftir (17). Sahra alt\u0131 Afrika\u2019da yap\u0131lan \u00e7al\u0131\u015fmada, 3075 kad\u0131ndan 424\u2019\u00fcn\u00fcn (%13.8) HPV-16, 305\u2019inin (%9.9) HPV-52 ve 279\u2019unun (%9) HPV-18 ile infekte oldu\u011fu bildirilmi\u015ftir (5).\u00a0<\/span><\/p>\n

T\u00fcrkiye\u2019den Gecer ve arkada\u015flar\u0131n\u0131n (22) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada en s\u0131k HPV-16 (n=127, %14.1) ve \u201cdi\u011fer HPV\u201d + HPV-16 (n=109, %12.1) genotipleri bildirilmi\u015ftir. \u00d6zmen ve arkada\u015flar\u0131n\u0131n (23) \u00e7al\u0131\u015fmas\u0131nda HPV-16 %25.6, HPV-18\/45 ise toplamda %9.0 oran\u0131nda tespit edilmi\u015ftir. Alacam ve arkada\u015flar\u0131n\u0131n (19) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada kad\u0131nlar\u0131n %30.9\u2019u (256\/829) HPV-16, %14.6\u2019s\u0131 (121\/829) HPV-39 ve %14.2\u2019si (118\/829) HPV-51 ile infektedir. Bizim \u00e7al\u0131\u015fmam\u0131zda da benzer \u015fekilde, HPV DNA pozitif 1271 olgunun 636\u2019s\u0131nda (%50.0) \u201cdi\u011fer HPV\u201d ve 460\u2019\u0131nda (%36.2) HPV-16 saptanarak en yayg\u0131n g\u00f6r\u00fclen genotipler olmu\u015ftur. HPV genotip da\u011f\u0131l\u0131m\u0131; ya\u015f, co\u011frafi b\u00f6lge ve pop\u00fclasyon \u00f6zelliklerine ba\u011fl\u0131 olarak de\u011fi\u015fti\u011finden, her \u00fclkeye \u00f6zg\u00fc epidemiyolojik veriler etkili tarama ve ba\u011f\u0131\u015f\u0131klama stratejilerinin olu\u015fturulmas\u0131 i\u00e7in gereklidir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda HPV genotip da\u011f\u0131l\u0131m\u0131 ara\u015ft\u0131r\u0131lan hastalar\u0131n %98.4\u2019\u00fc (n=1251) T\u00fcrk vatanda\u015f\u0131, %1.6\u2019s\u0131 (n=20) ise yabanc\u0131 uyruklu idi. T\u00fcrk vatanda\u015flar\u0131 ile yabanc\u0131 uyruklular aras\u0131nda istatistiksel olarak anlaml\u0131 d\u00fczeyde bir fark saptanmad\u0131 (p<\/i>=0.083). T\u00fcrklerde en s\u0131k g\u00f6r\u00fclen genotipler, %50.1 ile \u201cdi\u011fer HPV\u201d ve %36.2 ile HPV-16, yabanc\u0131larda da benzer \u015fekilde %45 ile \u201cdi\u011fer HPV\u201d ve %1.5 ile HPV-16 daha yayg\u0131nd\u0131. Y\u0131llara g\u00f6re genotip da\u011f\u0131l\u0131m\u0131 de\u011ferlendirildi\u011finde, 2019, 2021, 2022, 2023 ve 2024 y\u0131llar\u0131nda en s\u0131k \u201cdi\u011fer HPV\u201d, 2020 y\u0131l\u0131nda ise en s\u0131k HPV-16 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr; bu bulgu literat\u00fcrle uyumludur.<\/p>\n

HPV DNA pozitifli\u011finin ya\u015fa g\u00f6re da\u011f\u0131l\u0131m\u0131 inceledi\u011finde, Feng ve arkada\u015flar\u0131n\u0131n (6) \u00e7al\u0131\u015fmas\u0131nda en y\u00fcksek infeksiyon oran\u0131 \u226425 ya\u015f\u0131ndaki kad\u0131nlarda (%12.68) bildirilmi\u015ftir. Wei ve arkada\u015flar\u0131n\u0131n (24) \u00e7al\u0131\u015fmas\u0131nda HPV infeksiyonunun iki zirve noktas\u0131 \u226425 ya\u015f (%22.94) ve 56\u201365 ya\u015f (%21.25) gruplar\u0131ndad\u0131r. Yuan ve arkada\u015flar\u0131n\u0131n (25) \u00e7al\u0131\u015fmas\u0131nda HPV prevalans\u0131 en y\u00fcksek 21\u201330 ya\u015f grubundaki kad\u0131nlarda (%16.2; 271\/1670) g\u00f6zlenmi\u015ftir. Hurtado-Salgado ve arkada\u015flar\u0131 (26) taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmada en y\u00fcksek HPV prevalans\u0131 35\u201339 ya\u015f aras\u0131ndaki kad\u0131nlarda %10.4 olarak bildirilmi\u015ftir. Aydemir ve arkada\u015flar\u0131n\u0131n (27) \u00e7al\u0131\u015fmas\u0131nda HPV pozitifli\u011fi en y\u00fcksek 20\u201330 ya\u015f grubunda (%26.3; n=50) bulunmu\u015ftur (27). Alacam ve arkada\u015flar\u0131n\u0131n (19) \u00e7al\u0131\u015fmas\u0131nda ise en y\u00fcksek HR-HPV prevalans\u0131 17\u201334 ya\u015f grubunda (%44.1) tespit edilmi\u015ftir.<\/p>\n

