Plurihormonal PIT1-lineage pituitary neuroendocrine tumors: a clinicopathological study / 中华病理学杂志

Objective: To investigate the clinicopathological characteristics of plurihormonal PIT1-lineage pituitary neuroendocrine tumors. Methods: Forty-eight plurihormonal PIT1-lineage tumors were collected between January 2018 and April 2022 from the pathological database of Sanbo Brain Hospital, Capital Medical University. The related clinical and imaging data were retrieved. H&E, immunohistochemical and special stains were performed. Results: Out of the 48 plurihormonal PIT1-lineage tumors included, 13 cases were mature PIT1-lineage tumors and 35 cases were immature PIT1-lineage tumors. There were some obvious clinicopathological differences between the two groups. Clinically, the mature plurihormonal PIT1-lineage tumor mostly had endocrine symptoms due to increased hormone production, while a small number of immature PIT1-lineage tumors had endocrine symptoms accompanied by low-level increased serum pituitary hormone; patients with the immature PIT1-lineage tumors were younger than the mature PIT1-lineage tumors; the immature PIT1-lineage tumors were larger in size and more likely invasive in imaging. Histopathologically, the mature PIT1-lineage tumors were composed of large eosinophilic cells with high proportion of growth hormone expression, while the immature PIT1-lineage tumors consisted of chromophobe cells with a relatively higher expression of prolactin; the mature PIT1-lineage tumors had consistently diffuse cytoplasmic positive staining for keratin, while the immature PIT1-lineage tumors had various expression for keratin; the immature PIT1-lineage tumors showed more mitotic figures and higher Ki-67 proliferation index; in addition, 25.0% (12/48) of PIT1-positive plurihormonal tumors showed abnormal positive staining for gonadotropin hormones. There was no significant difference in the progression-free survival between the two groups (P=0.648) by Kaplan-Meier analysis. Conclusions: Plurihormonal PIT1-lineage tumor belongs to a rare type of PIT1-lineage pituitary neuroendocrine tumors, most of which are of immature lineage. Clinically increased symptoms owing to pituitary hormone secretion, histopathologically increased number of eosinophilic tumor cells with high proportion of growth hormone expression, diffusely cytoplasmic keratin staining and low proliferative activity can help differentiate the mature plurihormonal PIT1-lineage tumors from the immature PIT1-lineage tumors. The immature PIT1-lineage tumors have more complicated clinicopathological characteristics.

A summary of item and method of national chronic obstructive pulmonary disease surveillance in China / 中华流行病学杂志

COPD refers to a group of chronic respiratory diseases which seriously influence the people's health and life quality. The national COPD surveillance in China has been implemented since 2014 with the goal of monitoring the prevalence and trend of COPD and related risk factors in China. The paper summarizes the item and method of national COPD surveillance in China.

Survey of smoking prevalence in adults aged 40 years and older in China, 2014 / 中华流行病学杂志

Objective: Smoking is the most important risk factor for COPD. Understanding the smoking rate, current smoking rate, average age to start smoking and average daily consumption of cigarettes among people aged ≥40 years in China can provide scientific evidence for the effective control and prevention of COPD. Methods: Data were from COPD surveillance in China (2014 to 2015) which covered 31 provinces, autonomous regions and municipalities. A total of 75 107 adults aged ≥40 years selected through multi-stage stratified cluster sampling from 125 surveillance sites (county/district) were surveyed by electronic questionnaire during face to face interviews. The smoking rate and other smoking index were estimated by using weighting complex sampling design. Results: The smoking rate and current smoking rate were 40.0% (95%CI: 38.5%-42.0%) and 31.0% (95%CI: 29.7%-32.0%), respectively, among the Chinese aged ≥40 years in 2014. The smoking rate and current smoking rate in males (74.1% and 57.6%) were much higher than those in females (5.4% and 4.0%). And the two rates were significantly higher in rural area (41.2% and 32.4%) than in urban area (38.8% and 29.5%). The mean age of smokers to start smoking was 20.1 (95%CI: 19.7-20.5) years. The younger the smokers were, the earlier their average age to start smoking was (The ages to start smoking for smokers aged 40-, 50-, 60-, ≥70 years were 18.3, 19.2, 20.9 and 23.1 years, respectively). Average daily cigarette consumption of current daily smokers was 18.9 (95%CI: 18.1-19.7) cigarettes, and the daily cigarette consumption was higher in males (19.3 cigarettes) than in females (12.5 cigarettes). Conclusion: The smoking rate in males aged ≥40 years is high in China. Compared with urban area, the smoking rate in rural area is higher, posing a big challenge for COPD control and prevention.

