摘要
目的:探讨各级别宫颈上皮内瘤变(CIN)经宫颈环切术(LEEP)治疗前后高危型人乳头瘤病毒(HR-HPV)的变化规律及临床意义。方法:各级别CIN且HR-HPV阳性患者155例,行LEEP术后6个月再次行膜式液基细胞学检查(TCT)并测定HR-HPV负荷量。结果:(1)CINⅠ、CINⅡ、CINⅢ病变HR-HPV负荷量(RLU/CO)分别为333.23±911.83,303.88±795.30及220.72±680.92,三者差异无统计学意义(P=0.6868);(2)术后6个月HPV总转阴率为62.58%(97/155)。术前HPV负荷量≤300者术后转阴率为71.60%(58/81),>300者转阴率为52.70%(39/74),差异有统计学意义(P=0.0294)。并且术后病灶残留与术前高病毒负荷量相关。HPV清除率与年龄及病变程度无相关性;(3)术后6个月HPV负荷量≥10的患者中43.75%(14/32)的患者仍存在不同程度的CIN,而HPV<10的患者中只有0.81%(1/123)的患者存在CIN,以10为阈值判断病灶残留的敏感性达93.33%,特异性达87.14%。结论:(1)HPV负荷量高低与病变程度无关,但与术后病毒清除相关;(2)在切缘阴性的前提下,若术前高病毒负荷量,发生病灶残留的风险增高;(3)术后6月宫颈病变的转归与同期检测的病毒负荷量相关。
Objective：To investigate the presence and significance of high risk human papillomavirus（HR-HPV）after loop electrosurgical excision procedure（LEEP） in cervical intraepithelial neoplasm（CIN）.Methods：155 patients with CIN received the hybrid capture Ⅱ（HC-Ⅱ）HR-HPV test before LEEP.Thin prep Pap Test（TCT）and HC-Ⅱ test for HR-HPV were conducted at six months after LEEP,patients with positive results were examined by histology.Results：The pre-cone HR-HPV load（RLU/CO）in CINⅠ,CINⅡ and CINⅢ was（333.23±911.8）,（303.88±795.3） and（220.72±680.92）,respectively,which was no significant differences among 3 groups（P=0.6868）.62.58%（97/155） of the patients were negative for HPV at six months after LEEP.The viral clearance of high pre-cone viral load（300） was 52.70%（39/74）,which was lower than that of low pre-cone viral load（≤300）（71.60%,58/81）（P=0.0294）.The presence of postoperative residual lesions was correlated with high pre-cone HPV viral load,but the rate of HPV viral clearance was unrelated to age and grade of CIN.The optimum cut off of post-cone RLU/CO value to predict the residual lesions was 10,the sensitivity was 93.33%,while the specificity was 87.14%.Conclusion：The pre-cone HR-HPV load had no relationship with CIN grade but was associated with viral clearance.High pre-cone HR-HPV load may be a significant factor in predicting residue CIN on the premise of negative margin.There was prominent association between viral load at six months after LEEP and the prognosis of CIN.
出处
《现代妇产科进展》
CSCD
北大核心
2010年第9期680-683,共4页
Progress in Obstetrics and Gynecology
