高危型HPV定量检测在宫颈上皮内瘤变术后随访中的临床价值

Clinical value of high risk HPV(HR-HPV)quantitative detection in the follow-ups after conization in cervical intraepithelial neoplasia

目的探讨高危型人乳头瘤病毒定量检测在宫颈上皮内瘤变LEEP治疗后随访中的临床价值。方法收集2012年10月至2014年11月在我院因宫颈上皮内瘤变行LEEP术后病人共236例,术前检测HPV高危型均为阳性。采用PCR法进行高危型HPV定量检测病毒负荷量进行随访,以C0PY数为单位,CT值>40为阴性,<40为阳性,CT值越低,则病毒负荷量越大,对阳性者结合薄层液基细胞学检查(TCT)、阴道镜检查对这些病人进行术后追踪随访。结果 236例病人治疗后分别于术后3月、6月、12月、18月、24个月进行随访,观察高危型HPV负荷量与术后病毒持续感染的关系,阳性检出率分别为12.71%、7.63%、3.39%、2.96%、2.22%,说明随着随访时间的延长,病毒清除率逐渐提高;HPV阳性结合TCT、阴道镜检查结果发现CT值越低,发生CIN病变的级别越高;锥切术后病变级别高者,术后病变残留和复发显著升高。结论术后3个月高危型HPV阳性率约12.71%;术后6个月约7.63%;术后12个月约3.39%,术后18个月约2.96%。手术可有效清除hpv感染,但其转阴需要一定时间。治疗后hr-hpv仍阳性者应及时进行干预,以减少病变复发。高危型HPV负荷量越大,即CT值越低,宫颈病变级别越高,结合TCT检查和阴道镜检查可以提高检出阳性率,而又能避免一些过度的侵入性检查。对于锥切术后宫颈病变级别高者,应重点监测。HPV-DNA定量检测在宫颈上皮内瘤变治疗后随访中起重要作用,可作为随访手段,为判断残留、预测复发有重要价值。

Objective： To explore the clinical value of the high risk HPV （HR-HPV） quantitative detection in the follow- ups after LEEP treatment in cervical intraepithelial neoplasia. Methods： To collect the 236 women who were treated by LEEP conization because of cervical intraepithelial neoplasia between oct.2012 to nov.2014 in our hospital, preoperative detection of high risk HPV types were all positive. Then the patients were followed up by high risk HPV quantitative detection of viral load using the method of PCR, To COPY as a unit, the CT numerical value 〉 40 is negative, 〈 40 is positive, the lower the CT numerical value, the viral load is larger, these positive patients after operation.were followed up with thin-layer liquid based cytology （TCT） , colposcopy examination. Results： After treatment respectively in 3 months, 6 months, 12 months, 18 months, 24 months of follow-up, the 236 patients were observed the persistent infection of high-risk HPV load and postoperative virus, the positive rates were 12.71%, 7.63%, 3.39%, 2.96%, 2.22%, respect- tively, which shows that with longer follow-up times, virus clearance gradually improve; associate with TCT, colposcopy when high risk HPV was positive, results was found that the lower the CT numerical value, the higher the level of occurrence of CIN lesions; Lesion after conization was level high, the residual or recurrent lesions were significantly increased. Conclusion： After conization, 3month, 6months, 12months, 18months of follow-up, The positive rate was 12.71%, 7.63%, 3.39%, 2.96%, respectively, cervical conization can effectively scavenge HPV infection, but its negative need some time. After treatment, the positive HR-HPV patients should be timely intervented, in order to reduce the residue or recurrence of the lesion. High risk HPV load is larger, the lower the CT numerical value, the higher the level of cervical lesions, the combination of TCT test and colposcopy can improve the positive rate, and can avoid excessive invasive examination, the patients of the cervical lesion high level after conization should be the focus of monitoring. HPV-DNA quantitative detection plays an important role in cervical intraepithelial neoplasia＇ s follow-up after treatment, it can be used as a means for the follow-up, and it has important value.in the prediction of residue and recurrence.