重度宫颈上皮内瘤变治疗前后检测高危型HPV的临床价值

Value of HPV-DNA test before and after LEEP of CIN in detection of prognosis

目的研究重度宫颈上皮内瘤变(C IN)中高危型人乳头瘤病毒(HPV)感染情况,及术前与术后高危型HPV检测对预后的意义。方法门诊细胞学联合HPV检测,筛查出72例经病理诊断为C IN 2-3患者,采用电圈切除术(LEEP)治疗,术后每半年随访,包括:TCT,HPV,阴道镜。阴道镜检查有异常或HS IL者行活检,病理证实为C IN 2-3以上视为病变残留或复发。结果63例治愈,治愈率93.05%。9例(12.5%)复发或残留。72例患者中,58例HPV阳性,总感染率80.6%,C IN 3级患者HPV阳性率93.3%,较C IN 2患者阳性率71.4%显著升高。高危型阳性组LEEP术后病变残留或复发率与阴性组比较,差异无显著性。而术后高危型HPV检测残留或复发有较高的灵敏度和阴性预测价值。结论高危型HPV在重度C IN中感染率高,但术前高危型HPV与预后无关,术后高危型HPV检测预测残留或复发有重要价值。

Objective To determine the rate of HPV infection in cervical intraepithelial neoplasia（CIN） and to evaluate HPV- DNA test before and after LEEP in detection of prognosis. Methods A series of 72 women subjected to LEEP due to histologically confirmed CIN 2/3 were followed-up biannually including cervical cytology,hybrid capture tl （HC ~ ）,and colposcopy. Pa- tients presenting abnormal eolposcopy or high-grade squamous inrraepithelial lesion （HSIL） smear were subjected to new excision procedure,and presence of histologically confirmed CIN 2/3 or higher was considered residual or recurrent. Results Nine （12.5%） women showed residual or recurrence of disease during the follow-up. The overall cure rate was 93.05%. The positive HC2 rate 93.3% in CIN3 was significantly higher than that in CIN2（71. 4%A,P〈0.05）. Any statistically significant difference in residuals or recurrence between the two groups was not observed. HC2 in flow-up showed fairly high sensitivity and negative predictive value. Conclusion The rate of HPV infection in CIN2-3 is high. HPV-DNA test after LEEP values highly in detecting residuals or recurrence,but it has no significance before LEEP.