Epidemiological and Cytopathological Profile of Dysplastic Lesions of the Cervix in South-Kivu/Dr Congo

Background: Cervical cancer is one of the most common cancers in women in the world. The recrudescence of dysplastic lesions is increasing, especially in developing countries, because of the absence of screening. The objective of this work is to determine the prevalence of dysplastic lesions of the cervix in women who are sexually active in South Kivu province. Methods: It was a cross-sectional, descriptive and analytical study of 625 women who came for gynecological consultation, all of whom had cervical-uterine Pap smears, during the period from January 1st, 2017 to December 31st, 2018 at Panzi General Referral Hospital (South Kivu, DR Congo). Data analysis was done using Epi Info software version 7. Results: The median age of the respondents was 34 years, 47.0% of them were married, and 59.0% had a low socio-economic level. The majority had first sexual intercourse between the ages of 15 and 20 (67.5%), a number of former sexual partners estimated at 1 - 5 (87.8%), did not use tobacco (97.4%) and did not use contraception (78.1%). Pap smear was normal in 82.88% of cases, inflammatory in 2.4% of cases and with cytologic abnormalities in 14.72% of cases. Rates of dysplastic lesions were significantly higher among women aged ≥35 years (p = 0.0245), brides (p = 0.0183) and nulliparas (p = 0.0042). Multivariate analysis revealed the adjusted OR (95% CI) statistically insignificant (p < 0.05) for the age group, marital status and parity respondents. Conclusion: Cervical cancer remains a real scourge in the world, especially in sub-Saharan Africa, where the diagnosis is often made when the pathology is at its stage almost incurable. Early detection of dysplastic lesions by Pap smear is therefore imperative in the eradication of this pathology.

Epidemiological and Histopathological Aspect of Precancerous and Cancerous Lesions of the Cervix in the Health District of Commune 5 of Bamako, the CHU of Point “G” and the Gabriel TouréUniversity Hospital of Bamako in Mali

Objective: The aim was to take stock of the screening and treatment of precancerous and cancerous lesions of the cervix in the health district of commune V of Bamako, the “G” point and the Gabriel Touré University Hospital in Bamako, Mali. Patients and Methods: This was a descriptive, cross-sectional, analytical study with retrospective and prospective data collection over an 8-year period from January 1, 2010 to December 31, 2017. This was a multi-center study. Results: From January 1, 2010 to December 31, 2017, 42,492 women were screened, representing a frequency of 24.30%. The median age of the women screened was 32 years;25% were under the age of 25. Three-fourth of the women screened was in the 20 - 49 age group. Of the 22,842 women screened, 90.1% of them had a normal col to IVA/IVL. However, 4.1% of cervical positivity had with acetic acid and 5.1% of positivity to Lugol. 0.7% of the women screened clinically had cancerous lesions. Histologically, 96.5% of the women screened had a normal cervix with benign lesions. For pathological histological findings, we noted 2.6% of precancerous lesions and 0.8% of squamous cell carcinomas and 0.1% of adenocarcinoma. Conclusion: Improved screening indicators with IVA/IV reduce the rate of morbidity and mortality from cervical cancer.

Expression Analysis of p53, Ki-67 and bcl-2 in Pre-Malignant Lesions of the Cervix

Objectives: The present study has tried to analyze the individual and combined expression of the three markers—p53, Ki-67 and bel-2-in HPV associated pre-malignant lesions of the cervix. Methods: Thirty-four cases of high-grade lesions, 21 low-grade cases and 18 normal cases were histologically assessed. HPV-DNA presence and the viral types were determined through PCR and RFLP, respectively. Marker expression was performed by immuno-histochemistry.Results: With regards to viral types, HPV with high oncogenic potential represented the majority, with just one case reporting the low oncogenic potential for viral infection (HPV 6). HPV was the most frequent and could be associated with the high-grade lesion group, however, no significant associations were found between the viral ones and the marker expression. When the expression location, beyond the basal layer, was taken into account, the three markers proved to be good indicators of the lesion grade. The markers’ combined expression: p53(-), Ki-67(+), bcl-2(-) and p53(-), Ki-67(+), bcl-2(-) was statistically significant when associated with the lesion grade.Conclusions: The results suggest that the p53, Ki-67 and bel-2 markers can contribute to differentiate the lesion grades, whether in its isolate form or in combined form.

