人乳头瘤病毒筛查阳性患者病毒感染转归的随访研究

A follow-up study on high-risk human papillomavirus infection prognosis among HR-HPV screening positive patients

目的 探讨高危型人乳头瘤病毒（high-risk human papillomavirus,HR-HPV）检测阳性而细胞学检查正常患者的临床处理方案.方法 对274例首诊于北京积水潭医院妇产科的HR-HPV DNA检测阳性且宫颈薄层液基细胞学检查（thinprep cytologic test,TCT）正常的妇女分别于第6、12和24个月进行随访,分析HR-HPV病毒自然清除过程,对比干扰素治疗组（159例）和未治疗组（93例）患者的转归情况.结果 未治疗组在24个月时HR-HPV DNA检测自然转阴率为92.3％（84/91）.6、12、24个月自然转阴率与年龄无关联[6、12、24个月转阴率分别为77.4％（24/31）、87.8％（79/90）、92.3％（84/91）;6、12、24个月阳性与阴性患者年龄分别为32（28～47）和33（30～38）岁、32（28～38）和33（30～38）岁、33（30～39）和33（30～38）岁,U值分别为74.00、371.50、292.50,P值分别为0.661、0.436、0.982];基线HR-HPV DNA病毒载量在50.40 RLU/PC以下的患者在24个月时自然转阴的可能性较大[ROC曲线下面积为0.71（0.51～0.92）,P=0.061].未治疗组的转阴率（92.3％,84/91）高于干扰素治疗组（73.4％,102/139）,差异有统计学意义（x2=12.73,P＜0.01）.分层分析结果显示,在年龄≤55岁的研究对象中,未治疗组（92.1％,82/89）转阴率高于干扰素治疗组（77.9％,95/122）,差异有统计学意义（x2=7.75,P＜0.01）;在基线HPV DNA病毒载量≤50.40 RLU/PC的研究对象中,未治疗组（98.2％,55/56）转阴率高于干扰素治疗组（79.7％,55/69）,差异有统计学意义（x2=10.02,P＜0.01）.结论 HR-HPV阳性而细胞学检查正常的患者在24个月内自然转阴率较高,可结合初诊HPV DNA病毒载量进行治疗方案的考虑与选择.

Objective This study aimed to analyze clinical treatment protocol for patients who were positive in HR-HPV screening test but were normal in cytological examination.Methods Telephone follow-up at 6,12 and 24 months were conducted for 274 female patients who had positive results of HR-HPV screening test and negative results of thinprep cytologic test （TCT） at baseline examination in Department of Gynaecology and Obstetrics,Beijing Jishuitan Hospital.The natural clearance of HPV virus was analyzed and the outcomes in interferon treatment group （159 cases） and non-treatment group （93 cases） were compared.Doctors suggested all the cases accept treatment but final decision was made by participants themselves.Results The natural clearance rate of HR-HPV DNA in non-treatment group was 92.3% （84/91）.Natural clearance at 6,12,24 months were not associated with age [Natural clearance at 6,12 and24 months were 77.4% （24/31）,87.8% （79/90） and 92.3% （84/91）,respectively;the age of positive and negative patients at 6,12 and 24 months were 32 （28-47） and 33（30-38） years old,32 （28-38） and 33 （30-38） years old,33 （30-39） and 33（30-38） years old,respectively;the U values were 74.00,371.50 and 292.50,respectively and the P values were 0.661,0.436 and 0.982,respectively].The patients with HR-HPV viral load of ≤ 50.40 RLU/PC at baseline were more likely to have natural clearance of HPV at 24 month [AUC：0.71 （0.51-0.92）,P=0.061].The clearance rate for non-treatment group （92.3%,84/91） was higher than interferon treatment （73.4%,102/139） group （x2=l 2.73,P〈0.001）.As for stratify analysis,the clearance rates in non-treatment group （92.1%,82/89） was higher than treatment group （77.9%,95/122） among patients below 55 years old （x2=7.75,P=0.01）.And among patients with HPV viral load of ≤50.40 RLU/PC at baseline,the clearance rates in non-treatment group （98.2%,55/56） was also higher than treatment group （79.7%,55/69） （x2=10.02,P=0.01）.Conclusions The natural clearance rate for patients with positive results of HR-HPV screening test and negative TCT result was high in 24 months,and the HPV viral load at first visit should be taken into consideration in deciding treatment protocol for the patients.