宫颈环形电切术治疗宫颈病变对宫颈感染人乳头瘤病毒负荷的影响

目的研究宫颈环形电切术(LEEP)治疗宫颈病变对宫颈感染高危型人乳头瘤病毒(HPV)负荷的影响。方法选择2007年7月至2012年6月首都医科大学附属北京妇产医院收治的宫颈上皮内瘤变(CIN)患者509例,所有患者行LEEP治疗后,行宫颈液基细胞学检查(TCT)和高危型HPV负荷的杂交捕获法Ⅱ检查。观察宫颈细胞学结果及HPV病毒负荷变化。结果不同CIN级别患者的术前高危型HPV阳性率随病变级别的升高而升高,差异有统计学意义(χ2=2.316,P<0.01)。509例患者中有9例患者术后1年TCT异常,包括非典型鳞状细胞4例、低度鳞状上皮内病变4例、高度鳞状上皮内病变1例,再次阴道镜下活检为慢性宫颈炎2例,宫颈CIN-Ⅰ6例,CIN-Ⅱ1例。术后1年22例患者为HPV持续阳性,9例TCT再次发现异常的患者均为HPV持续阳性,且病毒负荷下降<50%。结论 LEEP术后6¹2个月高危型HPV持续阳性甚至负荷升高,再次发生宫颈病变的风险增加。

The Effect of Cervical Loop Electrosurgical Excision Procedure on Load of Cervical HPV Infection

Objective To study the influence of cervical loop electrosurgical excision procedure （LEEP） on load changes of cervical HPV infection.Methods A total of 509 cases of cervical intraepithelial neoplasia（CIN） from Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical L niversity during J ul.2007 and J un.2012 were included in the study,who received LEEP,cervical liquid based cytology（TCT） examination and high-risk HPV load（HC Ⅱ） examination.The cervical cytological results and HPV load changes were observed.Results Pre-operative HPV load increased with the increasing lesion level of CIN（x2 =2.316,P 〈 0.01）.In 509 cases,TCT of 9 cases at 1 year after surgery were abnormal,including 4 cases of ASC,4 cases of LSIL,1 case of HSIL,which were reexamined by biopsy under colposcopy：2 cases of chronic cervicitis,6 cases of cervical CIN-Ⅰ,1 case of CIN-Ⅱ.After 1 year there were 22 patients with persisting positive HPV,9 cases of abnormal TCT were all HPV positive,and viral load drop was 〈 50%.Conclusion 6-12 months after LEEP,high-risk HPV continues positive and the viral load even increases,and the risk of second time cervical lesions increases.