摘要
[目的]研究轻度宫颈上皮内瘤变(CINⅠ)的自然转归、人乳头瘤病毒(HPV)的自然清除率及两者之间的关系。[方法]对2003年5月到2006年4月期间,在北京大学深圳医院经阴道镜下活检病理诊断为CINⅠ的548名患者,定期随访4～6年。以宫颈液基细胞学检查(LCT)联合高危型HPV(HR-HPV)DNA检测(HC-Ⅱ)作为随访的监测方法,每6～12月随访一次。对于随访中细胞学为未明确诊断意义的不典型鳞状上皮细胞(ASCUS)及以上病变,及/或HR-HPV阳性者行阴道镜下多点活检,病理诊断。[结果]随访48个月时共失访27人,剔除34人,继续随访487人,累积未完全随访率为11.13%。随访6个月、12个月、24个月、36个月、48个月时进展为高度宫颈上皮内瘤变的百分率分别为0.55%、1.65%、3.10%、4.05%、4.11%;病变持续存在的百分率分别为70.25%、45.77%、23.79%、11.54%、7.19%;病变逆转为正常的百分率分别为29.20%、52.57%、73.11%、84.41%、88.71%。随访48个月时,35岁以上组和35岁以下组的病变进展率和逆转率均无显著性差异。随访开始时HR-HPV阳性的患者462例,随访6个月、12个月、24个月、36个月、48个月时病毒自然清除率分别为24.26%、48.69%、70.05%、81.54%、86.36%,HPV清除与CINⅠ病变逆转趋势一致。24个月内HPV持续阳性的患者,在48个月内进展为高度宫颈上皮内瘤变的比率为18.9%,显著高于HPV阴转组和HPV持续阴性组。[结论]2年内超过2/3的CINⅠ病变会自然逆转,HPV也会自然清除,但对于HPV持续阳性的患者应警惕其进展为高度宫颈上皮内瘤变。
[Purpose] To investigate the natural history of low-grade cervical intraepithelial neoplasia （CIN I ）, the natural clearance of human papilloma virus （HPV）, and the relationship between HPV infection and CIN I. [Method] From May 2003 to April 2006, 548 cases with CIN [ colposcopic biopsy proven were enrolled. They were followed up for 4 ~6 years regularly, using liquid-based cytology test combined with high-risk HPV test （HC- Ii ）, every 6 to 12 months. Colposcopy and biopsies were performed when the cervical cytology indicated as ASCUS or more severe lesion and/or HR-HPV positive. [Results] After 48 months＇ follow-up, 27 patients were lost, 34 were rejected, and the other 487 ones （88.87%） finished the whole study. The cumulatively incomplete follow-up rate was 11.13%. Within 6, 12, 24, 36, 48 months, the progression to high-grade CIN rate was respectively 0.55%, 1.65%, 3.10%, 4.05% and 4.11%, the persistence of CIN I rate was 70.25%, 45.77%, 23.79%, 11.54%, 7.19% and the CIN I regression rate was 29.20%, 52.57%, 73.11%, 84.41% and 88.71% respectively. Within 48 months, the progression or regression rate between the patients below 35 years old and above was not significant different. Within 6, 12, 24, 36, 48 months, the HR-HPV clearance in the 462 patients who had positive HR-HPV at the beginning of the follow-up was 24.26%, 48.69%, 70.05%, 81.54% and 86.36% respectively. The tendency of HPV clearance was consistent with CIN I regression.18.9%of the patients whose HR-HPV tests were persistently positive within 24 months progressed to high grade CIN within 48 months ,which was significantly higher than the ones whose HPV test was persistently negative and the ones whose HPV was clearance. [Conclusions] Within 2 years, more than 2/3 CIN I lesions could regress spontaneously, similarly as the HPV clearance. But to the patients whose HR-HPV were persistently positive, lesion progression should be caution.
出处
《中国肿瘤》
CAS
2010年第6期372-376,共5页
China Cancer
关键词
宫颈上皮内瘤变
人乳头瘤病毒
随访
疾病转归
cervical intraepithelial neoplasia
human papilloma virus
follow-up
disease outcome
