宫颈病变进展与高危型人乳头瘤病毒负荷量相关性研究

目的探讨高危型人乳头瘤病毒(HPV)的病毒负荷量与宫颈病变的发生及进展的关系,宫颈病变经LEEP或冷刀锥切手术后疗效评估。方法选择妇产科门诊就诊宫颈病变患者4712例,采用HC-Ⅱ方法检测其HPV-DNA含量,阴道镜下定位活检,病理学结果为确诊标准。其中CINⅠ～Ⅲ263例先后进行LEEP或冷刀锥切治疗手术,术后6、12月对所有HC-Ⅱ阳性患者进行随访HC-Ⅱ及细胞学检查,并以HC-Ⅱ阳性宫颈炎患者行同期相检查为对照进行疗效评价。结果4712例患者中高危型病毒负荷量随着宫颈病变程度增高而增高,它们之间显著正相关(H=1984.714,P0.05),慢性宫颈炎与其他3个组差异有统计学意义(P0.05),而CIN组间差异无统计学意义(P0.05)。CIN患者经LEEP或冷刀锥切手术后术前HC-Ⅱ阳性CINⅠ、CINⅡ、CINⅢ的术后HPV平均持续感染率分别为0%、0.8%、15.21%,较之保守治疗的慢性宫颈炎组HPV平均感染率36.2%,疗效差异有统计学意义(P0.05)。结论高病毒负荷量尤其是持续性高病毒负荷量与宫颈病变发生及进展呈正相关;经LEEP或冷刀锥切术后的宫颈病变患者,疗效明显优于持续性高病毒负荷量而采取保守治疗的患者。

Study on Correlation Between Progression of Cervical Lesions and Viral Load of High-risk Human Papillomavirus

Objective To explore the relationship between viral load of high-risk human papillomavirus （HPV） and occurrence,progression of cervical lesions,and to assess the therapeutic efficacy of loop electrosurgical excision procedure （LEEP） or cold-knife conization （CKC） for treatment of cervical lesions.Methods Totally 4,712 outpatients with cervical lesions were selected from Department of Obstetrics and Gynecology.HPV-DNA content was detected with hybrid cap-ture II （HC-Ⅱ） assay,and biopsy was performed using colposcopy.Pathological results were served as the diagnostic criteria.263 of these outpatients were treated with LEEP or CKC.After 6-month or 12-month,all of the outpatients tested positive by HC-II were followed up postoperatively by HC-Ⅱ assay and cytological examination,and the cervicitis outpatients tested positive by HC-II were served as control group.The therapeutic effects in these outpatients were evaluated.Results Outpatients with higher viral load had higher degree of cervical lesions,there was a significantly positive correlation between them （H = 1,984.714,P0.05）.There were statistically significant differences in viral load of high-risk HPV and degree of cervical lesions between chronic cervicitis group and the other three groups （P0.05）,while no statistically significant difference was found among the groups of cervical intraepithelial neoplasia （CIN） I～III （P0.05）.Among the CIN outpatients with preoperative HC-Ⅱ-positive,the average postoperative persistent infection rates of HPV in the groups of CIN Ⅰ,CIN Ⅱ,and CIN Ⅲ were 0.0%,0.8%,and 15.21%,respectively.The average HPV infection rate of chronic cervicitis outpatients with conservative treatment was 36.2%.There were statistically significant differences in the therapeutic efficacy between conservative treatment and LEEP or CKC （P0.05）.Conclusions High viral load of high-risk HPV,especially high viral load of persistent high-risk HPV is positively correlated with the occurrence and progression of cervical lesions.The therapeutic effects of LEEP and CKC are significantly superior to that of conservative treatment in cervical lesion patients with higher viral load of persistent high-risk HPV.