宫颈注射干扰素治疗宫颈上皮细胞内瘤变Ⅰ级的疗效观察

目的:了解和探讨宫颈注射α-干扰素治疗子宫颈上皮内瘤变Ⅰ(CINⅠ)的效果,为制定预防宫颈癌的有效措施提供科学依据。方法:对2004年1月~2004年12月期间我院妇科门诊就诊的患者进行TCT以及阴道镜下取活检等检查方法确诊为CINⅠ患者,将符合入选基本条件的148名CINⅠ患者按自愿选择的原则进行分组,其中治疗组108人,对照组40人。治疗组在非月经期采用宫颈分点注射α-干扰素,3个月后复查宫颈组织病理学检查及宫颈分泌物人乳头状瘤病毒(HPV)检查。结果:①CINⅠ治疗效果:治疗组第一疗程治愈率72.22%(78/108);无效的30例进入第二疗程,治愈率33.33%(10/30);两疗程累积治愈率81.48%(88/108)。第一疗程治愈率高于第二疗程,差异有极显著性统计学意义(P<0.001)。对照组40例中,自愈率35.00%(4/35)。治疗组治愈率高于对照组,差异有极显著性统计学意义(P<0.001)。②HPV感染对治疗效果的影响:治疗组中,单纯CINⅠ患者(未合并HPV感染者)23例,第一疗程治愈18例,第二疗程累积治愈21例,治愈率91.30%,CINⅠ合并HPV感染患者85例,第一疗程治愈60例,第二疗程累积治愈67例,治愈率78.82%。单纯CINⅠ治愈率高于CINⅠ合并HPV感染,但两者疗效对比无显著性差异(P>0.05)。对照组中,单纯CINⅠ患者15例,自愈率60.0%(9/15),CINⅠ合并HPV感染患者25例,自愈率20.0%(5/25)。单纯CINⅠ自愈率高于CINⅠ合并HPV感染,两者自愈率对比差异有显著性统计学意义(P<0.01)。结论:宫颈注射α-干扰素能够有效阻断宫颈上皮内瘤变的发展和清除人乳头状瘤病毒亚临床感染;对较顽固性CINⅠ的患者,适当延长治疗时间、加大治疗剂量,可增加治愈机会。是否合并HPV感染不影响治疗效果,但CINⅠ合并HPV感染自然转阴率低,故建议此类患者行干扰素治疗,以便及时阻断CINⅠ进展。

Clinical study on effectiveness of α-interferon in treating CIN Ⅰ by cervical injection

Objective:To evaluate the efficiency of α-interferon in treating cervical intraepithelial neoplasia Ⅰ(CINⅠ) to provide some clinical evidence in making measures to prevent cervical cancer.Methods:CINⅠpatients came to out-patient department of gynecology in this hospital from Jan 2004 to Dec 2004 were diagnosed by the approaches of liquid-based monolayers TCT and cytology-colposcopy-histology.148 women accordant with the conditions as research objects were classified as control group(40 cases) and treatment group(108 cases),and the patients in treatment group accepted the treatment of α-interferon which was injected into the cervix.Results:①HPV infection: among 148 patients,110 of them were infected with HPV,the percentage was 74.32%.Among 110 HPV positives,85 women(78.70%) were distributed to treatment group,the others(25 cases,62.50%) were in control group.The difference was not statistically significant(P>0.05).The effectiveness of treatment: 78 of 108 cases in treatment group were cured after finishing the first period of treatment,and the cure rate was 72.22%.②The treatment was not effective for 30 cases and they accepted the second period of treatment,10 of them were cured finally,the cure rate was 33.33%.The total cure rate combining the two periods was 81.48%.Comparing the cure rate of the two periods,the difference was statistically significant(P<0.05).For control group,14 cases recovered to normal automatically,the percentage was 35.0%.Comparing the cure rate between control group and treatment group,the difference was statistically significant(P<0.001).③The impact of HPV infection on the effectiveness: in treatment group,there were 23 patients with simple CIN Ⅰ,18 cases of them were cured after finishing the first period,and 3 cases were cured after finishing the second period.Among 85 CIN Ⅰ patients combined with HPV infection,60 cases were cured in the first period,and 7 cases cured after finishing the second period.There was no significant difference between the simple group and the combined group(P>0.05).For control group,there were 15 patients with simple CIN Ⅰ,9 cases of them recovered to normal automatically.Among 25 CIN Ⅰ patients combined with HPV infection,5 cases recovered to normal automatically,there was significant difference between the simple group and the combined group(P<0.01).Conclusion:①The cervical injection treatment of α-interferon is effective to CIN Ⅰ.To stubborn patients,prolonging the treatment time appropriately and increasing the dosage could increase the probability of cure.②Since the natural cure rate for CIN Ⅰ patients combined with HPV infection was low,it is suggested that the interferon treatment should given to these women to interdict the progress of CIN Ⅰ in time.