子宫颈HSIL治疗后接种二价HPV疫苗的有效性研究

Study on the Efficacy of Bivalence HPV Vaccine Inoculation after Cervical HSIL Treatment

目的:探究子宫颈高级别鳞状上皮内病变(HSIL)治疗后接种二价人乳头瘤病毒(HPV)疫苗的有效性。方法:回顾性分析2019年1月—2020年12月于江西省妇幼保健院行子宫颈环形电切术(LEEP)或子宫颈冷刀锥切术(CKC)的77例子宫颈HSIL患者的临床资料,均建议术后1周开始根据接种程序进行二价HPV疫苗的接种,并按自愿接种原则将患者分为接种组(n=32)、未接种组(n=45)。比较两组子宫颈HSIL复发率,分析子宫颈HSIL复发及HPV持续阳性的危险因素。结果:接种组复发1例,复发率为3.13%,未接种组复发8例,复发率为17.78%,两组复发率比较,差异有统计学意义(P<0.05)。复发组子宫颈鳞状上皮内病变(SIL)Ⅲ级、手术切缘阳性、未疫苗接种、腺体受累、阴道镜印象不充分及HPV16/18阳性占比均高于无复发组(P<0.05);两组年龄、绝经状态、手术方式比较,差异均无统计学意义(P>0.05)。logistic回归模型分析结果显示,SILⅢ级、手术切缘阳性、阴道镜印象不充分、HPV16/18阳性、未接种疫苗均是子宫颈HSIL复发的独立危险因素(P<0.05)。持续感染组手术切缘阳性、病变点数≥3、HPV16/18阳性占比均高于转阴组(P<0.05);两组孕次、产次、绝经状态、锥切标本厚度及疫苗接种占比比较,差异均无统计学意义(P>0.05)。病变点数≥3、HPV16/18阳性均是影响子宫颈HSIL治疗后HPV持续阳性的独立危险因素(P<0.05)。结论:接种二价HPV疫苗的子宫颈HSIL患者的复发风险明显降低,未接种二价HPV疫苗可作为子宫颈HSIL治疗后复发的独立危险因素。

Objective:To explore the efficacy of bivalence human papilloma viru(HPV)vaccine inoculation after cervical high-grade squamous intraepithelial lesion(HSIL)treatment.Method:The clinical data of 77 patients with cervical HSIL who underwent loop electrosurgical excision procedure(LEEP)of cervix or cold knife conization(CKC)of cervix in Jiangxi Maternal and Child Health Hospital from January 2019 to December 2020 were retrospectively analyzed.All of them were recommended to inoculated bivalence HPV vaccine according to the inoculation schedule from 1 week after surgery.According to the principle of voluntary inoculation,the patients were divided into inoculated group(n=32)and uninoculated group(n=45).The relapse rate of cervical HSIL was compared between the two groups,and the risk factors of cervical HSIL relapse and HPV persistent positive were analyzed.Result:1 case recurred in the inoculated group,with a relapse rate of 3.13%,and 8 cases recurred in the uninoculated group,with a relapse rate of 17.78%.There was significant difference in relapse rate between the two groups(P<0.05).The proportions of cervical squamous intraepithelial lesion(SIL)Ⅲgrade,positive surgical incisal edge,no vaccine inoculation,glandular involvement,inadequate colposcopic impression and HPV16/18 positive in inoculated group were higher than those in uninoculated group(P<0.05).There were no significant differences in age,menopausal status and surgical methods between the two groups(P>0.05).logistic regression model analysis showed that SILⅢgrade,positive surgical incisal edge,inadequate colposcopic impression,HPV16/18 positive and no vaccine inoculation were all independent risk factors for cervical HSIL relapse(P<0.05).The proportions of positive surgical incisal edge,lesion number≥3 and HPV16/18 positive in persistent infection group were higher than those in negative conversion group(P<0.05),there were no significant differences in gravidity,parity,menopausal status,conization specimen thickness and vaccine inoculation between the two groups(P>0.05).The lesion number≥3 and HPV16/18 positive were independent risk factors for persistent positive HPV after cervical HSIL treatment(P<0.05).Conclusion:The relapse risk of patients with cervical HSIL inoculated with bivalence HPV vaccine is significantly reduced,and non-inoculation HPV vaccine can be used as an independent risk factor for relapse after cervical HSIL treatment.