高强度聚焦超声和宫颈锥切术治疗宫颈高级别鳞状上皮内病变患者的临床疗效及其对T细胞亚群、炎症因子影响

Clinical efficacy between high-intensity focused ultrasound and cold-knife conization in the treatment of high-grade squamous intraepithelial lesions of the cervix and its effects on T cell subsets and inflammatory factors

目的比较高强度聚焦超声(HIFU)和宫颈锥切术(CKC)治疗宫颈高级别鳞状上皮内病变患者的临床疗效及对T细胞亚群、炎症因子影响。方法回顾性选取2018年6月至2020年6月沧州市人民医院妇科收治的110例宫颈高级别鳞状上皮内病变患者为研究对象,按照手术方式不同分为HIFU组(n=60)和CKC组(n=50)。HIFU组接受HIFU手术治疗,CKC组接受CKC手术治疗。比较两组手术相关指标(手术时间、术中出血量)、高危型人乳头瘤病毒(HR-HPV)转阴率、手术前后阴道T细胞亚群水平、血清炎症因子[白细胞介素(IL)-10、IL-6、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平、疗效及并发症发生、复发率情况。结果HIFU组手术时间为(8.13±1.75)min,明显短于CKC组[(23.61±3.89)min],术中出血量为(3.06±0.82)mL,明显少于CKC组[(3.06±0.82)mL],差异均有统计学意义(P<0.05)。术后6个月,两组HR-HPV转阴率比较,差异无统计学意义(P>0.05)。术后1个月,两组CD4^(+)、CD4^(+)/CD8^(+)水平较术前明显升高,CD8^(+)水平较术前明显降低,且HIFU组CD4^(+)、CD4^(+)/CD8^(+)水平分别为(42.21±6.33)%、2.10±0.05,均明显高于CKC组[(2.10±0.05)%、1.63±0.07],CD8^(+)水平为(42.21±6.33)%,明显低于CKC组[(42.21±6.33)%],差异均有统计学意义(P<0.05)。术后1个月,两组血清IL-10水平较术前明显升高,IL-6、CRP、TNF-α水平较术前明显降低,差异均有统计学意义(P<0.05),但两组术后各炎症因子水平比较,差异均无统计学意义(P>0.05)。两组疗效比较,差异无统计学意义(P>0.05)。HIFU组术后并发症发生率为0,明显低于CKC组(10.00%),差异有统计学意义(P<0.05)。两组术后1年复发率比较,差异无统计学意义(P>0.05)。结论HIFU和CKC治疗宫颈高级别鳞状上皮内病变均有较好的疗效,但HIFU手术时间更短,术中出血量和术后并发症发生率更少,术后T细胞亚群改善程度优于CKC,但是两种术式对炎症因子的影响差异不明显。

Objective To compare the clinical efficacy between high-intensity focused ultrasound(HIFU)and cold-knife conization(CKC)in the treatment of high-grade squamous intraepithelial lesions of the cervix and its effects on T cell subsets and inflammatory factors.Methods A retrospective study was conducted on 110 patients with high-grade squamous intraepithelial lesions of the cervix who were treated in the Department of Gynecology,Cangzhou People's Hospital from June 2018 to June 2020.According to the type of surgery,the patients were divided into were divided into the HIFU group(n=60)and the CKC group(n=50).The HIFU group received HIFU surgical treatment,while the CKC group received CKC surgical treatment.The surgery related indicators(surgical time,intraoperative bleeding volume),high risk human papillomavirus(HR-HPV)negative conversion rate,the levels of serum inflammatory factors[interleukin(IL)-10,IL-6,C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)],vaginal T cell subsets before and after surgery,curative effect,recurrence rate and complications were compared between the two groups.Results The surgical time in the HIFU group was(8.13±1.75)minutes,which was significantly shorter than that in the CKC group[(23.61±3.89)minutes],and the intraoperative bleeding volume was(3.06±0.82)mL,which was significantly lower than that in the CKC group[(3.06±0.82)mL],the differences were statistically significant(P<0.05).At 6 months after surgery,there was no difference in the conversion rate of HR-HPV between the two groups(P>0.05).One month after surgery,the levels of CD4^(+)and CD4^(+)/CD8^(+)were significantly higher than those before surgery,while the levels of CD8^(+)in two groups were significantly lower than those before surgery,and the levels of CD4^(+)and CD4^(+)/CD8^(+)in the HIFU group were(42.21±6.33)% and(2.10±0.05)%,respectively,which were significantly higher than those in the CKC group[(2.10±0.05)% and(1.63±0.07)%],the levels of CD8^(+)in the HIFU group was(42.21±6.33)%,which was significantly lower than that in the CKC group[(42.21±6.33)%],the differences were statistically significant(P<0.05).One month after surgery,the levels of serum IL-10,IL-6,CRP,and TNF-αin both groups were significantly lower than those before surgery,the differences were statistically significant(P<0.05),but there were no significantly differences in the levels of inflammatory factors between the two groups after surgery(P>0.05).There was significant difference in efficacy between the two groups(P>0.05).The postoperative complication rate of the HIFU group was 0,which was significantly lower than that in the CKC group(10.00%),the difference was statistically significant(P<0.05).There was no significant difference in 1-year postoperative recurrence rate between the two groups(P>0.05).Conclusion Both HIFU and CKC have good efficacy in treating high-grade squamous intraepithelial lesions of the cervix.However,HIFU has a shorter surgical time,less intraoperative bleeding,and a lower probability of postoperative complications.The improvement of T cell subsets after surgery is better than CKC.However,there is no significant difference in the impact of the two surgical methods on inflammatory factors.