吸烟及HPV16/18感染对低度宫颈上皮内瘤自然消退的影响

The Effects of Smoking and HPV16/18 Infection on Regression of Low-grade Cervical Intraepithelial Neoplasia

目的宫颈上皮内瘤变(cervical intraepithelial neoplasias,CIN)是一组与宫颈浸润癌密切相关的癌前期病变的统称,包括宫颈不典型增生和宫颈原位癌,反映了宫颈癌发生中连续发展的过程,本研究探讨吸烟及HPV16/18感染与宫颈上皮内瘤变自然消退之间的关系。方法追踪2009年1月～2010年12月在长沙市三医院及长沙市妇幼保健院确诊为宫颈上皮内瘤变Ⅰ、Ⅱ期患者并在1年后复检者共385例,其中吸烟者98例,不吸烟者287例,高危HPV16/18感染者242例,无高危HPV16/18感染者143例。1年后复检385例患者中166例宫颈上皮内瘤变自然消退。对HPV16/18及吸烟对宫颈上皮瘤变转归的关系进行统计学分析。结果一年后385例CIN中166自然消退,非HPV16/18感染患者较HPV16/18感染患者有更高的宫颈上皮内瘤变自然消退率(60.8%vs32.6%),而其中吸烟的HPV16/18感染者宫颈上皮内瘤变自然消退率最低(27.1%)。结论Ⅰ、Ⅱ期宫颈上皮内瘤变在12月内可自然消退,HPV感染(HPV16/18)是宫颈上皮内瘤变持续的重要因素,吸烟可能促进HPV感染患者宫颈上皮内瘤变的持续存在。

Objective Cervical intraepithelial neoplasia（CIN） is a name for a group of pre-cancerous lesions closely related with invasive cervical cancer,including cervical dysplasia and cervical carcinoma in situ,reflecting the continuous development of cervical cancer.In this article we investigate the relationship between smoking and/or HPV16/18 infection and regression of low-grade cervical abnormalities.Method Tracked 385 patients who were diagnosed as cervical intraepithelial neoplasia stage Ⅰ,Ⅱ and re-examined one-year later at Changsha Third Hospital and Changsha MCH between January 2009 and December 2010.Among the 385 cases,98 cases were smoking and 287 were non-smokers;242 cases were high-risk infected with HPV16/18 and 143 cases had no high-risk HPV16/18 infection.In the one-year later re-examination,166 cases of cervical intraepithelial neoplasia regressed.The effects of HPV16/18 infection and smoking on cervical intraepithelial neoplasia were statistically analyzed.Results Among the 166 patients with spontaneous regression of CIN one-year later,non-infected patients had higher regression rate than HPV16/18 infected patients（60.8% vs 32.6%）.Cases with both smoking and HPV16/18 infection had the lowest（27.1%） spontaneous regression rate of cervical intraepithelial neoplasia.Conclusion Cervical intraepithelial neoplasia in stage Ⅰ or Ⅱ may regress spontaneously within 12 months;HPV（HPV16/18） infection is a major factor for persistence of cervical intraepithelial neoplasia.Smoking may enhance the presence of HPV infected cervical intraepithelial neoplasia.