LEEP治疗中度宫颈上皮内瘤变对HPV感染的影响

Effect of LEEP on HPV infection in patients with moderate cervical intraepithelial neoplasia

目的探讨高危型人乳头瘤病毒(HPV)感染的中度宫颈上皮内瘤变(CINⅡ)患者在宫颈环形电切术(LEEP)治疗后的转归。方法选取206例CINⅡ合并高危型HPV阳性患者,予以LEEP治疗,分别于术后3、6、12及24个月随诊,行宫颈液基细胞学(TCT)、第二代捕获杂交法(HCⅡ)和23种HPV分型检查。结果 206例CINⅡ患者LEEP治疗后3、6、12及24个月HR-HPV转阴率分别为39.3%、74.8%、92.7%和96.6%;随访24个月,HPV依然阳性的患者中,96.6%(199/206)患者HPV转阴,未转阴的患者中,HPV的负荷量降低幅度≥50%的患者比率为1.9%(4/206),高于降幅﹤50%患者的0.1%(2/206)及上升患者的0.4%(1/206)。在治疗后第3个月,54.0%(53/98)感染16型或者包括16型在内的多重感染转阴,与其他高危型感染25.9%(28/108)相比,差异有统计学意义(χ2=4.25,P﹤0.05);而在治疗后的6、12及24个月,两者比较差异无统计学意义。结论高危型HPV感染的CINⅡ患者在LEEP治疗后多数在2年内转阴,治疗6个月后,16型或者包括16型在内的多重感染与其他高危型感染无差别。

Objective To investigate the prognosis of high risk human papilloma virus（HPV） infection in patients with moderate cervical intraepithelial neoplasia（CIN） after LEEP treatment. Method 206 cases of CINII with positive high-risk HPV were treated with LEEP, and were tested for TCT, HCII and 23 HPV typing in 3, 6, 12, and 24 months during follow- up. Result In 206 cases of CINII patients, the rates of negative HR- HPV were 39.3%, 74.8%, 92.7%, and96.6% in 3, 6, 12, and 24 months after treatment of LEEP, In those patients with positive HPV in 24 months during follow- up, 96.6%（199/206） patients finally had negative results, while in those who still had positive HPV, HPV load decrease ≥50% was seen in 1.9%（4/206）, and there were 0.1%（2/206） and 0.4%（1/206） patients with HPV load decrease 〈50% and even increased HPV load. In 3 months after treatment, 54.0%（53/98） patients with HPV type 16 or multiple infection（type 16 included） had negative results, with significantly difference observed as compared with patients with other high risk infection at 25.9%（28/108）（χ^2=4.25, P〈0.05）; While in 6, 12 and 24 months after treatment, the HPV testing results were similar between those patients. Conclusion Most patients with cervical intraepithelial neoplasia grade 2 and high risk human papilloma virus infection will have negative results in 2 years after treatment, but infection of HPV type16 or multiple infection that includes type 16 are similar with other high risk infection in respect of testing results in 6months after treatment.