宫颈上皮内瘤变Ⅲ级病人宫颈锥切术后HPV感染变化

HPV VIBRATION AFTER CONIZATION OF CERVIX FOR CERVICAL INTRAEPITHELIAL NEOPLASIA Ⅲ

目的探讨宫颈上皮内瘤变Ⅲ级(CINⅢ)病人宫颈冷刀锥切术(CKC)后的高危型人乳头瘤病毒(HPV)感染的变化情况。方法收集2009年1月—2011年12月在我院行CKC的CINⅢ病人393例的临床资料,根据病理结果是否累及腺体进行分组,并对其术前与术后的HPV感染变化情况进行分析。结果 393例CINⅢ病人中累及腺体者294例,未累及腺体者99例;CINⅢ累及腺体组病人高危型HPV感染率为95.2%,未累及腺体组病人为97.5%,两者比较差异无显著性(P>0.05);CKC术后连续随访至少18个月,CINⅢ累及腺体组HPV转阴率为74.3%,未累及腺体组为71.9%,两组比较差异无显著性(P>0.05);累及腺体组术后HPV转阴中位时间为5个月,长于未累及腺体组的3个月(t=-2.06,P<0.05);HPV转阴组术前HPV负荷量明显低于HPV未转阴组(Z=-76.8,P<0.05)。结论 CINⅢ累及腺体者较未累及腺体者术后HPV转阴所需时间延长;术前高危型HPV负荷量高者,术后应密切随访。

Objective To study the vibration of high risk human papillomavirus （HPV） after cold knife conization （CKC） of cervical intraepithelial neoplasia Ⅲ（CIN Ⅲ ）. Methods Clinical data of 393 patients with CINⅢ （who underwent CKC in our hospital between Jan.2009 and Dec. 2011） were collected. They were divided into two groups based on whether or not the gland was involved. The changes of HPV before and after operation were analyzed. Results Of the 393 patients, the gland was involved in 294, and 99 with no gland involvement. In the patients with gland involvement, high risk HPV infection rate was 95.2%, those without gland involvement, 97.5%, the difference was not significant between them （P〈0.05）. At least an 18- month of postoperative follow up showed that clinical clearance rate of HPV was 74.3 % in patients with gland involvement, and those without was 71.9%, the difference being not significant （P〈0.05）. The median HPV-clearance time in the patients with gland involvement was 5 months, which was longer than 3 months in those without gland involvement （t=-2.06,P〈20.05）. Pre- surgically, the load capacity of HPV in HPV-clearance group was lower than that in HPV-not-yet-clearance group （Z =-76.8, P〈0.05）. Conclusion Longer time is needed for HPV clearance in CINⅢ patients with gland involvement than those without. For those of high-risk and high HPV capacity before surgery, a closely postoperative follow up is required.