Analysis on passive smoking exposure in adults aged 40 years and older in China, 2014 / 中华流行病学杂志

Objective: To describe and analyze the passive smoking exposure level in adults aged ≥40 years in China. Methods: A total of 75 107 adults from 125 sites of COPD surveillance points in China were surveyed by electronic questionnaire during face to face interviews. After comprehensive weighting of the samples, the passive smoking exposure level was analyzed. Results: The passive smoking exposure rate of the adults aged ≥40 years was 44.9% (95%CI: 42.3%-47.5%). The exposure rate was highest in those aged from 40 to 49 years (51.0%, 95%CI: 47.9%-54.1%) in term of age groups, in those with senior high school education level and above (48.6%, 95%CI: 44.9%-52.2%) in term of education level, and in office workers (57.7%, 95%CI: 51.8%-63.7%) in term of occupation. The adults reporting passive smoking exposure every days in a week accounted for 27.7% (95%CI: 25.5%-29.8%), and those reporting household passive smoking exposure accounted for 28.3% (95%CI: 26.2%-30.5%). Logistic regression analysis showed that the passive smoking exposure level was different in different age groups and occupation groups. Conclusion: The passive smoking exposure level is still high in adults in China. Age and occupation are the influencing factors of passive smoking exposure level.

Analysis on occupational exposure to dust and harmful gas and corresponding protection in adults aged 40 years and older in China, 2014 / 中华流行病学杂志

Objective: To understand the current status of dust and/or harmful gas exposure in adults aged ≥40 years and corresponding protection in China, and provide evidence for strengthening the occupational protection against dust and harmful gas exposure. Methods: The data were obtained from 2014-2015 COPD surveillance in China. A total of 75 107 adults aged ≥40 years selected through multi-stage stratified cluster sampling from 125 surveillance points in 31 provinces (autonomous regions and municipalities) were surveyed in face to face interviews. Occupational exposure was defined as occupational exposure to dust and/or harmful gas for more than 1 year. The weighted percentages of exposure were estimated by using complex sampling design. Results: Among eligible 71 061 participants, the exposure rate of dust and/or harmful gas was 46.3%. The exposure rate in rural area (51.7%) was significantly higher than that in urban area (40.3%), and the exposure rate in the western area was higher than those in the eastern and central areas (P<0.001). Among the groups with different education level, the exposure rate in those with education level of primary school and below was highest (49.7%, P<0.001). The exposure protection rate was 26.7%, and the exposure protection rate was highest in the eastern area (29.9%), followed by that in the central area (27.0%) and that in the western area (22.9%) The exposure protection rate in urban area was significantly higher than that in rural area, and the exposure protection rate was lowest in those with education level of primary school and below. The regular exposure protection was taken by only 50.7% of the adults surveyed. Conclusion: The exposure rate of dust and/or harmful gas is high in China, while the exposure protection rate is very low. Health education, occupational protection and supervision should be strengthened among those with low education level, and those living in rural area and in the western area.

Current status of household polluting fuel use in adults aged 40 years and older in China, 2014 / 中华流行病学杂志

Objective: To analyze the status and distribution characteristics of household polluting fuel use in China. Methods: The data were collected from the adults aged ≥40 years who were recruited through multi-stage stratified cluster sampling in 2014-2015 COPD surveillance conducted in 31 provinces (autonomous regions and municipalities) in China. A total of 75 107 adults aged ≥40 years in 125 surveillance points were surveyed in face to face interview. Polluting fuels included biomass fuels (wood, dung, crop residues and charcoal), coal (including coal dust and lignite) and kerosene. The weighted percentage of family using polluting fuels, combustion method for cooking or heating and ventilation installation with 95%CI were estimated by complex sampling design. Results: According to the survey results from 75 075 adults, the percentage of family using polluting fuels for cooking or heating was 59.9% (95%CI: 54.2%-65.7%), the percentage in rural areas was significantly higher than that in urban areas (P<0.001). As for different polluting fuels, the percentage of using only biomass fuels for cooking or heating was 25.9% (95%CI:20.5%-31.3%), the percentage of using only coal (including kerosene) was 18.9% (95%CI: 13.2%-24.7%), and the percentage of using both biomass fuels and coal was 15.1% (95%CI: 10.8%-19.4%). Among seven geographic areas in China, the percentages of using biomass fuels ranged from 53.8% in southern China to 23.0% in northern China (P=0.039), the percentages of using coal (including kerosene) ranged from 59.5% in northwestern China to 22.3% in southern China (P=0.001). Among the families using polluting fuels, the percentages of mainly using traditional open fires and stoves were 21.3% (95%CI: 16.9%-25.8%) and 31.5% (95%CI: 25.8%-37.2%), respectively; the percentage of having ventilation installation was72.7% (95%CI: 66.9%-78.5%). Conclusions: Household polluting fuel use is common in China, but differs with area, traditional fuel combustion method is widely used, the coverage of ventilation installation need to be improved. In order to promote COPD prevention and control, it is necessary to develop strategies on fuels and fuel combustion method improvement to reduce indoor air pollution resulted from household fuel combustion.