Screening for Precancerous Cervical Lesions in Women of Reproductive Age in the Kara Region of Togo in 2022

Introduction: Worldwide, cervical cancer is the 4th most common cancer in women and is a public health problem. The objective of this study was to estimate the prevalence of precancerous cervical lesions and to describe its associated factors among women of reproductive age in the Kara region of Togo. Methods: A cross-sectional study was conducted from March 6 to 14, 2022 in 11 health centers in Kara. Data were collected using a standardized questionnaire and screening for precancerous cervical lesions was performed by visual inspection of the cervix, after application of 5% acetic acid and Lugol’s. Logistic regression analysis was performed to describe factors associated with precancerous lesions. Results: A total of 728 women with a median age of 36, interquartile range [31 - 41] were enrolled. The prevalence of precancerous cervical lesions was 3.9%, 95% confidence interval (95% CI: [2.6 - 5.4]. Factors associated with the presence of precancerous lesions were age at first sexual intercourse ≥ 18 years (adjusted odds ratio (aOR = 3.67;95% CI [1.17 - 18.4]) and being a sex worker (aOR = 8.14;95% CI [1.96 - 27.1]). HIV infection was not associated with the presence of precancerous lesions. Conclusion: The results of this study underscore the importance of intensifying cervical cancer screening efforts in resource-limited countries for better management. These efforts should prioritize vulnerable populations such as female sex workers.

HPV拓展分型联合液基细胞学筛查对宫颈高级别上皮内病变的诊断价值研究

目的探讨不同型别人乳头瘤病毒(HPV)感染联合细胞学检测对宫颈高级别病变检出的意义。方法我们收集了2019年6月至2023年8月首都医科大学附属北京天坛医院病理科宫颈活检病例共4131例,回顾性分析了单一和多重感染的HPV 16/18组、HPV 31/33/52/58组、其他高危HPV组联合液基细胞学检测对宫颈高级别上皮内病变(CIN 2级及以上的病变,CIN 2+)的检出率,并比较了组间的差异,旨在探讨进一步优化HPV风险分层的可能性。结果在细胞学阴性单一型别HPV感染中,共有1264例,HPV 16/18组、HPV 31/33/52/58组和其他高危HPV组的高级别病变检出率依次降低,分别为26.26%、16.33%和7.75%,差异具有统计学意义。而细胞学阴性多重HPV感染中,共有577例,HPV 16/18组的CIN2+检出率为24.92%,显著高于HPV 31/33/52/58组(12.65%)和其他高危多重组(7.31%),而后两组的检出率差异则无统计学意义。细胞学阳性HPV 16/18、HPV 31/33/52/58及其他高危单一感染的CIN2+检出率分别为56.83%、41.74%和17.12%,这些差异均具有统计学意义。细胞学结果为ASC-US(atypical squamous cells of undetermined significance,ASC-US)的病例中,3组的高级别检出率分别为44.11%、28.5%和9.7%,χ^(2)分析结果为10.097,P值<0.001,以及25.303,P值<0.001。HPV 16/18、HPV 31/33/52/58及其他高危多重感染的CIN2+检出率分别为54.54%、37.50%和16.76%,这种差异也具有统计学意义。无论是细胞学阴性还是阳性,相同型别组的单一和多重感染的高级别检出率差异无统计学意义。结论本研究认为在HPV感染中,其他12型高危HPV的风险分级需要进一步优化,而HPV 31/33/52/58的风险程度高于其他高危HPV组。此外,对于细胞学阴性的情况,应该缩短随访周期。而对于感染其他高危HPV组的病例,细胞学ASC-US的风险较低,可以选择随访观察。

HPV检测、液基细胞学及p16/Ki-67三重检测在宫颈高级别病变筛查中的诊断价值研究

目的探讨HPV检测、液基细胞学及p16/Ki-67三重检测在宫颈高级别病变筛查中的诊断价值。方法收集2021-2023年北京天坛医院病理科宫颈活检病例共1839例,回顾性分析HPV检测、液基细胞学(LBC)及p16/Ki-67三重检测的CIN2+检出率,并对比组间的差异,探讨高效而特异的检测方法。结果1839例宫颈活检病例中,CIN2+的总检出率为29.6%;仅HPV阳性、HPV及LBC双检阳性、HPV、LBC及p16/Ki-67三重检测阳性CIN2+检出率依次升高,分别为20.1%、32.3%、54.1%;亚组分析显示HPV16/18阳性,3组的CIN 2+检出率分别是24.4%、45.7%、70.4%;其他12种高危HPV阳性,3组的CIN 2+阳性检出率分别是14.6%、27.4%、45.3%。总体及亚组分析均显示HPV、LBC及p16/Ki-67三重检测的CIN 2+检出率最高,差异具有统计学意义(P<0.001)。结论本研究认为对于HPV阳性的女性,建议进行HPV、LBC及p16/Ki-67三重检测,提高CIN2+阳性检出率,减少漏诊,提升阴道镜的利用效率。