Bizim \u00e7al\u0131\u015fmam\u0131zda HPV genotipleri ya\u015f gruplar\u0131na g\u00f6re en s\u0131k %31.2 (n=397) ile 36\u201345 ya\u015f aral\u0131\u011f\u0131nda, ikinci s\u0131kl\u0131kta ise %23 (n=292) ile 26\u201335 ya\u015f aral\u0131\u011f\u0131nda saptand\u0131. Ya\u015f gruplar\u0131n\u0131n \u00e7o\u011funda en s\u0131k \u201cdi\u011fer HPV\u201d, ikinci s\u0131kl\u0131kta HPV-16 izlenirken, yaln\u0131zca 66 ya\u015f ve \u00fczeri grupta en s\u0131k HPV-16, ikinci s\u0131kl\u0131kta \u201cdi\u011fer HPV\u201d g\u00f6r\u00fcld\u00fc. Ya\u015fa g\u00f6re HPV infeksiyonunun da\u011f\u0131l\u0131m\u0131 farkl\u0131 \u00e7al\u0131\u015fmalarda de\u011fi\u015fmekle birlikte, genellikle gen\u00e7 ya\u015f gruplar\u0131nda daha y\u00fcksek pozitiflik oranlar\u0131 bildirilmektedir. Gen\u00e7 kad\u0131nlarda daha s\u0131k cinsel aktivite, \u00e7oklu partner \u00f6yk\u00fcs\u00fc ve imm\u00fcnolojik savunma d\u00fczeyinin nispeten daha d\u00fc\u015f\u00fck olmas\u0131, HPV infeksiyonuna yatk\u0131nl\u0131\u011f\u0131 art\u0131ran ba\u015fl\u0131ca fakt\u00f6rler olarak g\u00f6sterilmektedir. Bu nedenle, gen\u00e7 kad\u0131nlar\u0131n hedef al\u0131nd\u0131\u011f\u0131 a\u015f\u0131 ve tarama programlar\u0131n\u0131n yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131 gerekli ve \u00f6nceliklidir.<\/p>\n

Bu \u00e7al\u0131\u015fman\u0131n temel s\u0131n\u0131rl\u0131l\u0131klar\u0131ndan biri, verilerin retrospektif olarak hastane kay\u0131tlar\u0131ndan derlenmi\u015f olmas\u0131d\u0131r. Olgular yaln\u0131zca sa\u011fl\u0131k sorunlar\u0131 nedeniyle hastaneye ba\u015fvuran bireylerden olu\u015ftu\u011fundan, \u00e7al\u0131\u015fma toplum temelli bir tarama niteli\u011fi ta\u015f\u0131maz. Ayr\u0131ca ara\u015ft\u0131rma, yaln\u0131zca servikal s\u00fcr\u00fcnt\u00fc \u00f6rneklerinde HPV DNA tespitine dayanmakta ve servikal sitoloji bulgular\u0131n\u0131 kapsamamaktad\u0131r.<\/p>\n

Sonu\u00e7 olarak \u00e7al\u0131\u015fmam\u0131z, b\u00f6lgedeki HPV yayg\u0131nl\u0131\u011f\u0131na ve genotip analizlerinde en s\u0131k saptanan tipler olan \u201cdi\u011fer HPV\u201d ile HPV-16\u2019n\u0131n da\u011f\u0131l\u0131m\u0131na ili\u015fkin g\u00fcncel veriler sunmaktad\u0131r. K\u00fcresel \u00f6l\u00e7ekte HPV genotip da\u011f\u0131l\u0131mlar\u0131nda belirgin co\u011frafi farkl\u0131l\u0131klar g\u00f6r\u00fcld\u00fc\u011f\u00fcnden, \u00fclkeye \u00f6zg\u00fc genotipleme verileri a\u015f\u0131lama ve tarama programlar\u0131n\u0131n etkinli\u011fini art\u0131rmak, a\u015f\u0131r\u0131 tedaviyi \u00f6nlemek ve serviks kanseri tarama politikalar\u0131n\u0131 g\u00fc\u00e7lendirmek a\u00e7\u0131s\u0131ndan \u00f6nemlidir. \u00dclkemizde HPV\u2019ye kar\u015f\u0131 ulusal bir a\u015f\u0131lama program\u0131n\u0131n bulunmamas\u0131, toplumun HPV\u2019nin bula\u015fma yollar\u0131 ve korunma y\u00f6ntemleri konusunda bilgilendirilmesini ve HPV a\u015f\u0131s\u0131n\u0131n ulusal ba\u011f\u0131\u015f\u0131klama program\u0131na dahil edilmesine y\u00f6nelik \u00e7al\u0131\u015fmalar\u0131n \u00f6nemini ortaya koymaktad\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e \u0130nsan papilloma virusu (human papillomavirus, HPV), cinsel yolla bula\u015fan yayg\u0131n bir infeksiyon etkenidir. Cinsel olarak aktif bireylerin b\u00fcy\u00fck \u00e7o\u011funlu\u011fu, ya\u015famlar\u0131n\u0131n bir d\u00f6neminde genellikle semptom g\u00f6stermeden bu virusla infekte olurlar (1). \u0130nfeksiyonlar\u0131n \u00e7o\u011fu asemptomatik seyretmekte ve kendili\u011finden iyile\u015fmektedir; ancak kal\u0131c\u0131 HPV infeksiyonlar\u0131 hem kad\u0131nlarda hem de erkeklerde anogenital si\u011fillere, prekanser\u00f6z lezyonlara ve servikal, anogenital veya […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[4519,6196,6195,6197],"class_list":["post-31081","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-hpv-asisi","tag-hpv-genotipleri","tag-insan-papilloma-virusu","tag-servikal-kanser"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31081","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=31081"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31081\/revisions"}],"predecessor-version":[{"id":31443,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/31081\/revisions\/31443"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=31081"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=31081"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=31081"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}