摘要
目的研究不同程度的宫颈病变患者经必要治疗后的HPV转阴率,以探讨HPV分型检测在临床诊断和判断预后的应用价值。方法入选病例为2007年11月～2009年11月妇科门诊符合条件的妇女5 000例,利用核酸分子快速导流杂交基因分型技术进行21种HPV-DNA亚型检测,阳性者在知情同意下行TCT及阴道镜下定位活检。根据细胞和病理组织学诊断有无宫颈病变及其病变程度分组:①正常或炎症组:宫颈组织或细胞学正常或炎症者;②低度鳞状上皮内瘤变(LSIL)组:包括CINI和HPV感染;③高度鳞状上皮内瘤变(HSIL)组:包括浸润癌(Cancer)、CINⅢ、CINⅡ。对≥CINⅡ或CINⅠ无随访条件者予手术治疗或物理治疗,术后随访于3、6、12个月均行HPV-DNA、TCT、电子阴道镜检查,必要时再活检。结果宫颈癌根治术31例、子宫切除术87例、LEEP术334例、物理微波治疗256例,共治疗708例,随访3、6、12个月,在HSIS组、LSIL值,正常与炎症组累计HPV-H转阴率分别为86.4%(254/294)、91.9%(194/211)、95%(193/203),p<0.01。宫颈病变的多重感染组HPV转阴率明显低于单一感染组;全宫切除术后HPV感染的转阴率较LEEP、微波治疗组高;LEEP术后HPV转阴率与病变级别有关,宫颈病变越高级,治疗后HPV转阴率越低。术后6个月内HPV转阴者TCT及电子阴道镜检查均未发现阳性结果。结论手术与物理治疗可有效促使HPV转阴与病灶消除,病变级别越高,病毒清除越难;感染HPV-H以及多重感染者,手术与物理治疗后转阴率下降。持续不转阴预示病灶残留或复发。HPV-DNA分型检测可作为临床上宫颈癌及癌前病变常规筛查计划指标,用于CINⅡ、CINⅢ治疗后病灶残留或复发的预测以及预示发展状况的可靠指标之一,值得推广应用。
Objective To investigate HPV types negative rates after treatment and evaluate the value of human papillomavirus test for diagnosing and predicting the cervical disease. Methods 5000 women in Qingyuan hospital from September 2007 to September 2009 were selected for 21 genotypes HPV detecting by HybriMax.All of the positive patients received liquid-based cytology test（TCT） and colposcopy with multiple biopsy.According to cytological and pathological diagnosis,the patients were divided into three groups： ①normal or inflammatory group;② HPV infection and CINⅠ;③ CINⅡ,CINⅢ and infiltration cancer;The patients of more CIN Ⅱand CIN Ⅰ impossible to be follow up were treated with surgical or physical therapy.Postoperative follow up for one to twelve months and then determine the 21 HPV-DNA types. Results To follow the post-operation cases for twelve months,HPV-H was tested negative in normal or inflammatory,LSIL and HSIL groups at 95%、91.9% and 86.4% respectively,with HSIL group noticeably lower than the other two groups,p0.001. Conclusion HPV-DNA genotyping is of great importance in diagnosis and prognosis of cervical disease.
出处
《现代医院》
2012年第2期3-6,共4页
Modern Hospitals
基金
清远市科技局计划基金项目(编号:2008B0015)
关键词
宫颈病变
人乳头状瘤病毒
转阴率
治疗
Cervical disease
Human papillomavirus
Negativing rates
Treat
