宫颈和阴道上皮内瘤变手术治疗后HPV持续性感染影响因素分析

Risk factors of persistent HPV infection after treatment for cervical complicated with vaginal intraepithelial neoplasia

目的探讨宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)合并阴道上皮内瘤变(vaginal intraepithelial neoplasia,VaIN)患者经手术治疗后HPV转归状况,并分析术后24月HPV持续性感染的影响因素。方法收集于承德医学院附属医院确诊为宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)262例患者临床资料,其中67例宫颈HSIL合并阴道HSIL为研究组,195例仅有宫颈HSIL为对照组,对比分析两组患者的临床特征及其术后6月、12月、18月、24月的HPV转阴率。将研究组患者依据术后24个月HPV是否转阴分为转阴组和持续感染组,分析术后HPV持续性感染的影响因素。结果研究组患者平均年龄53岁,绝经后患者占比、HPV多重感染率明显高于对照组(P<0.05)。研究组患者术后6月、12月、18月、24月HPV转阴率分别为49.3%、61.2%、65.7%、71.6%,均低于对照组(P<0.05)。术后24个月研究组HPV持续性感染率高达28.4%,经单因素分析显示,HPV多重感染及阴道多中心病灶是影响术后HPV持续性感染的高危因素(P<0.05),而绝经状态、是否感染HPV16、CIN级别及VaIN级别与术后HPV持续性感染无相关性(P>0.05)。经多因素Logistic回归分析显示,阴道病变多灶性是宫颈HSIL合并阴道HSIL患者术后HPV持续性感染的独立危险因素(OR=7.157,95%CI:1.909-26.841,P=0.004)。结论宫颈HSIL合并阴道HSIL经手术治疗后HPV持续性感染率较高,阴道病变多灶性是导致术后HPV持续性感染的独立危险因素,术后应密切随访,以早期发现复发并及时处理。

Objective To evaluate the HPV prognosis after surgical treatment for cervical intraepithelial neoplasia(CIN)complicated with vaginal intraepithelial neoplasia(VaIN),and analyze the influencing factors of persistent human papillomavirus(HPV)infection 24 months after surgery.Methods Clinical data of 262 patients pathologically diagnosed with cervical high-grade squamous intraepithelial lesion(HSIL)at the Affiliated Hospital of Chengde Medical University were collected.Among them,67 cases of cervical HSIL complicated with vaginal HSIL were included in the study group,and 195 cases with only cervical HSIL were included in the control group.The clinical characteristics of the two groups and HPV negative rates at 6 months,12 months,18 months,and 24 months after surgery were analyzed.Patients in the study group were divided into negative group and persistent infection group based on whether HPV turned negative 24 months after surgery,and the risk factors of persistent HPV infection after surgery were analyzed.Results The median age of study group was 53 years.The proportion of postmenopausal patients and the rate of multiple HPV infections in study group were significantly higher than those in the control group(P<0.05).HPV negative rates of study group at 6 months,12 months,18 months,and 24 months after surgery was 49.3%,61.2%,65.7%and 71.6%respectively,all of them lower than that of control group(P<0.05).The persistent HPV infection rate in study group at 24 months after surgery was as high as 28.4%,univariate analysis showed that multiple HPV infections and multicentric lesions in the vagina were high-risk factors affecting persistent HPV infection after surgery(P<0.05),however,menopausal status,whether infected with HPVI6,CIN level,and VaIN level were not correlated with postoperative persistent HPV infection(P>0.05).Logistic regression multivariate analysis showed that multicentric vaginal lesions was independent risk factor for persistent HPV infection in patients with cervical HSIL complicated with vaginal HSIL after surgery(OR=7.157,95%CI:1.909-26.841,P=0.004).Conclusion The persistent HPV infection rate is high after surgical treatment for cervical HSIL complicated with vaginal HSIL.Multicentric vaginal lesions is independent risk factor for persistent postoperative HPV infection.Close follow-up should be conducted after surgery to detect recurrence early and handle it promptly.