高级别宫颈上皮内瘤变宫颈锥切术后高危型人乳头瘤病毒转归影响因素

Analysis of the factors affecting prognosis of human papilloma virus infection of patients with conization of cervix because of high-grade cervical intraepithelial neoplasia

目的:分析高级别宫颈鳞状上皮内病变(HSIL)宫颈锥切术后高危人乳头瘤病毒(HR-HPV)转归的关系.方法:选择2017年2月—2019年4月于本院妇科因HSIL行宫颈锥切术、术前HR-HPV感染者229例,分别于术后6、12、18、24个月行HR-HPV检测.结果:术后6、12、18、24个月转阴率分别为61.1%、71.6%、78.2%、84.3%.年龄≥40岁的患者术后6、12个月HR-HPV转阴率低于年龄<40岁(P<0.05),术后18、24个月HR-HPV转阴率不同年龄组间无差异(P>0.05);单一亚型感染与多种亚型感染患者术后各期HR-HPV转阴率无差异(P>0.05);HPV16/18感染的患者术后6、12、18、24个月HR-HPV转阴率低于其他HPV亚型感染患者(P<0.05).年龄≥40岁、HPV16/18感染是术后HR-HPV持续感染的独立危险因素(P<0.05),年龄≥40岁、多种亚型感染及HPV16/18感染对HR-HPV持续感染不具有预测效能,曲线下面积分别为0.549、0.583、0.542.结论:患者高龄及HPV16/18亚型感染是HSIL患者宫颈锥切术后HPV转阴的影响因素,临床应予以关注,加强术后随访.

Objective: To analyze the factors affecting the prognosis of high risk human papilloma virus(HR-HPV) infection of patients with conization of cervix because of cervical high-grade squamous intraepitheliallesion(HSIL). Methods: From February 2017 to April 2019,229 patients with HR-HPV infection who had undergone cervical conization because of HSIL were selected as subjects. The HR-HPV detection of these patients in the postoperative 6 th, 12 th, 18 th, and 24 th month were performed. Results: The negative conversion rates of HR-HPV infection of the patients in the postoperative 6 th, 12 th, 18 th, and 24 th month were 61.1%, 71.6%, 78.2%, and 84.3%, respectively. The negative conversion rate of HR-HPV infection of the patients with aged ≥40 years old in the postoperative 6 th or 12 th month was significantly lower than that of the patients with aged <40 years old(P<0.05). There was no significant difference in the negative conversion rate of HR-HPV infection in the postoperative 18 th month or 24 th month among the patients with different age(P>0.05). There was no significant difference in the negative conversion rate of HR-HPV infection between the patients with single subtype HR-HPV infection and the patients with multiple HR-HPV subtype infection(P>0.05). The negative conversion rate of HR-HPV infection of the patients with 16/18 subtype HR-HPV infection in the postoperative 6 th month, 12 th month, 18 th month, or 24 th month was significantly lower than that of the patients with other subtype HR-HPV infection(P<0.05). Age ≥40 years old and 16/18 subtype HR-HPV infection of the patients were the independent risk factors of their postoperative HR-HPV persistent infection(P<0.05). Age ≥40 years old, multiple subtypes HR-HPV infection, and 16/18 subtype HR-HPV infection of the patients had no predictive effect for their HR-HPV persistent infection,and the area under the curve(AUC)of which were 0.549,0.583,and 0.542,respectively.Conclusion:Age and 16/18subtype HR-HPV infection of the patients with HSIL are the influencing factors of the negative conversion of the HPV infection after conization of cervix,so the attention should be paid to these patients in clinic and the postoperative follow-up to these patients should be strengthened.