高危型HPV检测在判断CIN疗效及随访监测中的临床意义

High-risk HPV Testing in Evaluating the CIN Efficacy and Clinical Significance Follow-up Monitoring

目的:探讨人乳头瘤病毒(human papillomavirus,HPV)检测在判断宫颈癌前病变即宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的治疗效果及随访监测中的临床意义。方法:回顾性分析2006-01-01至2007-06-30在我院诊治的术前均检测HPV(+)的CIN患者198例,分别进行宫颈电环锥切术(LEEP)或宫颈冷刀锥切术,采用第二代杂交捕获(Hybird Cap-ture-2,HC2)技术,对其术前及术后6、12个月均行宫颈高危型HPV(HR-HPV)检测,观察其治疗前后HR-HPV负荷量变化及转阴率的情况。结果:198例CIN患者术前HPV平均负荷量为367.9,术后6个月、12个月HPV平均负荷量分别为14.2、3.6,故CIN患者行宫颈锥切术治疗后HPV平均负荷量较术前均明显降低,P<0.01;术后6个月、12个月HPV转阴率分别为82.3%、91.4%,术后HPV持续阳性率为8.6%,其中2例重新诊断为宫颈原位癌。结论:HR-HPV检测可有效地判断CIN疗效及随访监测其预后的指标,宫颈锥切术后HPV持续阳性患者为复发的高危人群,应严密随访。

Objective：To explore the clinical significance of human papillomavirus detection in evaluating the cervical precancerous lesions that cervical intraepithelial neoplasia treatment outcomes and follow-up monitoring.Method：We analysed retrospectively 198 patients with CIN in preoperation HPV（＋）from January 1,2006 to June 30,2007.Any exceptions to those loop electrosurgical excision procedure（LEEP）or cervical cold knife conization,using commercially available Hybrid CaptureⅡ（HC2）system,we detected the loads of cervical high-risk HPV（HR-HPV）among all the specimens pre-treatment and post treatment 6,12 months respectively.And studied the variation of high-risk HPV deoxyribonucleic acid viral loading and the negative ratio of HPV.Result：The HPV mean load of 198 CIN patients was 367.9 before surgery,postoperation 6 months,12 months HPV average load were 14.2,3.6,there was remarkable variance of HPV mean load between pre-treatment and post treatment for the patients with cervical intraepithelial neoplasia（P〈0.01）.The negative ratio of HPV at postoperation 6 months,12 months were 82.3% and 91.4% respectively.The continuous positive ratio of HPV postoperation was 8.6%,two of the cases diagnosed with cervical carcinoma in situ again.Conclusion：The human papillomavirus mean load of the patients with cervical precancerous lesion decreaced significantly post-treatment.The patients of continuous HPV-positive after conization of the cervix are high risk group of recurrence,we should closely follow up.