LEEP治疗宫颈上皮内瘤变后高危型HPV的变化及意义

目的:探讨各级别宫颈上皮内瘤变(CIN)经宫颈环切术(LEEP)治疗前后高危型人乳头瘤病毒(HR-HPV)的变化规律及临床意义。方法:各级别CIN且HR-HPV阳性患者155例,行LEEP术后6个月再次行膜式液基细胞学检查(TCT)并测定HR-HPV负荷量。结果:(1)CINⅠ、CINⅡ、CINⅢ病变HR-HPV负荷量(RLU/CO)分别为333.23±911.83,303.88±795.30及220.72±680.92,三者差异无统计学意义(P=0.6868);(2)术后6个月HPV总转阴率为62.58%(97/155)。术前HPV负荷量≤300者术后转阴率为71.60%(58/81),300者转阴率为52.70%(39/74),差异有统计学意义(P=0.0294)。并且术后病灶残留与术前高病毒负荷量相关。HPV清除率与年龄及病变程度无相关性;(3)术后6个月HPV负荷量≥10的患者中43.75%(14/32)的患者仍存在不同程度的CIN,而HPV10的患者中只有0.81%(1/123)的患者存在CIN,以10为阈值判断病灶残留的敏感性达93.33%,特异性达87.14%。结论:(1)HPV负荷量高低与病变程度无关,但与术后病毒清除相关;(2)在切缘阴性的前提下,若术前高病毒负荷量,发生病灶残留的风险增高;(3)术后6月宫颈病变的转归与同期检测的病毒负荷量相关。

Presence and significance of high risk human papillomavirus after loop electrosurgical excision procedure in cervical intraepithelial neoplasm

Objective:To investigate the presence and significance of high risk human papillomavirus(HR-HPV)after loop electrosurgical excision procedure(LEEP) in cervical intraepithelial neoplasm(CIN).Methods:155 patients with CIN received the hybrid capture Ⅱ(HC-Ⅱ)HR-HPV test before LEEP.Thin prep Pap Test(TCT)and HC-Ⅱ test for HR-HPV were conducted at six months after LEEP,patients with positive results were examined by histology.Results:The pre-cone HR-HPV load(RLU/CO)in CINⅠ,CINⅡ and CINⅢ was(333.23±911.8),(303.88±795.3) and(220.72±680.92),respectively,which was no significant differences among 3 groups(P=0.6868).62.58%(97/155) of the patients were negative for HPV at six months after LEEP.The viral clearance of high pre-cone viral load(>300) was 52.70%(39/74),which was lower than that of low pre-cone viral load(≤300)(71.60%,58/81)(P=0.0294).The presence of postoperative residual lesions was correlated with high pre-cone HPV viral load,but the rate of HPV viral clearance was unrelated to age and grade of CIN.The optimum cut off of post-cone RLU/CO value to predict the residual lesions was 10,the sensitivity was 93.33%,while the specificity was 87.14%.Conclusion:The pre-cone HR-HPV load had no relationship with CIN grade but was associated with viral clearance.High pre-cone HR-HPV load may be a significant factor in predicting residue CIN on the premise of negative margin.There was prominent association between viral load at six months after LEEP and the prognosis of CIN.