子宫颈炎症对宫颈上皮内瘤样变患者疾病转归的影响

The effects of cervical inflammation on the prognosis of cervical intraepithelial neoplasia patients

目的 对比人乳头瘤病毒16型（HPV16）感染阳性和HPV感染阴性的宫颈上皮内瘤样病变（cervical intraepithe-lial neoplasia,CIN）患者2年间复查资料,探讨在HPV自然清除时间内子宫颈炎症反应对CIN病情发展的影响.方法 选取2011-2016年广东省韶关市粤北人民医院和肇庆市第一人民医院CIN患者300例（HPV16阳性和HPV阴性各150例）作为研究对象,以宫颈薄层液基细胞学筛查和阴道镜下宫颈组织活检两种方法确诊CIN,HPV16检测采用PCR-反向斑点杂交法;2年间复诊患者阴道分泌物直接涂片镜检法进行白细胞（WBC）计数,采用“WBC计数均值”指标反映炎症情况.结果 WBC计数均值1.0～1.4、1.5～1.9、2.0～2.4、2.5～2.9、3.0～3.4,3.5～3.9、4.0～4.5各区间,HPV阳性组疾病恶化率分别为0（0/13）、11.1％ （2/18）、23.3％（7/30）、32.5％（13/40）、50.0％（14/28）、72.2％（13/18）、66.7％（2/3）[总体恶化率为34.0％（51/150）];HPV阴性组疾病恶化率分别为0（0/17）、0（0/17）、0（0/23）、5.4％（2/37）、6.4％（2/31）、13.3％（2/15）、30.0％（3/10）[总体恶化率为6.0％（9/150）].总体看,WBC计数均值越高,两组CIN发生恶化比率越高,并且HPV阳性组疾病转归更差（HPV阳性组：x2=35.82,P＜0.01;HPV阴性组：x2=17.25,P＜0.01）.但WBC计数均值各区间两组转归情况对比均有差异.结论 宫颈炎症情况对CIN患者疾病转归有影响,炎症反应程度高,疾病转归不良;HPV感染与炎症情况对疾病转归可能存在协同作用.

Objective To compare 2 years＇ review data of human papillomavirus type 16 （HPV16） infection for patients with cervical intraepithelial neoplasia （CIN） with CIN patients without HPV infection,and to discuss the impact of cervical inflammation on the development of CIN within natural clearance process of HPV.Methods A total of 300 CIN patients （150 patients each of HPV16 positive and HPV negative） were selected as the study subjects from 2011 to 2016 in Yue Bei People＇s Hospital in Shaoguan City and the First People＇s Hospital of Zhaoqing city in Guangdong province.CIN was diagnosed by both thin layer liquid based cervical cytological screening and colposcopy cervical tissue biopsy.PCR-reversed dot blot hybridization was used for HPV16 detection.Vaginal secretions of the patients reexamined for 2 years were examined by direct smear microscopy,and the ＂WBC counting mean＂ was used as the index of inflammation.Results In the ranges of WBC counting mean of 1.0 to 1.4,1.5 to 1.9,2.0 to 2.4,2.5 to 2.9,3.0 to 3.4,3.5 to 3.9,and 4.0 to 4.5,the proportions of disease progression within HPV positive group was 0 （0/13）,11.1％ （2/18）,23.3％ （7/30）,32.5％ （13/40）,50.0％ （14/28）,72.2％ （13/18） and 66.7％ （2/3） （average 34.0％,51/150）,respectively;the proportions of disease progression in HPV negative group was 0 （0/17）,0 （0/17）,0 （0/23）,5.4％ （2/37）,6.4％ （2/31）,13.3％ （2/15） and 30.0％ （3/10） （average 6.0％,9/150）,respectively.In general,higher average WBC counting means accompanied with higher rates of disease progession in both groups （HPV positive group：x2=35.82,P＜0.01;HPV negative group：x2=17.25,P＜0.01）,and the deterioration of CIN in HPV positive groups was worse.All differences between prognoses in two groups in each range of the average WBC counting mean were statistically significant.Conclusions Inflammation of the cervix had effects on the prognosis of C1N patients.High degree of inflammation linked to worse prognosis of CIN patients.HPV infection and inflammation may have synergistic effects on the prognosis.