预防性HPV疫苗对LEEP术后宫颈病变转归的影响

Effect of prophylactic HPV vaccine on cervical lesion outcomes after LEEP

目的探讨预防性HPV疫苗对宫颈病变患者行LEEP治疗术后预后的影响。方法回顾性分析2018年1月至2021年8月在南京医科大学第一附属医院妇科行宫颈LEEP治疗且随访≥12个月患者的临床资料,根据是否接种预防性HPV疫苗,将其分为疫苗组(111例)和对照组(281例)。比较两组患者的术前及术后临床资料、术后宫颈病变复发及阴道病变发生情况,分析疫苗接种时间以及类型对宫颈病变复发的影响,并比较两组患者术后HPV阳性率及TCT异常率。结果两组患者的术前一般资料及术后病理资料比较,差异均无统计学意义(P>0.05)。随访12个月后发现,疫苗组和对照组宫颈LEEP术后分别有3例(2.7%)和29例(10.3%)患者出现宫颈病变复发,接种疫苗可使术后宫颈病变的复发风险降低约73.8%(95%CI:43.5%-91.1%),差异有统计学意义(P<0.05),通过单因素分析发现,接种疫苗是预防LEEP术后宫颈病变复发的保护因素(OR=0.241,95%CI:0.072-0.809)。仅分析术后CIN2+复发的结果,差异同样具有统计学意义(P<0.05)。LEEP术前接种疫苗相较于术后接种宫颈病变的复发风险降低,术后HPV感染及TCT异常风险降低,但差异无统计学意义(P>0.05),(不同疫苗类型术后HPV阳性率差异具有统计学意义(P<0.05),宫颈病变复发、术后TCT异常率差异无统计学意义(P>0.05)。)接种疫苗可显著降低患者LEEP术后6个月初次筛查的HPV阳性率以及TCT异常率,差异均有统计学意义(P<0.05)。结论及时接种预防性HPV疫苗可显著降低LEEP术后患者宫颈病变复发风险和LEEP术后HPV阳性率和TCT异常率,相较于术后接种,术前接种疫苗可能使患者的获益更加显著,然而不同疫苗类型宫颈病变复发情况差异无统计学意义。

Objective To investigate the effect of prophylactic HPV vaccine on the postoperative prognosis of patients treated with LEEP for cervical lesions.MethodRetrospective analysis of clinical data of patients who underwent cervical LEEP treatment in the Gynecology Department of the First Afiliated Hospital of Nanjing Medical University from January 2018 to August 2021 and were followed up for≥12 months,and divided them into vaccine group(111 cases)and control group(281 cases)according to whether they were vaccinated with prophylactic HPV vaccine.Compared the preoperative and postoperative clinical data,as well as the incidence of cervical and vaginal lesions between two groups of patients after surgery.Analyzed the impact of vaccination time and type on cervical lesion recurrence,and compared the postoperative HPV positive rate and TCT abnormal rate between the two groups of patients.ResultsThere was no significant difference in the preoperative general information and postoperative pathological data between the two groups(P>0.05).After 12 months of follow-up,it was found that 3 patients(2.7%)in the vaccine group and 29 patients(10.3%)in the control group experienced recurrence of cervical lesions after LEEP surgery,respectively.Vaccination reduced the risk of recurrence of cervical lesions by about 73.8%(95%Cl:43.5%-91.1%),and the difference was statistically significant(P<0.05).Vaccination with different types of vaccines showed statistical differences in reducing postoperative HPV positivity rate(P<0.05).Univariate analysis showed that,vaccination was a protective factor against recurrence of cervical lesions after LEEP surgery(OR=0.241,95%CI:0.072-0.809).Only analyzing the results of postoperative CIN2+recurrence showed statistically significant differences(P<0.05).Preoperative vaccination of LEEP could reduce the risk of recurrence of cervical lesions compared to postoperative vaccination and reduce postoperative HPV infection and TCT abnormality rate,but the difference was not statistically significant(P>0.05).The difference of HPV positive rate afer different vaccine types was statisitically significant(P<0.05),there was no significant difference in the recurrence of lesions and the abornal rate of TCT after operation(P>0.05).Vaccination can significantly reduce the HPV positive rate and TCT abnormal rate of patients undergoing LEEP surgery at the first screening 6 months after surgery,and the differences were statistically significant(P<0.05).Conclusions Timely vaccination with prophylactic HPV vaccine can significantly reduce the risk of cervical lesion recurrence in patients after LEEP and the positive rate of HPV and the abnormal rate of TCT after LEEP,the preoperative vaccination may benefit patients more significantly than postoperative vaccination,but there is no significant difference between different vaccine types in preventing recurrence of cervical lesions.