宫颈高级别鳞状上皮内病变腺体受累和HPV感染对复发的影响

Effect of glandular involvement and HPV infection on the recurrence of high-grade squamous intraepithelial lesions of the cervix

目的分析腺体受累及人乳头瘤病毒(HPV)持续感染对宫颈高级别鳞状上皮内病变(HSIL)复发的影响,为术后临床管理提供依据。方法收集行宫颈冷刀锥切术治疗的596例HSIL患者临床资料,其中腺体受累240例(腺体受累组)、腺体未受累356例(腺体未受累组)。以术后2年或再次出现HSIL为研究终点,比较复发患者与未复发患者间差异,结合患者腺体受累和HPV-16持续感染情况将患者分为腺体受累伴HPV-16持续感染组、腺体受累不伴HPV-16持续感染组、腺体不受累伴HPV-16持续感染组和腺体不受累不伴HPV-16持续感染组,比较4组间HSIL复发率的差异。结果596例患者中,复发75例(12.6%)。腺体受累组患者的HPV-16感染率高于腺体未受累组(67.9%νs.23.0%,P<0.05)。复发患者的≥45岁者比例、腺体受累和HPV-16持续感染者比例与未复发患者比较差异均无统计学意义(P均>0.05)。腺体受累伴HPV-16持续感染组、腺体受累不伴HPV-16持续感染组、腺体不受累伴HPV-16持续感染组和腺体不受累不伴HPV-16持续感染组的复发率分别为33.8%、10.9%、8.5%和9.7%,腺体受累伴HPV-16持续感染组复发率高于其他3组(P均<0.017)。结论腺体受累同时伴HPV-16持续感染的HSIL患者在宫颈冷刀锥切术后易复发,应对该类患者采用更积极的手术治疗方案并加强随访。

Objective To evaluate the effect of glandular involvement and persistent human papillomavirus(HPV)infection upon the recurrence of high-grade squamous intraepithelial lesion(HSIL)of the cervix,aiming to provide evidence for postoperative clinical management.Methods Clinical data of 596 HSIL patients who underwent cold-knife conization were collected,including 240 cases of glandular involvement(glandular involvement group)and 356 cases of non-glandular involvement(non-glandular involvement group).The recurrence of HSIL at postoperative 2 years was considered as the end point.The dttrences between recurrent and non-recurrent patients were compared.According to glandular involvement and HPV-16 infection,patients were divided into the glandular involvement+HPV-16 infection,glandular involvement alone,HPV-16 infection alone and non-glandular involvement+non-HPV-16 infection groups,respectively.The di^rences in the recurrence rate of HSIL were compared among four groups.Results Among 596 HSIL patients,75 cases recurred(12.6%).HPV-16 infection rate in the glandular involvement group was 67.9%,significantly higher than 23.0%in the non-glandular involvement group,and the difference was statistically significant(P<0.05).In univariate analysis9 the proportion of>45 years old,glandular involvement and persistent HPV-16 infection were not significantly correlated with the recurrence of HSIL(all P>0.05).The recurrence rates of HSIL were 33.8%,10.9%,8.5%and 9.7%in the glandular involvement+HPV-16 infection,glandular involvement alone,HPV-16 infection alone and non-glandular involvement+non-HPV-16 infection groups,respectively.The recurrence rate of HSIL in patients with glandular involvement+HPV-16 infection was significantly higher than that in other three groups,and the difference was statistically significant(all P<0.017).Conclusions HSIL patients with glandular involvement and persistent HPV-16 infection are prone to relapse after cervical cold-knife conization.For these patients,active surgical regimen should be adopted and postoperative follow-up should be strengthened.