宫颈上皮内瘤变LEEP术后人乳头瘤病毒感染的临床分析

Clinical Analysis of Human Papillomavirus Infection after Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia

目的:探讨影响宫颈环形电切术(LEEP)治疗宫颈上皮内瘤变(CIN)术后人乳头瘤病毒(HPV)感染和预后的相关因素。方法:回顾分析2013年1月—2015年12月在中国医科大学附属盛京医院妇科门诊行LEEP术并参与术后随访至少一次的CIN患者临床资料,共297例,分析其临床病理指标、术后HPV分型检测及病变残留或复发等情况。结果:LEEP术后HPV阳性率为14.5%(43/297)。LEEP术后HPV感染与切缘情况、病变累及外阴和/或阴道壁具有相关性(P<0.05)。术后HPV阳性69.8%(30/43)在首次复查时发现,30.2%(13/43)为HPV首次复查转阴后再次感染。LEEP术后高危型HPV阳性与病变残留或复发具有相关性(r=0.401,P=0.000)。手术前后HPV同一型别持续感染发生病变残留或复发的风险明显高于HPV不同型别感染(χ2=5.619,P=0.046),常见型别是HPV16、HPV58。结论:术前CIN合并阴道上皮内瘤变(VAIN)和/或外阴上皮内瘤变(VIN)及切缘阳性是术后HPV感染的高危因素,LEEP术后HPV分型检测对预测病变残留或复发具有重要作用。

Objective:To assess relevant factors of human papillomavirus infection and prognosis after loop electrosurgical excision procedure(LEEP)in patients with cervical intraepithelial neoplasia(CIN).Methods:A retrospective study was performed with 297 women suffered CIN and treated with LEEP at China Medical University affiliated Shengjing Hospital between Jan 2013 and Dec 2015.Participated in at least one follow-up were analyzed retrospectively.The clinicopathological factors,HPV genotype,postoperation residual and recurrence factors were analyzed.Results:HPV positive rate was 14.5%(43/297)after LEEP.HPV positive was significantly related to margin positive and CIN accompanied with vaginal intraepithelial neoplasia(VAIN)and/or vulval intraepithelial neoplasia(VIN)(P<0.05).69.8%(30/43)of HPV positive was at first visit after LEEP.30.2%(13/43)of HPV positive was occurred after turning negative.The positive rate of high-risk HPV after LEEP was significantly correlated with the residual or recurrence of lesions(r=0.401,P=0.000).The risk of persistent infection of the same type of HPV before and after operation was significantly higher than that of different types of HPV infection(χ2=5.619,P=0.046).The most common genotypes were HPV16 and HPV58.Conclusions:Preoperative CIN combined with VAIN and/or VIN and positive incision margin are high risk factors for HPV infection.HPV typing after LEEP plays an important role in predicting residual or recurrence of lesions.