高级别宫颈上皮内瘤变LEEP术后HPV持续感染的危险因素及预测模型构建

Risk factor of HPV persistent infection of high-grade cervical intraepithelial neoplasia after treatment and build of a nomogram prediction model

目的探讨高级别宫颈上皮内瘤变(CINⅡ/Ⅲ)患者经宫颈电环切术(LEEP)治疗后高危型人乳头瘤病毒(HR-HPV)持续感染的相关危险因素,建立列线图模型预测高危人群,降低术后残留率或复发率。方法选取2016年1月-2017年12月在我院行LEEP术治疗的CINⅡ/CINⅢ患者139例为研究对象,术前及术后6个月行第二代杂交捕获试验、HPV分型及阴道微生态检查,同时记录患者初次性生活年龄、分娩方式、切缘情况、术后性生活保护情况等资料。运用logistic回归分析确定高危因素,建立预测HPV持续感染风险的列线图模型,分别用一致性系数和校准曲线评估模型的预测性能和符合度。结果术后6个月时HR-HPV持续阳性37例,阳性率17.3%,局限于7种高危亚型。多因素分析显示初次性生活年龄<16岁、术前HR-HPV DNA≥100 RLU/CO、切缘阳性、性生活无保护为术后HPV持续感染的独立危险因素(P<0.05),其OR值分别为0.239、4.876、14.135、0.359。用于预测HPV持续感染的列线图的准确度为0.821。结论基于初次性生活年龄<16岁、术前HR-HPV DNA≥100 RLU/CO、切缘阳性、性生活无保护构建的列线图,可用于指导临床发现高危人群,进行严密随访。

Objective To explore the risk factor of human papillomavirus(HPV)persistent infection of high-grade cervical intraepithelial neoplasia(CINⅡ/Ⅲ)patients after loop electrosurgical excision procedure(LEEP),establish a nomogram model to predict the high-risk population,and reduce the incidence rates of postoperative recurrence and residual.Methods A total of 139 CINⅡ/Ⅲpatients treated by cervical conization in the hospital from January 2016 to December 2017 were selected and followed up at six months after surgery.High-risk HPV and vaginal microflora were performed before treatment and during follow-up,age at onset of sexual life,delivery modes,incisal margin,condom use after surgery were recorded.A nomogram model for predicting the risk of HPV persistent infection was established,and the predictive performance and compliance of the model were evaluated using the consistency index(C-index)and the calibration curve.Results At six months after operation,37 patients with HPV persistent infection had the positive rates of 17.3%,limited to seven high-risk HPV subtypes.Multivariate logistic regression analysis showed that<16 years old when first sex,preoperative HR-HPV DNA≥100 RLU/CO,positive incisal margin and condom useless after operation were independent risk factors of HPV persistent infection;OR values were 0.239(95%CI 0.081-0.702),4.876(95%CI 1.801-13.149),14.135(95%CI 4.215-47.398),0.359(95%CI 0.130-0.994).The accuracy of nomogram used to predict the risk of HPV persistent infection was 0.821.Conclusion A nomogram,constructed based on<16 years old when first sex,the amount of HR-HPV DNA≥100 RLU/CO before treatment,positive incisal margin and condom useless after operation,can be used to find the high-risk population who need close follow-up.