高危型HPV阳性宫颈病变患者治疗后随访的相关研究

A follow-up study of high-risk HPV-positive cervical lesions after treatment

目的:探讨高危型HPV检测在宫颈癌及其癌前病变随访中的应用价值。方法:选择高危型HPV阳性、组织病理学确诊的宫颈病变患者300例,根据其病变程度分低度鳞状上皮内瘤变(LSIL)组,包括炎症和CINⅠ;高度鳞状上皮内瘤变(HSIL)组,包括CINⅡ～Ⅲ、宫颈鳞癌(SCC)。对≥CINⅡ或CINⅠ无随访条件者行手术治疗,随访于治疗后3、6、9、12、18、24个月均行HPV、细胞学检查,必要时再次活检。结果:干扰素栓治疗100例,宫颈锥切术103例,全子宫切除术39例,宫颈癌根治术58例,不同治疗方式的HPV转阴率差异有统计学意义(P<0.05),干扰素栓组与其他3组差异均有统计学意义(P均<0.05),CINⅡ～Ⅲ患者宫颈锥切术与全子宫切除术HPV转阴率差异无统计学意义(P>0.05),宫颈锥切、全子宫切除术两组HPV转阴率与宫颈病变级别无关(P>0.05)。年龄≤35岁、36～50岁、>50岁HPV转阴率分别为91.38%、90.91%、77.27%(P<0.05)。HPV低度载量组(1,100)、中度载量组(100,1000)、高度载量组(>1 000)治疗后HPV转阴率差异无统计学意义(P>0.05)。炎症和CINⅠ、CINⅡ～Ⅲ、SCC组治疗后HPV转阴时间的中位数分别为7、7、4个月(P<0.05)。267例HPV转阴者未发现病变残留及复发。结论:高危型HPV检测在不同级别宫颈病变的随访中起重要作用。不同治疗方法均可有效清除宫颈病灶及HPV感染,且手术治疗效果高于干扰素栓治疗,CINⅡ～Ⅲ患者可采用宫颈锥切术完全代替全子宫切除术。治疗前HPV载量高低与宫颈病变的转归无关,治疗后HPV持续阳性预示病灶残留或复发。

Objective： To investigate HPV negative situation of different levels of high - risk HPV - positive cervical lesions after standard treatment and explore the follow - up value of human papillomavirus test in cervical cancer and precancerous lesions. Methods ： 300 patients with high - risk HPV positive and patholigical diagnosis of cervical lesions were grouped according to the patholigical diagnosis ： ① low - grade squamous intraepithelial neoplasia （LSIL） group, including chronic cervicitis and CIN I ; ②high - grade squamous intraepithe- lial neoplasia （HSIL） group, including CIN Ⅱ- Ⅲ, cervical squamous cell carcinoma （SCC）. Patients of more CIN Ⅱ and CIN I impossi- ble to be followed up were treated with surgical therapy. After 3, 6, 9, 12, 18 and 24 months treatment, follow -up was underwent and HPV, cytology were examined. Results： 100 cases of cervical lesions were treated by interferon, 103 cases by cervical conization, 39 cases by hysterectomy, 58 cases by radical hysterectomy. There were significant differences in HPV negative rate among different treatments （X2 = 10. 461, P 〈 0. 05 ） . There were significant differences in HPV negative rate between interferon group and the other three groups （ P 〈 0. 05 ） . There was no significant difference between cervical conization and hysterectomy of CIN Ⅱ - Ⅲ patients （X2 = 0. 505, P 〉 0. 05 ） . HPV negative rate had nothing to do with the levels of cervical lesions （ P 〉 0. 05 ） . HPV - negative rate in≤35 years old, 36 - yesrs old, 〉 50 years old group were 91.38% , 90. 91%, 77. 27% （X2 = 7. 254, P 〈 0. 05 ） . There were no significant differences in HPV - negative rate among HPV low （ 1 100） , moderate （ 100 - 1 000） and high viral load groups （ 〉 1 000） （X2 = 2. 350, P 〉 0. 05 ） . Median of HPV clearance time in chronic cervicitis and CIN I , CIN Ⅱ - Ⅲ, SCC group were 7, 7, 4 months （X2 = 6. 799, P 〈 0. 05 ） . 267 cases of HPV negative patients found no residual and recurrence of lesions. Condusion： High - risk HPV testing plays an important role in the follow - up of cervical lesions. Different treatments can effectively remove cervical lesions and HPV infection, and surgical treatment is more effective than interferon treatment. CIN Ⅱ - Ⅲ patients can be the cervical conization completely replace hysterectomy. HPV viral load before treatment has nothing to do with the outcome of cervical lesions. The HPV persistent positive will predict residual lesions or recurrence.