HPV疫苗接种对HR-HPV感染的HSIL患者行LEEP锥切术后远期临床结局影响

Effect of HPV Vaccination on Long-term Clinical Outcome after LEEP Conectomy in HSIL Patients with HR-HPV Infection

目的探讨人乳头瘤病毒(HPV)疫苗接种对高危型HPV(HR-HPV)感染的子宫颈高级别鳞状上皮内病变(HSIL)患者行子宫颈环形电极(LEEP)锥切术后远期临床结局的影响。方法纳入我院2018年8月~2020年8月我院收治的HR-HPV感染的HSIL患者300例,均行LEEP锥切术,经手术病理证实为HSIL。利用系统抽样法随机将患者分成二价组(n=100)、四价组(n=100)、对照组(n=100)。二价组、四价组分别接受二价、四价疫苗接种,对照组不接种HPV疫苗。以患者入院第1d作为随访起始日,本次随访截止于2022年8月,记录三组随访期间的HSIL复发率。经多元Logistic回归模型分析HSIL患者远期临床结局的影响因素。结果经随访提示,四价组(5.00%)、二价组(16.00%)术后HSIL复发率低于对照组(31.00%),其中四价组复发率低于二价组(P<0.05)。复发组术前HR-HPV载量≥1000 RLU/CO、术后HPV持续阳性占比分别为48.08%、69.23%,高于非复发组的17.74%、28.23%,且复发组术后未接种HPV疫苗占比为59.62%,高于非复发组的27.82%(P<0.05)。多元Logistic回归分析提示,术前HR-HPV载量≥1000 RLU/CO、术后HPV持续阳性是HSIL患者LEEP术后复发的危险因素,术后接种二价/四价HPV疫苗,是降低复发风险的保护因素(P<0.05)。结论HR-HPV感染的HSIL患者行LEEP术后接种二价/四价HPV疫苗,能控制术后复发风险,且以四价疫苗的效果更好,复发率低,二价、四价疫苗接种均与患者远期复发风险存在相关性。

Objective To investigate the effect of human papillomavirus(HPV)vaccination on the long-term clinical outcome of cervical ring electrode(LEE P)coning in high-risk HPV(HR-HPV)infected patients with high-grade squamous intraepithelial lesions(HSIL).Methods A total of 300 patients with HR-HPV infection admitted to our hospital from August 2018 to August 2020 were enrolled,all of whom underwent LEE P coning resection and were confirmed to be HSIL by surgical pathology.Patients were randomly divided into two groups(n=100),four groups(n=100)and control group(n=100)by systematic sampling.The bivalent and quadrivalent groups received bivalent and quadrivalent vaccines,while the control group was not vaccinated with HPV vaccine.The HSIL recurrence rates of the three groups were recorded during the follow-up period,starting from 1 day after admission and ending in August 2022.Multiple Logistic regression model was used to analyze the factors affecting the long-term clinical outcome of patients with HSIL.Results The follow-up showed that the recurrence rate of HSIL in the quadrivalent group(5.00%)and bivalent group(16.00%)was lower than that in the control group(31.00%),and the recurrence rate in the quadrivalent group was lower than that in the bivalent group(P<0.05).The ratio of preoperative HR-HPV load≥1000 RLU/CO and postoperative HPV positive was 48.08%and 69.23%,respectively,higher than that of the non-recurrent group(17.74%and 28.23%),and the ratio of no HPV vaccine was 59.62%in the recurrent group.It was higher than that in the non-recurrence group by 27.82%(P<0.05).Multiple Logistic regression analysis suggested that preoperative HR-HPV load≥1000 RLU/CO and continuous positive HPV after surgery were risk factors for postoperative recurrence of LEEP in HSIL patients,and postoperative vaccination with bivalent/quadrivalent HPV vaccine was a protective factor for reducing the risk of recurrence(P<0.05).Conclusion For HSIL patients infected with HR-HPV after LEEEE P,bivalent/quadrivalent HPV vaccine can control the risk of postoperative recurrence,and the quadrivalent vaccine has a better effect and a lower recurrence rate.Both bivalent and quadrivalent vaccines are correlated with the long-term recurrence risk of patients.