人乳头瘤病毒感染与宫颈癌前病变和宫颈癌及其预后的关系

Association and prognostic correlation between human papillomavirus infection and cervical cancer and its precursors

目的 :探讨人乳头瘤病毒 (humanpapillomavirus ,HPV)与宫颈癌前病变 (cervi calintraepithelialneoplasia ,CIN)和宫颈癌的关系以及与它们的预后关系。方法 :采用第 2代杂交捕获试验法检测我院门诊和住院患者 994例随访手术治疗患者 99例 ,随访患者同时行宫颈细胞学、阴道镜检查 ,以病理结果为金标准 ,按宫颈病变严重程度比较高危型HPV的检出率 ,以及比较术前术后宫颈癌前病变、宫颈癌感染高危型HPV变化情况。结果 :以HPVDNA≥ 1 0pg/mL为阳性标准 ,慢性宫颈炎、CIN各组及宫颈癌分别为 46 92 % ( 2 0 6/4 3 9)、65 71% ( 2 3 /3 5 )、81 82 % ( 3 6/4 4)、 98 41%( 62 /63 )、82 3 2 % ( 3 40 /4 13 )。随访患者细胞学 ,阴道镜检查除 1例CIN3患者为阳性 ,其余均为阴性 ,术后HPV持续阳性率为 2 1 18% ,其中 1例诊断为宫颈原位癌。结论 :高危型HPV感染与宫颈癌前病变和宫颈癌有明显相关性 ;宫颈锥切术后HPV持续阳性患者为复发的高危人群 。

OBJECTIVE:To evaluate the association between human papillomavirus infection and cervical cancer, its precursors and the prognostic correlation between them.METHODS:Cells exfoliated from cervix (collected by clincian) of 994 outpantient and inpantient women, including 99 follow-up women treated,were analyzed by Hybrid Captrue Ⅱ test (HC Ⅱ),which can detect 13 HPV types of high-risk HPV. Follow-up cervical cytology, colposcopy examination were performed on all patients.The prevalence of high-risk HPV was comprised in cervical dysplasia and the presence and persistence of high-risk HPV were analysed before and aftertreatment,based on the pathology results as a gold standard.RESULTS:When the test was positive at the RLU/CO (relative light units/cutoff ) ratio of 1 pg/mL, the HPV-DNA rates in chronic cervicitis, CIN1-3 and cervical cancer were 46.92%(206/439),65.71%( 23/35),81.82%(36/44), 98.41%(62/63) and 82.32%( 340/413),respectively.One patient with positive HPV and cytology and colposcopy found in CIN3 group was diagnosed as carcinoma in situ.The persistence of high-risk HPV was 21.18% after treatment.CONSLUSIONS:There is a highly significant association between high-risk HPV and cervical carcinomas and its precursors; the patients with persistent HPV infection after conization were at risk of developing recurrence,and should be regularly investigated.