高危型HPV感染的宫颈CIN在Leep术后的转归研究

Development of cervical intraepithelial neoplasia with high risk HPV infection after LEEP treatment

目的:探讨高危型人乳头瘤病毒(HR-HPV)感染的宫颈上皮内瘤变(CIN)在宫颈环形电切术(LEEP)治疗术后的转归。方法:对109例高危型HPV感染的CINⅠ～Ⅲ患者进行LEEP治疗,术后6个月再次检测其宫颈HR-HPV的平均负荷量,同时行阴道镜检查及宫颈活检。结果:LEEP术后6个月,CIN患者HR-HPV平均负荷量较治疗前均显著降低(P<0.01)。HR-HPV负荷量转阴率为73.39%(80/109),但各级别CIN HR-HPV转阴率差异无统计学意义(P>0.05)。根据LEEP术后6个月宫颈HPV-DNA负荷量,低度负荷量组8例中,7例为TCT正常者,1例为CIN;中度负荷量组10例中,7例为TCT正常者,3例为CIN;重度负荷量组11例中,7例为TCT正常者,4例为CIN。中、高度HR-HPV病毒负荷组与低度HR-HPV病毒负荷组之间CIN转归存在差异(P<0.05)。结论:LEEP是目前治疗CIN有效的方法,HR-HPV感染的宫颈CIN在LEEP术后,HR-HPV负荷量明显降低,宫颈CIN的转归与持续HR-HPV负荷量的高低密切相关,HC-Ⅱ动态监测HR-HPV负荷量,对术后宫颈CIN预后有指导意义。

Objective： To study the development of cervical intraepithelial neoplasia （CIN） with high risk human papillomavirus （HR-HPV） infection after loop electrosurgieal excision procedure （LEEP）. Methods：A total of 109 women with high risk HPV infection and CIN Ⅰ/Ⅱ/Ⅲ confirmed by histology were treated by LEEP. Six months later high risk HPV load was measured by Hybirdcapture Ⅱsystem again. The eolposcopy and cervical biopsy were performed in the meantime. Results. The average high risk human papillomavirus load of CIN patients were decreased after treatment of LEEP significantly after six moths （P〈0.01）. HPV loading turned to be negative postoperatively in 73.39~ （80/109） of the women, but the negative conversion rate had no significant differences among CIN Ⅰ/Ⅱ/Ⅲ groups（P^0. 05）. After LEEP treatment, in the low viral loading group, 7 cases turned to chronic cervictis and 1 re-mained CIN~ in the mediumin viral loading group, 7 cases turned to chronic cervictis, 3 cases remained CIN^the high viral loading group, 7 cases turned to chronic cervictis 4 cases remained CIN. The Positive Rate of CIN between the three groups was significant （P〈0.05）. Gondusions.. LEEP is a effective treat- ment of cervical lesion and can reduce the viral loading of HR-HPV at CIN significantly. The prognosis of CIN is related to high viral loading of HR-HPV after LEEP therapy. HC-II examination is useful in the prognosis of HR-HPV infection of patients with CIN.