ÖZET
Amaç: Servikal intraepitelyal neoplazi tanısı konulan hastaların serviks biopsilerinde PCR yöntemi ile HPV 16 ve 18 suşlarının ve bölgemizde hangisinin daha fazla servikal intraepitelyal neoplazi etkeni olduğunun araştırılması.Çalışmanın Yapıldığı Yer: Fırat üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum ABD, Devlet Hastanesi Kadın Doğum Bölümü, Elazığ.Materyal ve Metod: Aralık 1997-Ekim 2001 tarihleri arasında Fırat üniversitesi tıp fakültesi araştırma hastanesi ve Elazığ devlet hastanesi kadın doğum bölümüne başvuran hastalardan servikal smear sonucu class 3 gelen hastalara kolposkopiyi takiben şüpheli alanlardan biopsi alındı. Servikal biopsi örneklerinde histopatolojik olarak servikal intraepitelyal neoplazi tanısı konulan vakalardan 40 vaka ile (G1= Servikal intraepitelyal neoplazi=Çalışma), total abdominal histerektomi materyallerinde normal servikal bulgu tanısı konulan 40 vaka (G2=Normal serviks=Kontrol) prospektif çalışma programına alındı. Vakaların parafin bloğa gömülü serviks biopsi doku örneklerinden 5-10 mm kalınlığında 80 parafin blok örneği alındı. Bu örneklerde PCR yöntemi kullanılarak HPV 16 ve 18 suşlarının genomları araştırıldı. Nominal veriler için c2, ordinal veriler için Mann Whitney U testi kullanıldı. p<0.05 anlamlı kabul edildi. HPV 16 ve 18 genomları için Relatif risk (RR; %95 CI) hesaplandı.Bulgular: Servikal intraepitelyal neoplazi vakalarında HPV 16 genomu 13 vakada (%33), HPV 18 genomu ise 2 vakada (%5), kontrol grubunda ise HPV 16 genomu 2 vakada (%5), HPV 18 genomu 1 vakada (%2.5) saptandı. HPV 16 genomu anlamlı olarak servikal intraepitelyal neoplazi grubunda yüksek (p=0.003, c2 test), RR=6.5, (%95 CI=1.5-30) bulundu. HPV 18 genomu ise benzer (p>0.05, Fisher exact test), RR=2, (%95 CI=0.2-21) bulundu.Sonuç: Bölgemizdeki servikal intraepitelyal neoplazi vakalarında HPV16 suşu 6.5 kat daha fazla etkin rol oynamaktadır.

ABSTRACT
Objective: To investigate HPV 16 and HPV 18 sushes in the cervical biopsies of patients diagnosed as cervical intra-epithelial neoplasia by using PCR method and to find out which of the two is a more frequent agent of cervical intra-epithelial neoplasia in our region. Instution: Fırat University, School of Medicine, Obstetrics and Gynecology Department, State Hospitals Obstetrics Department, Elazığ.Material and Method: Of the patients who were admitted to the Fırat University School of Medicine research hospital and Elazığ State Hospitals Obstetrics department between December 1997 and October 2001, those who were class 3 according to cervical smear were examined by colposcope and after that, biopsies were taken from suspected sites. 40 cases who were diagnosed as cervical intra-epithelial neoplasia after the histopathologic investigation of cervical biopsy samples (G1= cervical intra-epithelial neoplasia = study group) and 40 cases who were diagnosed as having normal cervical findings in their total abdominal hysterectomy materials (G2= normal cervix = control group) were included in a prospective study program. 80 paraffin block samples of 5-10 µm. thickness were taken from the cases cervix biopsy tissue samples embedded in paraffin block. The genomes of HPV 16 and HPV 18 sushes were investigated by using PCR method in these samples. X2 was used for nominal data and Mann Whitney U Test for ordinal data. P < 0.05 was regarded significant. Relative risk for HPV 16 and HPV 18 genomes were calculated (RR; 95% CI).Results: In the cervical intra-epithelial neoplasia cases, HPV genome was found in 13 cases (33%) and HPV 18 genome in 2 cases (5%), while in the control group HPV 16 genome was identified in 2 cases (5%) and HPV 18 in 1 case (2.5%). HPV 16 genome was found to be significantly higher in cervical intra-epithelial neoplasia cases (p = 0.003, c2 test) and RR was found equal to 6.5 (95% CI = 1.5-30). HPV 18 genome was found similar and RR was equal to 2 (95% CI = 0.2-21).Conclusion: HPV 16 genome plays a 6.5 times more effective role in cervical intra-epithelial neoplasia cases in our region.