Prevalence of biomass fuel exposure in women aged 40 years and older in China, 2014 / 中华流行病学杂志

Objective: To understand the prevalence of biomass fuel exposure in women aged ≥40 years in China during 2014-2015, and provide evidence for the prevention and control of bio-fuel exposure. Methods: All participants were selected from a national representative cross-sectional survey during 2014-2015 in the mainland of China. A multi-stage stratified cluster sampling strategy was used. A total of 37 795 women aged ≥40 years received a face-to-face questionnaire survey at 125 surveillance points in 31 provinces. The level of biomass fuel exposure was analyzed after complex sample weighting to represent the overall Chinese women aged ≥40 years. Results: A total of 37 777 women were included in the analysis. With complex weighting, the rate of biomass fuel exposure in Chinese women aged ≥40 years was 35.8% (95%CI: 29.6%-42.1%), the exposure rate was higher in rural women than in urban women (P<0.001). The biomass fuel exposure rate was highest in northeastern and lowest in northern areas of China (χ(2)=17.03, P=0.009). The estimated biomass fuel exposure rate decreased with the increase of educational level (P<0.001). Conclusion: The prevalence of biomass fuel exposure is high in women aged ≥40 years in China, especially in those in rural areas. The exposure level differs with age and area. Appropriate measures should be taken to reduce the level of biomass fuel exposure in Chinese women.

Survey and analyses of population at high risk of chronic obstructive pulmonary disease in China, 2014 / 中华流行病学杂志

Objective: To understand the distribution and characteristics of people aged ≥40 years who are at high risk of COPD in China and provide evidence for COPD prevention and control. Methods: The survey was conducted among the subjects selected through multi-stage stratified cluster sampling from 31 provinces (autonomous regions and municipalities) in China for 2014-2015 national chronic obstructive pulmonary disease surveillance. A total of 75 107 people aged ≥40 years in 125 surveillance points were surveyed in face to face interviews. Subjects who met at least one of the following conditions, including chronic respiratory symptoms, exposure to risk factors, medical history of respiratory diseases, and family history, were defined as population at high risk. The weighted proportion of the population at high risk of COPD and 95%CI were estimated by using complex sampling design. Results: Among eligible 74 296 subjects, the proportion of population at high risk of COPD was 89.5% (95%CI: 87.8%-91.2%). The proportion significantly increased with age (P<0.001). The proportion of the population at high risk was significantly higher in men than in women (P<0.001), and in rural area than in urban area (P<0.001). The highest proportion of population at high risk was observed in men in rural area in western China. The proportion of population at high risk of COPD who met at least two conditions was 32.0% (95%CI:29.7%-34.2%), the proportion of those who met at least three conditions was 7.4% (95%CI: 6.6%- 8.3%), and the proportion of those who met all the conditions was 1.5% (95%CI: 1.2%-1.8%). Among population at high risk of COPD, those who only had exposure to one risk factor accounted for 61.7% (95%CI: 59.8%-63.7%). Conclusion: About 90% of people aged ≥40 years in China are at high risk for COPD. It is necessary to conduct population-based screening for COPD and take comprehensive measures to reduce prevalence of risk factors.

