宫颈癌前病变程度、高危型HPV病毒负荷量及HPV清除率关系的研究

The relevance of high-risk HPV viral load,HPV clearance rate and the degree of cervical cancer precancerous lesions

目的:探讨宫颈癌前病变程度、高危型人乳头瘤病毒(hr-HPV)病毒负荷量以及HPV清除率之间的关系。方法:选取2013年1月至2014年12月南方医科大学附属深圳市龙华新区人民医院收治的354例宫颈癌前病变患者,均为不同级别的宫颈上皮内瘤变(CIN)(hr-HPV均为阳性),分析不同病变程度与hr-HPV病毒载量关系,对hr-HPV阳性患者行2年的跟踪检查,研究HPV清除率与宫颈癌前病变程度及HPV病毒载量之间的关系。结果:CINⅠ期患者术前hr-HPV病毒载量低于CINⅡ期、CINⅢ期患者(P<0.05)。Spearman等级相关性分析结果显示,宫颈癌前病变患者病变级别与其术前hr-HPV病毒载量无相关关系(r=0.421,P=0.23)。不同CIN分期的患者术后3个月、6个月、12个月及24个月hr-HPV清除率比较,差异均无统计学意义(均P>0.05);不同术前病毒载量的CIN患者术后3个月、6个月hr-HPV持续感染率组间两两比较差异均有统计学意义(均P<0.05),hr-HPV持续感染率随病毒载量的升高而升高,术前病毒载量≥1 000RLU/CO的患者术后3个月、6个月、12个月hr-HPV持续感染率显著高于1~99RLU/CO和100~999RLU/CO的患者(P<0.05),术后24个月不同术前病毒载量的CIN患者hr-HPV持续感染率比较差异无统计学意义(P>0.05)。结论:宫颈癌前病变患者病变级别与其术前hr-HPV病毒载量及术后hr-HPV清除率无关,但高病毒载量宫颈癌前病变患者术后hr-HPV持续感染率较高。

Objective：To study the relevance of high-risk human papillomavirus （hr-HPV） viral load, HPV clearance rate and the degree of cervical cancer precancerous lesions. Methods： 354 patients with different grades of cervical intraepithelial neoplasias （CIN） （all positive with hr-HPV） treated in our hospital from January 2013 to December 2014 were selected. The relationship between the severity of lesions and hr-HPV viral load were analyzed. After a two-year follow-up for these positive hr-HPV patients, the relationships of HPV clearance rate with hr-HPV viral load and precancerous lesions degree were analyzed. Results：Patients with CIN grade I had lower hr-HPV viral load than those with CIN grade II and III at preoperation （ P d0.05）. Spearman＇s rank correlation analysis showed that the CIN grade was not associated with preoperational hr-HPV viral load （ r = 0. 421, P = 0.23）. No significant differences were found in hr-HPV clearance rates at 3, 6, 12 and 24 months postoperation among patients with different CIN grades （ P 0.05）. There were statistical differences in hr-HPV continuous infection rates at 3 and 6 months postoperation among patients with different preoperative hr-HPV viral load （ P d0.05）. The hr-HPV continuous infection rates were increased concurrently with the elevated hr-HPV viral load. Patients with preoperative hr-HPV viral load ≥1000 RLU/CO had higher hr-HPV continuous infection rates at 3, 6 and 12 months postoperation than those with 1-99 RLU/CO and 100-999 RLU/CO （ P 〈0.05）. There was no significant difference in hr-HPV continuous infection rates at 24 months postoperation among patients with different preoperative hr-HPV viral load （ P 〉0. 05）. Conelusion. Patients with different CIN grads were not correlated with their preoperative hr-HPV viral load and postoperative hr-HPV clearance rates, but those with high hr-HPV viral load might have high postoperative hr-HPV continuous infection rate.