高级别宫颈上皮内瘤变及早期宫颈癌子宫切除术后患者高危型人乳头瘤病毒消退规律及相关因素分析

目的 探讨生殖道高危型人乳头瘤病毒（high risk-human papillomavirus， HR-HPV）感染致高级别宫颈鳞状上皮内病变（high-grade squamous intraepithelial lesion， HSIL）及早期宫颈癌的患者行子宫切除术后，阴道残端HR-HPV的消退规律及相关影响因素。方法 采用回顾性队列研究方法对首都医科大学附属北京朝阳医院2013年1月1日至2018年3月31日因HSIL及早期宫颈癌行子宫切除术的术后患者进行随访性研究，应用Kaplan-Meier法计算病毒消退时间、消退相关影响因素及病毒消退曲线；Cox比例风险回归模型分析病毒消退时间的影响因素。结果 纳入人群276例，HSIL 85例（30.8%），早期宫颈癌191例（69.2%），平均年龄（49.43±9.80）岁，术前94.9%的患者HR-HPV阳性，术后2年内HSIL及早期宫颈癌HR-HPV消退率分别为78.4%及94.1%， HSIL患者术后消退时间比宫颈癌患者延长，消退比例明显低于宫颈癌，差异有统计学意义（P=0.040），年龄、多种亚型混合感染均与病毒消退无关。阴道残端病毒消退曲线的特征：术后短期内病毒消退较为快速，一定时间后消退明显减慢， HSIL及早期宫颈癌患者对应时间点分别为术后15个月及13个月，且不同亚型其消退时间不同。少部分患者存在同一亚型HR-HPV的持续感染。与消退时间相关的因素为患者的血型（P=0.025） 、肿瘤家族史（P=0.007）及体质量指数（body mass index，BMI）分级（P=0.003）。结论 因宫颈因素行子宫切除术的患者术后HR-HPV消退率较高，术后较长时间内仍未消退者存在持续感染、病变复发及阴道病变风险，但相关影响因素尚无定论，有待进一步研究。

Analysis of the regression of high-risk human papillomavirus and related factors in the patients after hysterectomy for high-grade squamous intraepithelial neoplasia and cervical cancer in early stage

Objective To investigate the regression of high-risk human papillomavirus (HR-HPV) and related factors in vaginal stump after hysterectomy for high-grade squamous intraepithelial lesion (HSIL) and cervical cancer in early stage. Methods A retrospective cohort study included data from patients with hysterectomy for HSIL and cervical cancer in early stage at the Beijing Chaoyang Hospital, Capital Medical University from January 1, 2013 to March 31, 2018. The Kaplan-Meier method was used to analyze the virus regression time and related factors, and obtained the virus regression curve. Cox proportional hazard regression model was performed to obtain the factors affecting time of the virus regression. Results A total of 276 patients were enrolled, including 85 patients with HSIL (30.8%) and 191 patients with cervical cancer in early stage (69.2%). The average age of all was (49.43±9.80)years. There were 208 patients (94.9%) appeared positive HR-HPV test before operation. The HPV regression rates of patients with HSIL and cervical cancer were respectively 78.4% and 94.1% during 2 years after operation. There was a statistical difference between the time of viral regression and the main diagnosis of HSIL or cervical cancer(P=0.040), but not the age and the mixed infection of multiple subtypes. The regression curve of the virus in vaginal stump suggested that the virus disappeared rapidly in a short term after operation, and the rate was considerably slowed down after a certain time. The corresponding time points of HSIL and cervical cancer patients were 15 months and 13 months, respectively. Also the time of regression varied between the different types. A small number of patients still had persistent infection with the same subtype. However, the affecting factors are still inconclusive. The factors affecting the regression time were the patient's blood type (P=0.025), family history (P=0.007), and body mass index (BMI) grade (P=0.003). Conclusion Patients with hysterectomy due to cervical factors have a higher rate of HR-HPV regression. There is a risk of persistent infection, recurrence of lesions and vaginal lesions progression in patients without HPV regression for a long time after operation. However, the affecting factors are still inconclusive, further research is needed to determine the affecting factors.