宫颈脱落细胞人乳头瘤病毒基因分型检测在宫颈上皮内瘤变子宫颈电环切除术术后随访中的意义

目的 探讨宫颈脱落细胞人乳头瘤病毒(HPV)亚型(C-HPV-S)在宫颈癌早期诊断和宫颈上皮内瘤变(CIN)子宫颈电环切除术(LEEP)术后随访中的价值.方法 选择2008年1月至2011年9月在济南军区总医院检查C-HPV-S的6695例,包括查体者1339例(体检组)和因患妇科疾病就诊者5356例(患者组),受检者均行宫颈薄层液基细胞学检查(TCT)并采用导流杂交基因芯片技术行C-HPV-S检测.对其中病理诊断为CIN者(491例)中472例LEEP,术后6个月、1～2年随访时行TCT和C-HPV-S检查.结果 ①体检组和患者组HPV感染率分别为17.8％ (238/1339)和27.4％ (1470/5356) (P ＜0.05).②本组宫颈炎、CINⅠ～Ⅱ、CINⅢ、宫颈癌的HPV感染率分别为28.8％ (167/579)、80.8％ (286/354)、90.5％ (124/137)、97.5％(115/118)与宫颈炎组比较,差异有统计学意义(P＜0.05).③随着病变级别的增高单一亚型感染率20.9％ (121/579)、68.9％ (244/354)、78.8％ (108/137)、90.7％ (107/118)]呈增高趋势(P＜0.05).④对CIN患者行LEEP后1～2年随访,CIN Ⅰ～Ⅱ组复发率为1.2％ (4/335),CIN Ⅰ～Ⅱ组HPV持续感染率为3.9％ (13/274)；CINⅢ组复发率4.4％(6/137),其HPV持续感染率为9.5％ (13/124),其中13例复发者HPV持续感染率为92.3％ (12/13).2组复发率差异有统计学意义(P＜0.05),CINⅢ组HPV持续感染率高于CIN Ⅰ～Ⅱ组(P＜0.05).结论 C-HPV-S检测有助于早期发现和预测CIN,也可作为CIN术后随访的重要指标,为预防宫颈癌的发生提供干预依据.

Clinical analysis of cervical cytology human papilloma virus subtyping test in early diagnosis of cervical cancer and follow-up of cervical loop electrosurgical excision procedure in cervical intraepithelial neoplasia

Objective To investigate the value of the cervical cytology human papilloma virus （HPV） sub- types （C-HPV-S） in early diagnosis of cervical cancer and follow-up of cervical loop electrosurgical excision proce- dure （LEEP） in cervical intraepithelial neoplasia （CIN）. Methods From January 2008 to September 2011,6695 cases were checked C-HPV-S in Jinan Military General Hospital, including 1339 cases of physical examination group （physical examination group） and 5356 cases of patient group（ patient group）. All subjects underwent cervical thin prep cytologic test （TCT） and the HPV subtypes were detected by flow-through hybridization gene chip technology. 472 patients with CIN underwent LEEP. HPV and TCT were tested again form 6 months to 24 months after LEEP during follow-up stage. Results @The C-HPV-S infection rate in physical examination group and patient group were respectively 17.8 % （238/1339） and 27.4% （1470/5356） （ P 〈 0.05 ）. （~）The C-HPV-S infection rate of cer- vicitis, CIN I - II, CIN m, cervical cancer were 28.8% （ 167/579）, 80.8% （286/354）, 90.5% （124/137） and 97.5% （115/118） （P 〈0.05）. （~）The single type infection rates 20.9% （ 121/579）, 68.9% （244/354）, 78.8% （108/137） and 90.7% （107/118） ] of cervicitis, CIN I - I], CIN m and cervical cancer was increasing with se- verity of the disease had increased with the degree of cervical lesions（P 〈 0.05）. @In this study, after treatment by LEEP CIN I - I1 and CIN HI recurrence rates were 1.2% and 4.4% （P 〈 0.05 ） during 1 to 2 years follow-up stage,the HPV persistent infection were 3.9% and 9.5% （P 〈0.05）. Conclusion The detection of C-HPV-S is valuable for the postoperative follow-up and prognosis of CIN, which also can provide intervention basis for the pre- vention of cervical cancer.