摘要
目的探讨高危型人乳头瘤病毒(HR-HPV)和P16蛋白检测对宫颈上皮内瘤变(CIN)患者宫颈环形电切除术(LEEP)后复发的诊断价值。方法选取2016年6月至2018年6月间上海市金山区亭林医院收治行宫颈环形电切除术治疗的116例CIN患者。所有患者术前分别予薄层液基细胞学检查(TCT)、HR-HPV检测和阴道镜指导下活检,病理证实为CIN,经知情同意后行LEEP手术治疗,手术标本常规病理检查,并进一步做P16蛋白检测。术后3~6个月、术后12个月,随访TCT、HR-HPV、P16蛋白和阴道镜检查,以了解患者的恢复情况、复发或病情进展等。结果116例CIN患者术前HR-HPV阳性113例,阴性3例。术后3~6个月,HR-HPV阳性45例,阴性71例,阴道镜活检7例患者残留,残留率为6.0%,其中HR-HPV阳性6例,残留率为13.3%,HR-HPV阴性1例,残留率为1.4%。术后12个月,HR-HPV阳性23例,阴性93例,阴道镜检查后活检提示8例患者复发,复发率为6.9%,其中HR-HPV阳性7例,复发率为30.4%,HR-HPV阴性1例,复发率为1.1%。116例CIN患者术中P16蛋白阴性3例,弱阳性12例,阳性26例,强阳性75例。术后3~6个月,P16蛋白阴性84例,弱阳性17例,阳性10例,强阳性5例。阴道镜活检7例患者残留中,P16蛋白阳性3例,残留率为30.0%,P16蛋白强阳性4例,残留率为80.0%。术后12个月,P16蛋白阴性91例,弱阳性12例,阳性5例,强阳性8例,阴道镜活检8例患者中,P16蛋白弱阳性1例,复发率8.3%,P16蛋白阳性2例,复发率40.0%,P16蛋白强阳性5例,复发率为62.5%。结论HR-HPV和P16蛋白检测可有效预测CIN患者LEEP术后复发的风险,建议纳入随访检查中。
Objective To evaluate the diagnostic value of high-risk human papillomavirus(HR-HPV)and P16 protein to identify postoperative recurrence of cervical intraepithelial neoplasia(CIN)after loop electrosurgical excision procedure(LEEP).Methods A total of 116 patients undergoing LEEP at Tinglin Hospital,Jinshan District from June 2016 to June 2018 were selected.Thinprep cytologic test(TCT),HR-HPV detection and colposcopy biopsy were performed on all the patients.After the diagnosis of CIN by pathology and informed consent,they underwent LEEP.Conventional pathologic examination was conducted for the surgical specimens,and further P16 protein detection was performed.At 3 to 6 months and 12 months after the operation,they were followed-up for TCT,HR HPV,P16 protein and colposcopy detection to understand patient’s recovery and recurrence or progression,etc.Results Of the 116 CIN patients,positive HR-HPV was discovered in 113 patients and 3 patients were found HR-HPV-negative before the operation.At 3 to 6 months after surgery,positive HR-HPV was discovered in 45 patients and negative HR-HPV in 71 patients.Residual was found in 7(6.0%)patients by colposcopy biopsy.Among them,6(13.3%)patients were HR-HPV-positive and 1(1.4%)patient was HR-HPV-negative.At 12 months after the operation,positive HR-HPV was discovered in 23 patients and negative HR-HPV in 93 patients.Recurrence occurred in 8 patients and the recurrence rate was 6.9%.Among them,7 patients were found HRHPV-positive with the recurrence rate of 30.4%and 1 patient was found HR-HPV-negative with the recurrence rate of 1.1%.During the operation,P16 protein-negative was found in 3 patients,weakly positive 12 patients,positive 26 patients and strongly positive 75 patients.At 3 to 6 months after surgery,P16 proteinnegative was found in 84 patients,weakly positive 17 patients,positive 10 patients and strongly positive 5 patients.Among the 7 patients with residual detected by biopsy,P16 protein-positive was found in 3 patients with residual rate of 30.0%.P16 protein-strongly positive was found in 4 patients with residual rate of80.0%.At 12 months after the operation,P16 protein-negative was found in 91 patients,weakly positive12 patients,positive 5 patients and strongly positive 8 patients.Among 8 patients who underwent colposcopy biopsy,P16 protein-weakly positive was found in 1 patient with the recurrence rate of 8.3%,P16 proteinpositive was found in 2 patients with the recurrence rate of 40.0%and P16 protein-strongly positive was found in 5 patients with the recurrence rate of 62.5%.Conclusion HR-HPV and P16 protein detection can timely and effectively predict the risk of recurrence of CIN in patients undergoing LEEP.
作者
徐水芳
徐凤英
张锋英
李燕云
邵秀兰
徐英
XU Shui-fang;XU Feng-ying;ZHANG Feng-ying;LI Yan-yun;SHAO Xiur-lan;XU Ying(Department of Obtetrics and Gynecology,Tinglin Hospital,Jinshan District,Shanghai 201505,China;Department of Obstetries and Cyecology,Obstetries and Ggyecology Hospital Ailiated to Fudan University,Shanghai,200001,China)
出处
《中国肿瘤临床与康复》
2020年第5期596-598,共3页
Chinese Journal of Clinical Oncology and Rehabilitation
基金
上海市金山区医药卫生类科技创新资金项目(2017-3-16)。