宫颈环形电切术联合阴道镜治疗宫颈癌前病变的临床效果

目的探讨宫颈环形电切术(LEEP)+阴道镜治疗宫颈癌前病变的临床效果。方法选取2019年1月至2021年12月在滨州医学院附属医院治疗的400例宫颈癌前病变患者,按照随机数字表法分为对照组(200例,采用LEEP治疗)、观察组(200例,采用LEEP+阴道镜治疗),比较两组临床总有效率、手术相关指标、生活质量(SF-36)、并发症发生情况。结果观察组临床总有效率高于对照组(P<0.05);观察组术中出血量少于对照组,住院时间短于对照组(P<0.05);观察组术后SF-36评分高于对照组(P<0.05);观察组并发症总发生率低于对照组(P<0.05)。结论LEEP+阴道镜治疗宫颈癌前病变的临床效果较好。

基于Lasso-Logistic回归分析子宫颈高度鳞状上皮内病变锥切术后切缘阳性及病灶残留的影响因素

目的探讨基于Lasso-Logistic回归分析子宫颈高度鳞状上皮内病变(HSIL)锥切术后切缘阳性及病灶残留的影响因素。方法选取2021年7月至2022年1月衡水市人民医院收治的160例子宫颈HSIL患者作为研究对象,均行宫颈锥切术治疗。根据是否存在锥切术后切缘阳性及病灶残留分为研究组(n=39)和对照组(n=121),术后切缘阳性或有病灶残留为研究组,术后切缘阴性为对照组。比较两组临床资料,采用Lasso-Logistic回归分析子宫颈HSIL患者锥切术后切缘阳性及病灶残留的影响因素。结果子宫颈HSIL患者锥切术后切缘阳性率为24.38%,切缘阳性患者中病灶残留率为48.72%。高危型人乳头瘤病毒(HR-HPV)、病变级别、累及象限、累及腺体、转化区类型、电切环形状、锥切深度、锥切宽度、锥切体积、接触性出血均为子宫颈HSIL锥切术后切缘阳性及病灶残留的独立影响因素(P<0.05)。结论HR-HPV、病变级别、累及象限、累及腺体、转化区类型、电切环形状、锥切深度、锥切宽度、锥切体积、接触性出血均为子宫颈HSIL患者锥切术后切缘阳性及病灶残留的影响因素,临床应结合相关影响因素优化治疗方案,以减少切缘阳性及病灶残留率。

环形电刀切除术对子宫颈高级别鳞状上皮内病变患者分娩的影响

目的探讨环形电刀切除术(LEEP)对子宫颈高级别鳞状上皮内病变(HSIL)患者分娩的影响。方法选取2020年1月至2022年6月平度市人民医院收治的80例HSIL患者作为研究对象,按照随机数字表法分为对照组与观察组,每组40例。对照组采用冷刀锥切术(CKC)治疗,观察组采用环形电刀切除术(LEEP)治疗,比较两组围手术期指标、临床疗效、分娩情况、围产儿不良结局及术后并发症发生情况。结果两组锥切组织面积比较差异无统计学意义;观察组手术时间、切口愈合时间及住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。两组治愈率、复发率比较差异无统计学意义。两组妊娠率、流产率、早产率、阴道分娩率及剖宫产率比较差异无统计学意义。观察组围生儿不良结局发生率15.63%,低于对照组的42.86%,差异有统计学意义(P<0.05)。观察组术后并发症发生率为7.50%,低于对照组的20.00%,差异有统计学意义(P<0.05)。结论LEEP和CKC两种术式治疗HSIL患者疗效相当,相对于CKC,LEEP术式具有操作方便、无需麻醉、术中出血量少、手术时间短、术后恢复快及对妊娠结局影响小等优点,值得临床推广应用。

