摘要
目的探讨预测重度宫颈上皮内瘤变（CIN2及CIN3）进行环状电切手术（LEEP）治疗后残余病灶和疾病复发的高危因素,以及术后及早发现病变的时间点。方法回顾性分析我院进行LEEP治疗的CIN2及CIN3共428例患者资料,治疗后用脱落细胞学和人乳头瘤病毒（HPV）杂交捕获二代（HC2）随访,以阴道镜活检为金标准判定残余和复发,据此评定其余指标的诊断价值。以logistic回归分析危险因素,κ检验验证3月和6月指标的一致性。结果 428例患者中CIN2有296例,CIN3有132例,治疗前HPV HC2阳性率为86.7%（371/428）,随访中26例（6.1%）有残余或者复发,LEEP切缘受累特别是锥顶阳性是疾病持续或复发的高危因素〔比值比=9.364,95%可信区间（CI）：0.712~46.108,P=0.001〕。其他因素如年龄（截断值40岁）、HPV负荷量（截断值100RLU）、HPV类型（16/18vs.其他类型）均与疾病复发无关。有残余病灶或复发的26例患者术后3月HPV HC2检测均为阳性,HPV HC2在术后3和6个月对于残余病灶的检测敏感性均为100%,均高于细胞学检测（P〈0.05）,而特异性低于细胞学检测（P〈0.05）。3和6个月的HPV HC2〔κ值为0.70（95%CI,0.469~0.892）〕和细胞学检测结果〔κ值为0.79（95%CI：0.592~0.873）〕都显示出较好的一致性。结论 LEEP手术后切缘受累特别是锥顶阳性是病灶残余或复发的危险因素。术后3月HPV检测可提供关于病灶残余或复发的及时信息。
Objective To explore the risk factors for residual/recurrent disease of cervical intraepithelial neoplasia（CIN）2 or worse after loop electrosurgical excision procedure（LEEP）and the timing point for postoperative follow-up. Methods 428 patients with CIN 2 or CIN 3 who were treated with LEEP were retrospectively reviewed.Postoperative follow-up was performed by Pap smear and human papillomavirus（HPV）hybrid capture 2（HC2）testing.The definition of persistent/recurrent disease was biopsy-proven CIN 2or worse.Results 296 patients were CIN 2and 132 were CIN 3among 428 patients.The positive rate of HPV HC2 before LEEP was 86.7%（371/428）.During follow-up,26patients（6.1%）had residual/recurrent disease,the positive LEEP margin,especially the cone top status,was a significant risk factor for persistent/recurrent disease.Other factors such as age,HPV viral load 〔≥100relative light units（RLU）〕,and HPV typing（type 16/18 vs.other types）did not predict recurrence.HPV HC2 test at 3 months after LEEP can find all the residual/recurrent disease,the sensitivity and negative predictive value of the HPV HC2 test for residual/recurrent disease were both100% at 3and 6months.Conclusion The positive margin of LEEP specimen especially the cone top status was a significant risk factor for residual/recurrent disease after LEEP.HPV test at 3months during follow-up can offer timely information about residual/recurrent disease and help for the risk control in treatment selection.
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2015年第2期321-325,共5页
Journal of Sichuan University(Medical Sciences)
