宫颈上皮内瘤变患者手术后疾病复发的主要危险因素分析

Factors of Recurrence of Disease after Operation in Patients with Cervical Intraepithelial Neoplasia

目的:探讨宫颈上皮内瘤变(CIN)患者手术后疾病复发的主要危险因素。方法:160例CIN手术患者,根据宫颈锥切术后6个月时随访复查结果分为CIN复发组(n=80)和未复发组(n=80),分析2组患者个体因素、术前CIN病理特征及术后6个月时的辅助检查指标对术后患者CIN复发的影响;以术后患者CIN复发为因变量,采用拟合二分类Logistic回归分析术后患者CIN复发的影响因素。结果:复发组绝经人数、年龄>45岁人数显著高于未复发组,差异有统计学意义(P<0.05);复发组人群CIN病理分级为CIN2~3级、CIN病变区域为3~4个象限人数显著高于未复发组,差异有统计学意义(P<0.05);复发组HPV阳性、TCT阳性、P16inkta阳性人数显著高于未复发组,差异有统计学意义(P<0.05);回归分析结果显示,术后6月HPV阳性(OR=5.419,95%CI介于1.321~22.225)、TCT阳性(OR=4.759,95%CI介于1.357~16.683)、P16inkta阳性(OR=3.975,95%CI介于1.301~12.148)、病理分级(OR=3.857,95%CI介于1.190~12.503)、CIN病变区域(OR=3.127,95%CI介于1.220~8.011)、绝经(OR=2.801,95%CI介于1.160~6.767)、年龄(OR=2.560,95%CI介于1.124~5.831)、吸烟史(OR=2.484,95%CI介于1.134~5.441)是CIN患者术后复发的影响因素。结论:术后6月HPV、TCT及P16inkta阳性情况是CIN患者术后复发的主要影响因素。

Objective:To explore the major risk factors for recurrence of disease after operation in patients with cervical intraepithelial neoplasia.Methods:160 patients with CIN were divided into CIN recurrence group(n=80)and non-repetition group(n=80)according to the results of follow-up review at 6 months after cervical conectomy.The effects of individual factors,pathological features of preoperative CIN and auxiliary examination indexes on recurrence of CIN were analyzed.Recurrence of CIN in postoperative patients was used as dependent variable to analyze the influencing factors of CIN recurrence in postoperative patients by fitting two-class Logistic regression.Results:The number of menopause,age>45 years in the recurrent group was significantly higher than that in the unrepeated group,and the difference was statistically significant(P<0.05).In the recurrent group,the CIN pathological grade was CIN2~3,and the number of patients with CIN lesion was 3~4 quadrants higher than that in the group without recurrence.The difference was statistically significant(P<0.05).The HPV positive,TCT positive and P16inkta positive in the recurrent group were significantly higher than those in the unrepeated group,and the difference was statistically significant(P<0.05).The results of regression analysis showed that HPV positive at 6 months postoperative(OR=5.419,95%CI between 1.321 and 22.225),TCT positive(OR=4.759,95%CI between 1.357 and 16.683),P16inkta positive(OR=3.975,95%CI between 1.301 and 12.148),pathological grade(OR=3.857,95%CI between 1.190 and 12.503),CIN lesion region(OR=3.127,95%CI between 1.220 and 8.011),menopause(OR=2.801,95%CI between 1.160 and 6.767),age(OR=2.560,95%CI between 1.124 and 5.831),history of smoking(OR=2.484,95%CI between 1.134 and 5.441)were the influencing factors of recurrence of CIN patients.Conclusion:HPV,TCT and P16inkta are the main factors affecting recurrence after operation in patients with CIN.