Awareness of knowledge about chronic obstructive pulmonary disease and related factors in residents aged 40 years and older in China, 2014 / 中华流行病学杂志

Objective: To understand the awareness of knowledge about COPD and related factors in residents aged ≥40 years in China. Methods: Through multi-stage stratified cluster sampling, residents aged ≥40 years were selected from 125 sites of COPD surveillance (2014-2015) in 31 provinces of China for a face to face questionnaire survey. The demographic characteristics and awareness rate of knowledge about COPD among 75 082 subjects were described as frequency and percentage. The awareness rate of knowledge about COPD and its 95% confidence interval (CI) among the residents aged ≥40 years were estimated with complicated sampling weights. Meanwhile, the knowledge awareness related factors were screened in complicated sampling data. Results: The awareness rate of COPD was 9.2%. The awareness rate of pulmonary function test was 3.6% and the awareness rate of COPD-related knowledge was 5.8%. All of the awareness rates were associated with gender, age, education level and occupation. Besides, the awareness rate of pulmonary function test and COPD-related knowledge were related with living area. Compared with females, the ORs of the three awareness rates among males were 0.88, 0.81 and 0.78. Compared with the residents aged ≥70 years, the ORs of the three awareness rates among those aged 60-69 years were 1.28, 1.08 and 1.51. Compared with the residents with education level of primary school or below, the ORs of the three awareness rates among those with college degree or above were 2.28, 3.43 and 3.14. The OR of the awareness rate of pulmonary function test among the residents in the eastern area was 1.77 compared with those in the central area. The ORs of the awareness rate of COPD-related knowledge among the residents in the eastern and western areas were 1.95 and 2.16 compared with those in the central area(all above P<0.05). Among COPD symptoms, the awareness rate of dyspnea was highest (67.9%), and among the risk factors for COPD, the awareness rate of smoking was highest (81.3%). The source of awareness of COPD for most residents was television program (38.2%). Conclusion: The awareness rate of knowledge about COPD was low in residents aged ≥40 years in China in 2014. It is necessary to strengthen the health education about COPD to improve the prevention and control of the disease.

Survey and analyses of rate of spirometry examination in adults aged 40 years and older in China, 2014 / 中华流行病学杂志

Objective: To understand the performance of spirometry examination in adults aged ≥40 years and provide evidence for the improvement of comprehensive prevention and control of COPD and the evaluation on the effects of current prevention and control measures. Methods: The study subjects were those included in national COPD surveillance in China during 2014-2015. The surveillance used a multi-stage, stratified cluster sampling strategy and a total of 125 surveillance points in 31 provinces were covered. A total of 75 107 adults aged ≥40 years received a questionnaire survey in face to face interviews to collect the information about their acceptance of spirometry examination in previous years. The estimated rate (95%CI) of spirometry examination was calculated based on complex sampling weight design. Results: A total of 74 591 subjects were included in the analyses. The estimated rate of spirometry examination was 4.5% (95%CI: 3.7%-5.2%), and it was significantly higher in men than in women (P<0.001), in urban population than in rural population (P<0.001). The rate of spirometry examination increased with the increase of education level (P<0.001). The rate of spirometry examination was highest in retirees (10.8%, 95%CI: 8.2%-13.3%), and lowest in those working in the industry of agriculture, forestry, animal husbandry, fishery and water conservancy (2.4%, 95%CI: 2.0%-2.9%). The rate of spirometry examination was high in those with previous chronic respiratory diseases and respiratory symptoms, i.e. 13.4% (95%CI: 10.5%-16.4%) and 15.0% (95%CI: 10.5%-19.4%) respectively. The rate of spirometry examination in former smokers was 7.4% (95%CI: 6.0%-8.8%), slightly higher than those in current smokers and never smokers, 4.7% (95%CI: 3.9%-5.5%) and 3.9% (95%CI: 3.0%-4.7%), respectively. In different population groups, the rate of spirometry examination was lowest in rural population who had received no formal education (1.8%, 95%CI: 1.2%-2.3%) and highest in urban population with respiratory symptoms (20.2%, 95%CI: 12.6%-27.8%). Conclusion: The rate of spirometry examination is extremely low in adults aged ≥40 years in China, therefore effective measures should be taken to increase the rate of spirometry examination in adults in China.

