高危HPV持续感染与宫颈病变级别的关系及治疗前后的清除状况研究

Correlation between High-risk HPV Persistent Infection and Cervical Lesion grade and Clearance before and after Treatment

目的:探究高危人乳头瘤病毒(H-HPV)持续感染与宫颈病变级别的关系及治疗前后的清除状况。方法:选取本院门诊因宫颈炎就诊并经检测的13种高危型HPV-DNA(H-HPV-DNA)阳性患者102例。随访并统计未经临床干预下HPV在距首次阳性6、12、18及24个月的清除率、病毒负荷量、液基薄层细胞学技术(TCT)检查结果,根据宫颈病变决定是否临床治疗,随访资料进行回顾性分析。结果:随访24个月,与首次HPV检测结果比较,102例中有12例HPV转阴性(6个月转阴性2例,12个月转阴性2例,18个月转阴性8例),HPV负荷量下降19例,无明显上升59例,在临床未干预情况下有90例TCT均阴性,12例是同一患者治疗前后,随访至12个月时6例HPV负荷呈上升趋势,TCT及病理结果均呈阳性。其中HPV负荷上升明显患者中行宫颈微波6例,H-HPV在术后3个月就下降明显、TCT阴性,术后12个月HPV、TCT均为阴性;6例曾宫颈上皮瘤样病变(CIN)Ⅰ级的患者未经治疗在18个月后才随访到第2次,TCT阳性、活检病理为CINⅡ级1例和CINⅠ级5例、HPV病毒负荷量上升,行宫颈电环切(LEEP)术,术后3个月HPV下降明显、TCT阴性,术后6个月5例HPV阴性、TCT阴性。结论:H-HPV持续阳性患者应定期随访,随访应TCT联合HPV,HPV感染后自身有一定的清除率,HPV阳性患者CIN应行临床干预。

Objective:To explore the relationship between persistent infection of high-risk human papillomavirus(H-HPV)and the grade of cervical lesions and the clearance status before and after treatment.Method:A total of 102 patients with 13 high-risk HPV-DNA(H-HPV-DNA)positive because of cervicitis from our hospital were selected.Follow-up and statistics of HPV clearance rate,viral load,liquid-based thinlayer cytology(TCT)test results at 6,12,18 and 24 months after the first positive reaction without clinical intervention,and determine whether clinical treatment was based on cervical lesions,the follow-up data were analyzed retrospectively.Result:Follow-up 24 months,compared with the first HPV test results,among 102 cases,12 cases turned negative for HPV(2 cases turned negative in 6 months,2 cases turned negative in 12 months,8 cases turned negative in 18 months),19 cases decreased HPV load,59 cases did not increase significantly,90 cases were TCT negative in the absence of clinical intervention,12 cases were the same patients before and after treatment,the HPV load of 6 cases showed an upward trend after 12 months of follow-up,and the TCT and pathological results were positive.Among the patients with significant increase in HPV load,cervical microwave was performed in 6 cases,H-HPV decreased significantly 3 months after operation and TCT was negative,HPV and TCT were negative 12 months after operation.6 patients with cervical intraepithelial neoplasia(CIN)Ⅰwere followed up for the second time after 18 months without treatment,TCT was positive,biopsy pathology was CINⅡin 1 case and CINⅠin 5 cases,and the load of HPV increased,the patients underwent LEEP,HPV decreased significantly and TCT was negative in 3 months after operation,5 patients were HPV negative and TCT negative in 6 months after operation.Conclusion:Patients with persistent positive H-HPV should be followed up regularly,TCT combined with HPV should be used in the follow-up,after HPV infection,there is a certain clearance rate of HPV itself,CIN of HPV-positive patients should be given clinical intervention.