CINⅢ患者宫颈锥切术后高危型人乳头瘤病毒持续感染情况及危险因素分析

Persistent infection of high-risk human papillomavirus in CINIII patients’after cervical conization surgery

目的 探讨CINⅢ患者宫颈锥切术后12个月及24个月高危型人乳头瘤病毒(HPV)持续感染情况及危险因素。方法 选择浙江省温州市中西医结合医院2017年1月~2021年6月宫颈上皮内瘤变Ⅲ级(CINⅢ)患者379例,所有患者均接受宫颈锥切术治疗,观察术后6个月、12个月、18个月、24个月宫颈HPV感染情况及术后12个月及24个月HPV持续感染的危险因素。结果 379例CINⅢ患者宫颈锥切术后6个月、12个月、18个月、24个月HPV的转阴率分别为64.64%、85.49%、89.71%、91.82%;宫颈锥切术后12个月、24个月HPV的转阴率分别为85.49%、91.82%。HPV多重感染、HPV16或HPV18感染、HPV载量>500 RLU/CO是宫颈锥切术后12个月HPV持续感染的独立危险因素(P<0.05或P<0.01);HPV载量>500 RLU/CO是宫颈锥切术后24个月HPV持续感染的独立危险因素(P<0.05),而年龄>45岁均非宫颈锥切术后12个月或24个月HPV持续感染的独立危险因素(P>0.05)。结论 HPV多重感染、高危分型及HPV载量会影响宫颈锥切术后12个月HPV的转阴率,其中HPV载量过高可能增加了术后24个月HPV持续感染的风险。临床需重视HPV高载量的患者,尽早发现宫颈病变的复发,以便及时干预处理。

Objective The purpose of this study is to investigate the persistent positive status and high-risk factors of high-risk human papillomavirus(HPV)in CINⅢ patients after cervical conization surgery at 12 and 24 months.Method A total of 379 patients with cervical intraepithelial neoplasia grade Ⅲ(CINⅢ)were selected from Wenzhou Integrated Traditional Chinese and Western Medicine Hospital in Zhejiang Province from January 2017 to June 2021.All patients underwent cervical conization surgery and were observed for cervical HPV infection at 6,12,18and 24 months postoperatively,as well as high-risk factors for sustained HPV positivity at 12 and 24 months postoperatively.Results The HPV conversion rates of 379 CINⅢ patients at 6 months,12 months,18 months,and 24 months after cervical conization were 64.64%,85.49%,89.71%,and 91.82%,respectively;The conversion rates of HPV to negative at 12 and 24 months after cervical conization were 85.49%and 91.82%,respectively.Multiple HPV infections,HPV16 or HPV18 infections,and HPV load>500 RLU/CO are independent risk factors for sustained HPV positivity at 12 months after cervical conization(P<0.05 or P<0.01);HPV load>500 RLU/CO is an independent risk factor for sustained HPV positivity 24 months after cervical conization(P<0.05),while age>45 years is not an independent risk factor for sustained HPV positivity 12 or 24 months after cervical conization(P>0.05).Conclusion Multiple HPV infections,high-risk subtypes,and HPV load can affect the conversion rate of HPV to negative at 12 months after cervical conization.High HPV load may increase the risk of sustained HPV positivity 24 months after surgery.Clinical attention should be paid to patients with high HPV load,and early detection of recurrence of cervical lesions is necessary for timely intervention and treatment.