高危型人乳头瘤病毒对宫颈病变治疗后监测临床意义研究

目的 人乳头瘤病毒(human papillomavirus,HPV)在宫颈癌发生、发展过程中具有重要作用,为此本研究通过动态观察HPV的变化,探讨高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)在宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)及Ⅰ期宫颈癌治疗后临床监测中的意义.方法 选择2010-01-01-2012-12-31新疆医科大学附属肿瘤医院收治的327例CIN(CIN Ⅰ 52例,CINⅡ40例,CINⅢ142例)及Ⅰ期宫颈癌(93例)患者为研究对象,分析其临床资料并动态检测HR-HPV,观察其治疗前后HR-HPV感染率、转阴率和持续感染率以及病变的复发率.结果 宫颈病变的HR-HPV总感染率为89.9％,CIN及Ⅰ期宫颈癌各组感染情况比较,CINⅡ与CINⅢ级之间差异有统计学意义、但存在样本量相差较大问题,其余各组比较差异均无统计学意义.CIN及Ⅰ期宫颈癌手术治疗后HR-HPV总转阴率为78.9％,各组宫颈病变的HR-HPV转阴率差异无统计学意义,P＞0.05;但HR-HPV转阴的平均时间为5～6个月,治疗后6个月是CIN Ⅰ与CINⅢ的HR-HPV转阴高峰期,治疗后9个月是CINⅡ及宫颈癌Ⅰ期HR-HPV转阴高峰期.年龄≤35岁(A组)、35～45岁(B组)、46～55岁(C组)和≥56岁(D组)间HR-HPV转阴时间,总体差异有统计学意义,P＜0.05.进一步行组间两两比较结果显示,A组与C组、A组与D组、B组与C组、B组与D组间差异有统计学意义,P＜0.05;A组与B组、C组与D组间差异无统计学意义,P＞0.05.本组随访时间为6.5～60.0个月,中位随访时间为28.3个月.CIN组HR-HPV持续感染者9例,均复发,平均复发时间16.3个月;HR-HPV阳性持续存在率和复发率明显高于术后HR-HPV转阴患者,差异有统计学意义(P＜0.05),灵敏度100％,特异度100％.宫颈癌Ⅰ期患者术后随访HR-HPV持续感染者9例,均复发,另有1例HR-HPV检测阴性者复发,平均复发时间16.8个月;HR-HPV阳性持续存在率和复发率明显高于术后HPV转阴患者,差异有统计学意义(P＜0.05),灵敏度90％,特异度100％.结论 HR-HPV的动态变化可作为CIN、宫颈癌治疗后随访监测的良好指标,持续HR-HPV感染高度预警宫颈病变的复发,具有一定的临床意义.

Clinical monitoring of high-risk human papillomavirus test during the follow-up of cervical lesions

OBJECTIVE As the important role of HPV in the development of cervical cancer,in order to explore the clinical monitoring of high-risk HPV test during the follow-up of cervical lesions,we had dynamically detected the HR-HPV.METHODS The clinical data about 327 patients with CIN or cervical cancer,treated from January 2010 to December 2012 in Affiliated Tumour Hospital of Xinjiang Medical University,had been analyzed by dynamic detection of HR-HPV,in order to study the infection rate of HR-HPV,negative rate of HR-HPV,persistent infection rate of HR-HPV and the recurrence rate of cervical lesions.RESULTS The infection rate of HR-HPV in CIN and early cervical cancer was 89.9％,no significant difference among the groups of cervical lesions.The negative rate of HR-HPV in cervical lesions was 78.9％ after surgical treatment,no significant difference among the groups,but the average time was mostly in 5 to 6 months.The peak time of negative HR-HPV was 6 months in CIN Ⅰ and CIN 1Ⅲ and 9 months in CIN Ⅱ and stage Ⅰ cervical cancer.The age were divided into 4 groups,A (35 years old or less),B (35 to 45 years old),C (46 to 55 years old) and D(56 years old or over).There were significant difference among aged intervals(P＜0.05).Further pairwise comparison,there were no significant differences between A and B,C and D,but there were significant differences between A and C,A and D,B and C,B and D.The median follow-up time was 28.3 months (6.5-60 months) in this study.Nine patients with CIN persistently infected HR-HPV and then relapsed,the average time of them was 16.3 months.There were significant differences between persistent infection rate of HR-HPV and the recurrence rate of cervical lesions (P＜0.05) with a sensitivity of 100％ and specific degree of 100％.Nine patients with stage Ⅰ cervical cancer persistently infected HR-HPV and then relapsed,another 1 with negative HR-HPV relapsed too,the average time of them was 16.8 months.There were significant differences between persistent infection rate of HR-HPV and the recurrence rate of cervical lesions,(P＜0.05) with a sensitivity of 90％ and specific degree of 100％.CONCLUSIONS The dynamic changes of HR-HPV could be used as follow-up monitoring index after treatment for CIN and cervical cancer patients.Persistent HR-HPV can early find the local recurrence of cervical lesions early,so this testing has important clinical significance.