青海地区藏族妇女高危型HPV载量变化与宫颈病变的结局分析

Relationship between human papilloma viral load change and the outcome of cervical lesion in region of QingHai Tibetan

目的研究青海地区藏族妇女高危型HPV载量动态变化与宫颈病变的相关性,评价病毒载量预测宫颈病变的发生风险。方法采用第2代杂交捕获技术（HC2）检测方法检测高危型HPV载量,并将患者分为低载量组、中载量组和高载量组;按照宫颈活检病理结果,将患者分为正常或炎症组、宫颈上皮内瘤变CIN1组、CIN2组、CIN3组和宫颈鳞癌（SCC）组,随访观察8~12个月。结果数据完整的病例353例,HPV低载量构成比在宫颈正常或炎症组最高,HPV中载量构成比在CIN组最高,HPV高载量构成比在SCC组最高,差异有统计学意义（P〈0.05）;初诊病理正常或炎症组在随访期间HPV转阴率为89.45%;初诊CIN1组行LEEP术后HPV转阴率为93.75%（45/48）;初诊CIN2组行LEEP术后HPV转阴率为91.30%（21/23）;初诊CIN3组行宫颈锥形切除及全子宫切除术后转阴率100%;未行手术干预的患者复诊HPV载量上升者宫颈病理结果较初诊时升级的例数增加,HPV载量下降组中病理结果降级的例数增加。结论高危型HPV高载量,宫颈鳞癌的发生风险可能升高,HPV感染后病毒载量长期持续上升,宫颈病变可能加重;手术干预可降低CIN患者的HPV阳性率,防止CIN的复发。

Objective To investigate the correlation between the dynamic change of high-risk human papilloma virus load and cervical lesions,thus to evaluate the load of virus whicn may predict the occurrence of cervical lesions.Methods HR-HPV viral load was detected by HC2 method,patients were divided into low loads,middle and high loads group according to the HR-HPV viral load.According to the cervical biopsy diagnosis,patients divided into normal group,intraepithelial neoplasial（CIN1）group,CIN2 group,CIN3group and cervical squamous carcinoma group.Viral load change and cervical pathological changes were detected repeatedly after 8~12months.The relationship between virus load and cervical lesions was investigated.Results A total of 353 cases recruited in this study.In low loads group,the constituent ratio of normal group is the highest,in the middle loads group,the constituent ratio of CIN is the highest and in high loads group,the constituent ratio of SCC is the highest;In normal group,the negative conversion rate of HPV after 8~12 months was 89.45%;The negative conversion rate of HPV after LEEP surgery in CIN1 group and CIN2 group was 93.75%and 91.30%.In CIN3 group,the negative conversion rate of HPV after conization of cervix or hysterectomy was 100%.Conclusions The risk of cervical carcinoma might rise with the rise of HR-HPV load.Cervical lesions might exacerbate with the ceaseless aspiring of HPV load.In QingHai Tibetan,the surgical intervention could reduce the positive expression of HPV in patients with CIN,which may prevent the recurrence of CIN.