宫颈脱落细胞人乳头状瘤病毒基因分型检测在宫颈癌筛查及宫颈上皮内瘤样病变宫颈环形电切术后随访中的意义

Clinical Analysis of Cervical Cytology HPV Subtyping Tests and the Significance in CIN Follow up after Cervical Loop Electrosurgical Excision

目的探讨宫颈脱落细胞人乳头状瘤病毒(HPV)亚型(C-HPV-S)在宫颈癌早期诊断和宫颈上皮内瘤样病变(CIN)宫颈环形电切术(LEEP)后随访中的价值。方法选择2008年1月～2011年9月在济南军区总医院检查C-HPV-S的6695例患者,包括查体者1339例(体检组)和因患妇科疾病就诊者5356例(患者组),受检者均行宫颈薄层液基细胞学检查(TCT)并采用导流杂交基因芯片技术行C-HPV-S检测。对其中病理诊断为CIN者行LEEP,术后6个月、1～2年随访时行TCT和C-HPV-S检查。结果①体检组和患者组HPV感染率分别为17.8%和26.0%,差异有统计学意义(P<0.05)。对体检组和患者组宫颈柱状上皮异位(CCE)、其他宫颈炎、宫颈尖锐湿疣、CINⅠ-Ⅱ、CINⅢ及宫颈癌同类疾病HPV感染率分别比较,差异均无统计学意义(P>0.05)。②HPV及HR-HPV感染率随宫颈病变病理级别的增高(宫颈炎→CINⅠ-Ⅱ→CINⅢ→宫颈癌)而增高,且单一感染率增高,多重感染率无明显变化。CINⅠ-Ⅱ、CINⅢ和宫颈癌HPV及HR-HPV感染率、单一HPV感染率均显著高于宫颈炎,差异有统计学意义(P<0.05)。③对CIN患者LEEP后1～2年随访,CINⅠ-Ⅱ组复发率为1.2%(4/335),HPV持续感染率为3.9%(13/274);CINⅢ组复发率为4.4%(6/137),HPV持续感染率为9.5%(13/124)。两组复发率与HPV持续感染率差异均有统计学意义(P<0.05)。结论 C-HPV-S有助于早期发现和预测CIN,也可作为CIN术后随访的重要指标,为预防宫颈癌的发生提供干预依据。

Objective To investigate the value of the cervical cytology HPV subtypes（C-HPV-S） in early diagnosis of cervical cancer and follow up of cervical loop electrosurgical excision procedure（LEEP） in cervical intraepithelial neoplasia（CIN）.Methods From January 2008 to September 2011,6695 patients who were checked C-HPV-S in Jinan Military General Hospital,including 1339 patients in the physical examination group（PE group） and 5356 patients in the patient group（P group）.All subjects underwent cervical thinprep cytologic test（TCT） and the HPV subtypes were detected by flow-through hybridization gene chip technology.Pathological analysis was used for confirmation.491 patients with CIN underwent LEEP.HPV and TCT were tested again on month 6,12 and 24 after LEEP during the follow-up stage.Results ①The C-HPV-S infection rate in PE group and P group（both groups containing patients with CCE,CIN and cervical cancer） were 17.8% and 26.0%（P0.05）,respectively.The C-HPV-S infection rate showed no statistical difference in same disease in both PE group and P group（P0.05）.②The C-HPV-S infection rate rised along with the increasing pathological abnormalities from cervicitis→CIN Ⅰ-Ⅱ→CIN Ⅲ→cervical cancer.The single type infection rate increased along with the pathological degree rising;however,the rates of multiple HPV subtypes infection did not increase.③The recurrence rate of CIN Ⅰ-Ⅱ was 1.1%（4/354） and the HPV persistent infection rate was 4.5%（13/286）.The recurrence rate of CIN 1 Ⅱ was 4.4%（6/137） and the HPV persistent infection was 10.5%（13/124） in CIN Ⅲ after LEEP during 1 to 2 years follow-up stage.The recurrence and HPV persistent infection rates were statistically different from CIN Ⅰ-Ⅱ to CIN Ⅲ groups（P0.05）.Conclusion The detection of C-HPV-S is valuable not only to early diagnose and forecast CIN,but also to indicate the prognosis of CIN,which can provide intervention basis for prevention of cervical cancer.