HPV和TCT检测对LEEP治疗CIN效果的监测意义

The Significance of Detection of HPV and CIN after LEEP Treatment of CIN

目的:探讨Leep治疗CIN的疗效和是否能有效消除HPV感染,以此评估该治疗方法对CIN治疗的有效性。方法:对98例TCT异常,高危型HPV阳性,组织学检查证实为CIN1～3的妇女实行Leep治疗,治疗后3个月再次行TCT检查并检测高危型HPV,阳性病例行组织学检查。结果:CIN1HPV转阴率为74.2%(49/66),病变残留率为4.5%(3/66),病变残留与HPV持续阳性成正比;CIN2～3HPV转阴率为46.9%(15/32),病变残留率为34.4%(11/32),病变残留与HPV持续阳性成正比;CIN1组治疗后HPV阴转率及病灶彻底切除率均高于CIN2～3组,统计学分析有显著意义。结论:高危型HPV感染率与CIN程度成正比,CIN2～3高于CIN1;Leep不仅可以有效治疗CIN1,而且可以有效降低HPV感染率;Leep治疗对部分CIN2～3尚不够充分,应加大宫颈组织的切除范围和深度;Leep治疗后残留病变与HPV持续阳性密切相关;TCT和HC-2检测不仅可以评价CIN疗效,而且可以作为CIN治疗后追踪随访的有效手段。

Objective： To explore the curative effect （LEEP） therapy and concurrent elimination of HPV infection Methods： Ninety-eight cases with high-risk HPV infection of loop electrosurgical excision procedure on cervical intraepithelial neoplasia （CIN）. and CIN Ⅰ/Ⅱ/Ⅲ were confirmed with Thin- Prep liquid-based cytology test （TCT） and histology. The patients were treated with LEEP. TCT and hybrid capture Ⅱ （HC-2） were conducted to screen for HPV three months later, and the patients with positive results were examined by histology. Results： Seventy-four percent of CIN Ⅰ cases tested negative for HPV （49/66）, and the HPV clearance rate was 4.5% （3/66）. The rates of viral clearance and HPV persistent infection were as expected. CIN Ⅱ/Ⅲ had lower rates of viral clearance and higher rates of HPV persistent infection, and statistical significance was clear. Conclusions： The presence of highrisk HPV infection is directly proportional to the pathological change of CIN, with CIN Ⅱ/Ⅲ having higher infection rates than CIN Ⅰ. LEEP is an effective procedure for curing CIN Ⅰ and can eliminate HPV infection. This procedure is not quite satisfactory for treatment of CIN Ⅱ/Ⅲ, so enlarged excision of cervical tissue is essential. TCT and HC-2 examination can estimate the therapeutic effect of LEEP on CIN and become a good method for making a prognosis for CIN.