“主客交”理论在子宫颈癌前病变中的应用

基于“主客交”理论结合现代医学研究,探讨子宫颈癌前病变的发病机制及中医药应用策略。子宫颈癌前病变的主要病因病机为肝脾肾之“主”失调,加之痰湿热毒之“客”邪内聚、蕴结,终成癥瘕,渐成痼疾,发为宫颈癌前病变并趋向恶性发展。治以“扶正达邪,分离主客”,在疏肝健脾固肾的同时厘清主客强弱,精准辨证。分阶段灵活选用清热、祛湿、解毒、理气、活血、化瘀等“通”法以祛邪通络。

改良宫颈环形电切术与传统宫颈环形电切术在宫颈高度鳞状上皮内瘤变患者中的效果比较

目的比较宫颈高度鳞状上皮内瘤变(HSIL)患者采用改良宫颈环形电切术(LEEP)与传统宫颈环形电切术的疗效。方法选取2021年6月至2022年6月在泉州玛珂迩妇产医院阴道镜室的第一次接受LEEP治疗的60例HISL育龄期女性患者作为研究对象,根据术中手术方式的不同将其分为改良LEEP术组(30例)和传统LEEP术组(30例)。比较两组患者的术中阴道出血量、术后阴道出血量、手术时间、宫颈再生率。结果改良LEEP术组的手术时间短于传统LEEP术组,差异有统计学意义(P<0.05)。改良LEEP术组的术中阴道出血量少于传统LEEP术组,差异有统计学意义(P<0.05)。改良LEEP术组的术后1d~1周发生的再出血率低于传统LEEP术组,差异有统计学意义(P<0.05)。改良LEEP组的术后12月宫颈长度测量长于传统LEEP组,差异有统计学意义(P<0.05)。改良LEEP组的术后宫颈再生率优于传统LEEP组,差异有统计学意义(P<0.05)。结论对HSIL患者采用改良LEEP术,能够有效降低术中出血及术后出血,缩短手术时间,提高宫颈再生率,值得推广应用。

HPV16/18型阳性且TCT正常患者发生HSIL+风险预测模型的构建

目的探究HPV16/18阳性且薄层细胞学检测(thinprep cytologic test,TCT)正常患者发生宫颈高级别上皮内病变及以上(high-GRADE squamous intraepithelial lesion or worse,HSIL+)病变的风险因素并构建风险预测模型,以期为临床医生提供一种转诊阴道镜及宫颈活检的辅助评估工具。方法收集2021年6月至2023年6月就诊于内蒙古自治区人民医院门诊,HPV16/18型阳性且TCT正常并行阴道镜+宫颈活组织病理学检查的患者,共207例,通过Logistic回归分析筛选独立风险因素,构建预测模型,建立连线图,并评估模型的预测性能、符合度、准确度及临床实用性。结果(1)单因素卡方检验显示,BMI(χ^(2)=12.13,P<0.001)、吸烟(χ^(2)=15.28,P<0.001)、阴道微生态(χ^(2)=10.074,P=0.002)、感染时间(χ^(2)=82.444,P<0.001)、阴道状态(χ^(2)=66.458,P<0.001)为HPV16/18阳性且TCT正常患者发生HSIL+的独立风险因素;(2)风险预测模型的AUC为0.94(95%CI=0.89~0.98);(3)列线图模型进行内部验证后,其一致性指数(C-index)为0.937。结论本研究基于BMI、阴道微生态、吸烟、感染时间及阴道状态等影响因素建立的预测模型预测HPV16/18型阳性且TCT正常患者发生HSIL+具有较好的区分度、准确度及临床实用性,可为临床医生面对HPV16/18型阳性且TCT正常患者是否行阴道镜+宫颈活组织病理学检查提供参考意见。