Interaction between abnormal expression of fragile histidine triad and methyl-CpG-binding protein 2 on cervical cancerization / 中华流行病学杂志

Objective: To explore the relationship between abnormal expression of fragile histidine triad (FHIT) gene and methyl-CpG-binding protein 2 (MeCP2) as well as their interaction on cervical cancerization. Methods: A total of 73 patients with cervical squamous cell carcinoma (SCC), 113 patients with cervical intraepithelial neoplasia (CIN Ⅰ, n=45; CINⅡ/Ⅲ, n=68) and 60 women with normal cervix (NC) were included in the study. Real time PCR and Western blot were performed to detect the expression levels of mRNA and protein about FHIT and MeCP2, respectively. The methylation status of FHIT gene CpG island was tested by methylation-specifc PCR (MSP). Kruskal-Wallis H test, χ(2) test, trend χ(2) test and Spearman correlation analysis were conducted with software SPSS 20.0. The interaction was evaluated by generalized multifactor dimensionality reduction (GMDR) model. Results: With the deterioration of cervical lesion, the methylation rates of FHIT gene CpG island (χ(2)=18.64, P<0.001; trend χ(2)=18.08, P<0.001) increased gradually, while the expression levels of FHIT mRNA (H=27.32, P<0.001; trend χ(2)=12.65, P<0.001) and protein (H=47.10, P<0.001; trend χ(2)=29.79, P<0.001) decreased gradually. There was a negative correlation between the methylation rates of FHIT gene CpG island and the expression level of FHIT protein (r=-0.226, P<0.001). The levels of MeCP2 mRNA (H=26.19, P<0.001; trend χ(2)=11.81, P=0.001) and protein (H=69.02, P<0.001; trend χ(2)=47.44, P<0.001) increased gradually with the aggravation of cervical lesions. There was a positive correlation between the expression level of MeCP2 protein and the FHIT mRNA Ct ratio (r=0.254, P<0.001). Expression of proteins were negatively correlated between MeCP2 and FHIT (r=-0.213, P=0.001). The results analyzed by GMDR model showed that there were interactions among high MeCP2 protein expression, the CpG island methylation of FHIT and mRNA and protein expression in CINⅡ/Ⅲ group, and among high MeCP2 mRNA and protein expression, the CpG island methylation of FHIT and low mRNA and protein expression in SCC group. Conclusion: High expression of MeCP2 mRNA and protein, the CpG island methylation and low mRNA and protein expression of FHIT could increase the risk of cervical carcinogenesis, and there might be a synergistic effect on cervical carcinogenesis.

Relationship between daily exposure to bisphenol A and male sexual function-a study from the reproductive center / 中华流行病学杂志

Objective: To explore the relationship between male sexual function and daily exposure to bisphenol A (BPA) at a reproductive center in Taiyuan. Methods: Male patients who were seeking treatment of infertility due to problems caused by either of the spouse were selected from the Shanxi reproductive center between September 2014 and April 2015. Information on general characteristics, sexual function and fasting venous blood samples were collected. Total scores of sexual function were evaluated by Delphi expert scoring method. Levels of serum BPA were measured by high-performance liquid chromatography. Data was analyzed by Spearman rank correlation, rank sum test, multivariate logistic regression analysis and χ(2) trend test. Relationship between BPA and sexual function was presented as OR and corresponding 95%CI. Results: Among the 353 participants, 45.0% was defined as sexual dysfunction with low sexual desire (47.3%) as the major reason. BPA was detected in all the 353 patients, with a range of concentration as 0.38-21.93 ng/ml and an average as 5.79 ng/ml. Results from the Spearman rank correlation analysis revealed significant negative correlations between serum BPA and sexual function, sexual desire, erectile ability and ejaculation intensity, while serum BPA was positively correlated with premature ejaculation. According to the four percentile of BPA concentration (ng/ml), the subjects were divided into four groups. Compared with the low concentration group (0.38-3.79 ng/ml), the risk of sexual dysfunction significantly increased in the groups with higher BPA levels. Particularly, in the highest BPA group (8.68-21.93 ng/ml), more obvious effects were seen on sexual dysfunction (OR=1.55, 95%CI:1.00-3.23), reduced sexual desire (OR=4.75, 95%CI: 2.44-9.22), reduced erection ability (OR=2.40, 95%CI: 1.18-4.88), reduced ejaculation intensity (OR=2.53, 95%CI: 1.25-5.16) and premature ejaculation (OR=1.95, 95%CI: 1.02-3.72). Conclusion: Low sexual desire appeared as the main type of male sexual dysfunction, the exposure to higher levels of BPA in daily life might lead to male sexual dysfunction.

