宫颈上皮内瘤变LEEP预后与HPV感染的关系及影响因素研究

Research on the relationship between prognosis of cervical intraepithelial neoplasia after LEEP and HPV infection and its influencing factors

目的探讨宫颈上皮内瘤变(CIN)环形电切除术(LEEP)预后与人乳头瘤病毒(HPV)感染的关系,并分析CIN病灶残留或复发的影响因素。方法选取139例CIN行LEEP的患者进行术后随访,收集HPV感染情况、临床和病理学资料,比较CIN患者LEEP前后HPV感染率,HPV持续感染与CIN残留或复发的关系,采用Logistic回归分析LEEP后残留或复发的相关因素。结果接受LEEP的CIN患者139例,术前131例感染HPV,感染率为94.24%(131/139);术后6个月随诊监测,HPV阳性患者75例,感染率为53.96%;LEEP前后HPV感染率比较,差异有统计学意义(P<0.05)。139例接受LEEP的CIN患者,经病理检查与阴道镜检查确认病灶残留34例,复发27例,消退78例;术后6个月HPV持续感染率46.76%(65/139);CIN残留或复发的HPV持续阳性率与消退比较,差异有统计学意义(P<0.05)。术后6个月HPV持续阳性指标预测CIN残留或复发的灵敏度为90.16%(55/61)。年龄、病变程度、HPV持续感染、切缘阳性与LEEP后CIN残留或复发有关(P<0.05)。切缘阳性、HPV持续感染是CIN患者LEEP后残留或复发的独立危险因素(P<0.05)。结论 CIN患者LEEP后6个月HPV持续感染是CIN残留及复发的有效预测因子,可作为疾病监控指标;HPV持续感染、切缘阳性是CIN残留及复发的独立危险因素。

Objective To investigate the relationship between prognosis of loop electrosurgical excision procedure （LEEP） for cervical intraepithelial neoplasia （CIN） and human papillom.avirus （HPV） infection, and analyze the influencing factors of residual or recurrence of CIN lesions. Methods A total of 139 CIN patients with LEEP were selected for postoperative follow-up, the HPV infection, the clinical and pathological data were collected, the infection rate of HPV, relationship between persistent infection of HPV and positive rate of CIN residue or recurrence were compared before and after LEEP in CIN patients. Logistic regression analysis was used to analyze the related factors of residual or recurrence after LEEP. Results 139 cases of CIN received LEEP, 131 cases were infected with HPV before surgery, the infection rate was 94.24% （131/139）, and 75 cases were HPV positive after 6 months follow-up monitoring, the infection rate was 53.96%. There was a significant difference in the HPV infection rate before and after LEEP （P〈0.05）. In 139 CIN patients who underwent LEEP, 34 cases were confirmed by pathological examination and vaginoscopy, 27 cases relapsed and 78 cases disappeared; the persistent infection rate of HPV was 46.76% （65/139） 6 months after surgery; the persistent positive rate of HPV with residual or recurrent in CIN compared with that of regression, the differences were statistically significant （P〈0.05）. The sensitivity of HPV to predict CIN residual or recurrent was 90.16% （55/61） after 6 months of surgery. Age, degree of lesion, persistent infection of HPV and positive margin of incision were associated with residual or recurrence of CIN after LEEP （P〈0.05）. Positive margins and persistent infection of HPV were independent risk factors for residual or recurrence in CIN patients after LEEP （P〈0.05）. Conclusion Postoperative HPV infection for 6 months is an effective predictor of CIN residual or recurrence after LEEP, and can be used as disease monitoring indicator. Persistent infection of HPV and positive margin are CIN independent risk factors for residual or recurrence.