CO_(2)激光与LEEP术治疗适龄期女性宫颈高级别鳞状上皮内病变的临床疗效及妊娠结局

目的比较CO_(2)激光与宫颈环形电切(loop electrosurgical excision procedure,LEEP)术治疗适龄期女性宫颈高级别鳞状上皮内病变的临床疗效及妊娠结局。方法回顾性分析2019年1月至2021年12月在复旦大学附属妇产科医院就诊的适龄期女性(20~34岁)的临床资料。所有患者阴道镜检查转化区(transformation zone,TZ)为1型/2型,阴道镜活检病理诊断为宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL),根据医师建议及患者意愿,接受激光或LEEP治疗。评估两种手术的有效性,比较术后细胞学、人乳头瘤病毒(human papilloma virus,HPV)结果、阴道镜病理;随访术后妊娠率、妊娠并发症和妊娠结局。结果共纳入566例患者,其中233例接受激光消融治疗(激光组),333例接受LEEP治疗(LEEP组)。两组患者术前细胞学、HPV结果、宫颈管长度的差异无统计学意义。术后6个月,激光组有91.5%的患者细胞学正常,而LEEP组有86.9%的患者细胞学正常。两组的组织学治愈率均为91.5%,HPV转阴率均为74.6%。两组细胞学、HPV结果和阴道镜病理均无显著差异。术后激光组的宫颈管显著长于LEEP组[(29.09±3.15)mm vs(.27.05±3.84)mm,P<0.001]。两组术后妊娠率、妊娠结局差异无统计学意义。结论对于TZ1型或2型、有生育要求的宫颈HSIL患者,CO_(2)激光消融和LEEP两种手术的临床疗效及妊娠结局均无明显差异,但LEEP术后组织标本送检病理可减少浸润癌的漏诊。

120例宫颈高级别鳞状上皮内病变患者HPV感染特点及高危HPV阴性的筛查特征研究

目的:分析宫颈高级别鳞状上皮内病变患者人乳头瘤病毒(HPV)感染特点及高危HPV阴性的筛查特征。方法:选取2020年1月—2022年10月安阳市妇幼保健院收治的120例宫颈高级别鳞状上皮内病变患者作为研究对象,所有患者均接受高危型HPV、液基薄层细胞学检查,对比分析两种方式的检测结果。结果:120例宫颈高级别鳞状上皮内病变患者经HPV检查显示有110例阳性,阳性率为91.67%,以单一感染居多,多重感染较少,高危型HPV阴性患者中液基薄层细胞学检查高于不能明确意义的非典型鳞状细胞有7例,占比70.0%,1例宫颈液基细胞学为非典型鳞状细胞和2例宫颈液基细胞学低于非典型鳞状细胞的均因临床症状转诊阴道镜。结论:宫颈高级别鳞状上皮内病变患者中HPV感染以高危型HPV感染及单一型感染居多。高危型HPV和宫颈液基细胞学联合筛查的阳性率最高。高危型HPV阴性的宫颈高级别鳞状上皮内病变患者往往没有显著的临床症状和宫颈液基细胞学异常。

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

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。

宫颈高级别鳞状上皮内病变手术治疗后高危型人乳头瘤病毒持续感染的影响因素分析

目的分析宫颈高级别鳞状上皮内病变(HSIL)手术治疗后高危型人乳头瘤病毒(HPV)持续感染的影响因素。方法择取2019年1月至2021年12月在郓城县中医医院就诊的110例HSIL患者,均接受手术治疗。统计术后高危型HPV持续感染的发生率,并采用单因素及多因素logistic回归分析术后高危型HPV持续感染的影响因素。结果术后高危型HPV持续感染20例,发生率为18.18%;两组人工流产次数、HPV16和18感染比例、多重高危型HPV感染比例、术前宫颈上皮内瘤变分级、术后避孕情况、绝经比例比较,差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,人工流产次数多、绝经、HPV16和18感染、术后未使用避孕套为术后高危型HPV持续感染的独立危险因素(P<0.05)。结论HSIL患者术后高危型HPV持续感染发生率较高,临床应针对相关影响因素制订相应的预防措施。

阴道镜联合宫颈环形电切术治疗高级别鳞状上皮内病变的临床效果

目的探讨阴道镜联合宫颈环形电切术(LEEP)治疗高级别鳞状上皮内病变的临床效果。方法选择2018年6月至2022年12月旬阳市人民医院收治的72例高级别鳞状上皮内病变患者为研究对象,根据随机抽签法分为两组,各36例。对照组给予宫颈冷刀锥切术治疗,研究组给予阴道镜联合LEEP治疗,比较两组临床效果。结果研究组治疗总有效率较对照组高,手术时间及住院时间较对照组短,术中出血量少于对照组,病变切除深度小于对照组(P<0.05);研究组复发率、并发症总发生率较对照组低(P<0.05);术后6个月研究组生活质量评分优于对照组(P<0.05)。结论阴道镜联合LEEP治疗高级别鳞状上皮内病变,可以提升治疗有效率,降低并发症发生率及复发率,改善生活质量。

