高危型HPV DNA负荷量在预测CINⅠ转归可能性中的价值

The Value of Hing-risk Human Papilloma Virus Viral Load in Predicting Outcome of CIN I

目的：探讨高危型人乳头瘤病毒（HR-HPV）DNA负荷量在宫颈上皮内瘤变（CIN）Ⅰ级的转归预测中的价值。方法分析2009年～2012年就诊于济南市第五人民医院的CINⅠ患者156例，分为观察组和微波治疗组。于6个月、12个月、18个月、24个月复查液基细胞学检查（TCT），对HR-HPV阳性患者复查HR-HPV DNA负荷量，对细胞学检查中出现ASCUS及以上改变者或HR-HPV DNA持续2年仍阳性者在电子阴道镜下行宫颈活检，比较随访2年后两组HR-HPV DNA负荷量的变化，不同HR-HPV DNA负荷量CINⅠ转归情况，CINⅠ不同转归组中HR-HPV DNA负荷量变化。结果①随访2年后微波治疗组HR-HPV DNA负荷量明显低于观察组（P＜0．01）。微波治疗组治疗后2年HR-HPV DNA负荷量较治疗前明显下降（P＜0．01）。②高负荷量组中观察组病变持续存在或进展为CINⅡ及以上病变比率高于微波治疗组（P＜0．05）。观察组中高度负荷量组随访2年后发生病变持续存在或进展为CINⅡ及以上病变比率高于中度负荷量组，差异有统计学意义（P＜0．05）。③HR-HPV DNA负荷量与病理学改变程度呈正相关，随着病变级别的升高，HR-HPV DNA负荷量增高（P＜0．05）。结论 CINⅠ患者的随访中可依据HR-HPV DNA负荷量对CINⅠ转归进行评估，对于不同HR-HPV DNA负荷量采取不同的治疗方案。

Objective To investigate the value of high-risk human papillomavirus DNA load in predicting the outcome of CINⅠ. Methods From 2009 to 2012,156 cases were diagnosed as CINⅠin fifth people＆#39;s hospital of Jinan city .They were divided into observation group and microwave treatment groups .After 6 months,12 months,18 months and 24 months,they were reviewed liquid-based cytology.HR-HPV-positive cases were reviewed HR-HPV DNA load.The cases who appeared to ASCUS or above ASCUS were biopsied under colposcopy . The cases who remained HR-HPV DNA positive for two years were biopsied under colposcopy .The changing of HR-HPV DNA load after 2 years,the outcome of CINⅠin different HR-HPV DNA load groups and the changing of HR-HPV DNA load in different CINⅠoutcome groups were compared .Results ①After 2 years the HR-HPV DNA load of microwave group was significantly lower than that in observation group （ P〈0.01）.HR-HPV DNA load decreased significantly after microwave treatment than before treatment （P〈0.01）.②In high HR-HPV DNA load group,the incidence rate of CINⅡor worse in observation group were higher than in microwave treatment groups after 2 years（P〈0. 05）.In observation group,the incidence rate of CINⅡor worse in high load group was higher than in middle load group （P〈0.05）.③HR-HPV DNA load was positively correlated with the pathological degree .According with the levels of cervical lesions ,HR-HPV DNA load in-creased（P〈0.05）.Conclusion In following-up of cases with CINⅠ,we can evaluate outcomes of CINⅠaccording to HR-HPV DNA load. Cases with different HR-HPV DNA load should adopt different treatment .