Seasonal, avian and pandemic influenza: are we prepared? / 中华流行病学杂志

China experienced a very high and severe influenza seasonal epidemics during the past winter and spring of 2017-2018 season. This year of 2018 is the 100(th) anniversary of the 1918 "Spanish influenza" pandemic, a series of papers under the topic "One Hundred Years of Influenza Pandemics" are produced to demonstrate the impact, characteristics and responses of the past influenza pandemics in global and China, to review the progress and experiences of influenza surveillance, prevention and control strategies, vaccination and antivirus in China, and to discuss the gap and challenges of the prevention, control and response to the seasonal influenza, human avian influenza infection and influenza pandemics. We hope this series could help to raise the awareness of the seasonal and pandemic influenza in publics, and to improve the pandemic preparedness in China.

Technical guidelines for seasonal influenza vaccination in China, 2018-2019 / 中华流行病学杂志

Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and its complications. Currently, China has licensed trivalent (IIV3) and quadrivalent inactivated influenza vaccine (IIV4), including split-virus influenza vaccine and subunit vaccine. In most parts of China, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients need to pay for it. To strengthen the technical guidance for prevention and control of influenza and the operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC), Influenza Vaccine Technical Working Group (TWG), updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)" , based on most recent existing scientific evidences. The main updates include: epidemiology and disease burden of influenza, types of influenza vaccines, northern hemisphere influenza vaccination composition for the 2018-2019 season, and, IIV3 and IIV4 vaccines'major immune responses, durability of immunity, immunogenicity, vaccine efficacy, effectiveness, safety, cost-effectiveness and cost-benefit. The recommendations include: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for any influenza vaccine product for persons who can accept ≥1 licensed, recommended, and appropriate products. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-60 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to pregnant during the influenza season. Children aged 6 months to 8 years old require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in previous influenza season, 1 dose is recommended. People ≥ 9 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. Influenza vaccination should continue to be available for those unable to be vaccinated before the end of October during the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for CDC members who are working on influenza control and prevention, PoVs members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and members of maternity and child care institutions at all levels.

Effect of hnRNP K and its interaction with HPV16 on cervical intraepithelial neoplasia / 中华流行病学杂志

Objective: To investigate the effect of heterogeneous nuclear ribonucleoprotein K (hnRNP K) and its interaction with human papillomavirus 16 (HPV16) on cervical intraepithelial neoplasia (CIN). Methods: The participants included 67 women with normal cervix (NC), 69 women with CINⅠ and 68 women with CINⅡ/Ⅲ in a community cohort of pathologically diagnosed women established in Jiexiu of Shanxi province, from June 2014 to June 2015. A structured questionnaire was used to collect the demographic data of the subjects and the related factors of cervical lesions. Cervical exfoliated cells and cervical tissues from biopsy or surgery were selected. The infection status of HPV16 was detected by flow-through hybridization. The protein expression levels of hnRNP K were evaluated by Western blot. SPSS 23.0 software was used to collate and analyze the data. To study the differences in demographic characteristics, related factors, hnRNP K protein and HPV16 infection among NC, CINⅠand CINⅡ/Ⅲgroups, χ(2) test, trend χ(2) test, and Kruskal-Wallis H test were conducted. Multiple comparisons of hnRNP K protein in three groups were completed by using the Bonferroni method. The OR and its 95%CI of hnRNP K, HPV16 and CIN were calculated by using the unconditional logistic regression models. Two-way interactions between hnRNP K protein and HPV16 infection on CIN were analyzed by using additive model and related indicators. Results: HPV16 infection rates were 10.4% in women with normal cervix, 14.5% in women with CINⅠ and 41.2% in women with CINⅡ/Ⅲ, respectively. The differences among three groups were significant (P<0.001). Moreover, the infection rates of HPV16 gradually increased with the increasing severity of CIN (trend χ(2)=18.512, P<0.001). The differences in protein expression of hnRNP K among three groups were significant (H=48.138, P<0.001) and the expressionincreased with the development of cervical lesionss (trend χ(2)=21.765, P<0.001). Results from the interaction analysis indicated that there were additive effects between high expression of hnRNP K protein and HPV16 in CINⅡ/Ⅲ group compared with normal group (API=0.639, 95%CI: 0.083-1.196). In contrast, no such additive effect was found in CINⅠ group. Conclusions: HPV16 infection and over-expression of hnRNP K protein were associated with the increased risk of cervical intraepithelial neoplasia. There might be interaction between hnRNP K protein overexpression and HPV16 infection existed on the progress of CINⅡ/Ⅲ.