Practice of Screening for Precancerous Cervical Lesions in Koumpentoum Health District (Senegal)

Introduction: Cervical cancer is preventable through vaccination against papillomaviruses and screening for precancerous lesions. The objective of this study was to determine the frequency of screening practice and to identify associated factors. Methods: This was a cross-sectional descriptive and analytical study. Data were collected from individual interviews during household surveys. Data collection took place from (1st) to (30th) September (2021). The following were explored: socio-demographic characteristics, knowledge, attitudes and practices of women regarding screening. Results: A total of (294) women aged between (18) and (69) years were included. The mean age was (35.79) years (±9.81). The median age was (34) years. The frequency of screening was (16%);that of precancerous lesions was (4.26%). Factors statistically and significantly associated with screening uptake were cervical cancer information (OR = 5.42 (1.27 - 23.16);p = 0.003), knowledge of the availability of screening (ORa = 7.73 (3.01 - 18.51);p - 7.31);p = 0.014). Conclusion: Frequency of pre-cancerous lesions of cervical cancer is high in Koumpentoum health district (4.26%), while the practice of screening is low there (16%). The factors associated with this low performance are related to a lack of adequate knowledge of women about cervical cancer.

宫颈高级别鳞状上皮内病变腺体受累和HPV感染对复发的影响

目的分析腺体受累及人乳头瘤病毒(HPV)持续感染对宫颈高级别鳞状上皮内病变(HSIL)复发的影响,为术后临床管理提供依据。方法收集行宫颈冷刀锥切术治疗的596例HSIL患者临床资料,其中腺体受累240例(腺体受累组)、腺体未受累356例(腺体未受累组)。以术后2年或再次出现HSIL为研究终点,比较复发患者与未复发患者间差异,结合患者腺体受累和HPV-16持续感染情况将患者分为腺体受累伴HPV-16持续感染组、腺体受累不伴HPV-16持续感染组、腺体不受累伴HPV-16持续感染组和腺体不受累不伴HPV-16持续感染组,比较4组间HSIL复发率的差异。结果596例患者中,复发75例(12.6%)。腺体受累组患者的HPV-16感染率高于腺体未受累组(67.9%νs.23.0%,P<0.05)。复发患者的≥45岁者比例、腺体受累和HPV-16持续感染者比例与未复发患者比较差异均无统计学意义(P均>0.05)。腺体受累伴HPV-16持续感染组、腺体受累不伴HPV-16持续感染组、腺体不受累伴HPV-16持续感染组和腺体不受累不伴HPV-16持续感染组的复发率分别为33.8%、10.9%、8.5%和9.7%,腺体受累伴HPV-16持续感染组复发率高于其他3组(P均<0.017)。结论腺体受累同时伴HPV-16持续感染的HSIL患者在宫颈冷刀锥切术后易复发,应对该类患者采用更积极的手术治疗方案并加强随访。

The Relationship between p53 Expression and Human Papillomavirus in Premalignant and Malignant Uterine Cervical Lesions

Objective: We aimed to retrospectively examine a series of premalignant and malignant cervical tissues to study a high-risk HPV 16 infection that, among cervical tissue lesions, carries the greatest risk of conversion to cancer, and the presence of p53 protein immunoreactivity, a tumor suppressor gene product. Methods: Paraffin blocks were studied via immunohistochemical (IHC) method to explore the presence of HPV 16 in 59 premalignant and malignant cervical lesions as well as immunoreactivity of the p53 oncoprotein, the most common cellular tumor suppressor gene product in human cancers. Results: In our series, mutant p53 positivity rate was 35.3% for low-grade CIL, 40% for high-grade CIL, and 46.8% for invasive carcinoma cases. Immune staining for high-risk HPV 16 type yielded a positive staining rate of 47% in low-grade CIL, 80% in high-grade CIL, and 50% in invasive carcinoma. Conclusion: The results of our study indicate a progressive increase in p53 oncoprotein reactivity from cervical intraepithelial neoplasia to invasive carcinoma. This suggests the clinical importance of p53 immunoreactivity in dysplastic progression and neoplastic transformation. HPV is the most commonly encountered oncogenic type in cervical lesions, especially in high-grade CIL and invasive carcinomas. Results of the previous reports suggest that HPV-positive carcinomas release wild type p53 and HPV-negative ones release mutant type p53 were not confirmed by our results, which indicated a mutant type p53 reactivity in HPV- 16 positive carcinoma cases.