高危型HPV感染的宫颈CIN在Leep术后的转归研究

目的:探讨高危型人乳头瘤病毒(HR-HPV)感染的宫颈上皮内瘤变(CIN)在宫颈环形电切术(LEEP)治疗术后的转归。方法:对109例高危型HPV感染的CINⅠ～Ⅲ患者进行LEEP治疗,术后6个月再次检测其宫颈HR-HPV的平均负荷量,同时行阴道镜检查及宫颈活检。结果:LEEP术后6个月,CIN患者HR-HPV平均负荷量较治疗前均显著降低(P<0.01)。HR-HPV负荷量转阴率为73.39%(80/109),但各级别CIN HR-HPV转阴率差异无统计学意义(P>0.05)。根据LEEP术后6个月宫颈HPV-DNA负荷量,低度负荷量组8例中,7例为TCT正常者,1例为CIN;中度负荷量组10例中,7例为TCT正常者,3例为CIN;重度负荷量组11例中,7例为TCT正常者,4例为CIN。中、高度HR-HPV病毒负荷组与低度HR-HPV病毒负荷组之间CIN转归存在差异(P<0.05)。结论:LEEP是目前治疗CIN有效的方法,HR-HPV感染的宫颈CIN在LEEP术后,HR-HPV负荷量明显降低,宫颈CIN的转归与持续HR-HPV负荷量的高低密切相关,HC-Ⅱ动态监测HR-HPV负荷量,对术后宫颈CIN预后有指导意义。

Development of cervical intraepithelial neoplasia with high risk HPV infection after LEEP treatment

Objective: To study the development of cervical intraepithelial neoplasia(CIN) with high risk human papillomavirus(HR-HPV) infection after loop electrosurgical excision procedure(LEEP).Methods:A total of 109 women with high risk HPV infection and CINⅠ/Ⅱ/Ⅲ confirmed by histology were treated by LEEP.Six months later high risk HPV load was measured by HybirdcaptureⅡsystem again.The colposcopy and cervical biopsy were performed in the meantime.Results: The average high risk human papillomavirus load of CIN patients were decreased after treatment of LEEP significantly after six moths(P<0.01).HPV loading turned to be negative postoperatively in 73.39%(80/109) of the women,but the negative conversion rate had no significant differences among CINⅠ/Ⅱ/Ⅲ groups(P>0.05).After LEEP treatment,in the low viral loading group,7 cases turned to chronic cervictis and 1 remained CIN;in the mediumin viral loading group,7 cases turned to chronic cervictis,3 cases remained CIN;the high viral loading group,7 cases turned to chronic cervictis;4 cases remained CIN.The Positive Rate of CIN between the three groups was significant(P<0.05).Conclusions: LEEP is a effective treatment of cervical lesion and can reduce the viral loading of HR-HPV at CIN significantly.The prognosis of CIN is related to high viral loading of HR-HPV after LEEP therapy.HC-II examination is useful in the prognosis of HR-HPV infection of patients with CIN.