宫颈上皮内瘤样病变宫颈环形电切术后HPV—DNA检测的意义  

作　　者：苏莉[1] 

机构地区：[1]江苏省扬中市人民医院妇产科,212200

出　　处：《浙江临床医学》2011年第8期865-867,共3页Zhejiang Clinical Medical Journal

摘　　要：目的评价宫颈上皮内瘤样病变（CIN）宫颈环形电切（LEEP）术后HPV—DNA检测的意义，以及LEEP术对于CIN1患者HPV清除的有效性。方法37例HPV阳性患者（阴道镜活检证实为CIN2—325例，CIN112例）行LEEP术，分别在术后随访的第3个月和第6个月行HPV—DNA及细胞学检查。结果在随访的第3个月、第6个月细胞学异常分别为11例、4例。CIN1组HPV—DNA阳性率下降44％和36％，差异无统计学意义（P=0．41）。37例中2例病灶残留或复发，占5．4％，此2例最初均为CIN3，在第3个月、第6个月时HPV—DNA均阳性。CIN1无复发或持续感染病例。第3个月、第6个月细胞学改变分别为29．7％和10．9％，差异有统计学意义（P=0．03）。第6个月4例细胞学异常者同时有HPV持续感染。HPV持续感染常伴有细胞学异常，HPV阴性常无细胞学异常。结论LEEP术后第6个月时并未降低HPV感染率，HPV—DNA检测及细胞学检查有助于监测CIN术后有无病灶残留（或复发）。Objective To assess human papilloma viruses （HPV） DNA test for detection of recurrences in cervical intraepithelial neoplasia （CIN） patients after loop electrosurgical excision procedure （LEEP）. Also effect of LEEP on the clearance of HPV infection was evaluated for CIN 1 lesions. Methods HPV DNA positive 37 patients （25 CIN 2 - 3 and 12 CIN 1 cases proven by colposeopic biopsies） were treated with LEEP and followed prospectively with HPV DNA and cytology at third and sixth months. Results There were 11 patients with abnormal cytologic results in third month and 4 in sixth month. HPV DNA positivity rate declined in CIN 1 group between third and sixth month but this did not reach to statistical significance （44 vs. 36% , P = 0. 41 ）. There were 2 treatment failures out of 37 patients （5.4%）. These two patients had CIN 3 at the beginning and two of them had positive HPV DNA in two controls. There were no recurrence/treatment failure for CIN 1 patients. Regarding 37 patients, decrease in cytologic abnormality incidence between third and sixth month control was statistically significant （29. 7 vs. 10. 9% , P = 0. 03 ）. All four patients with cytologic abnormality at the sixth month had HPV persistence. Cytologic abnormality was more prevelant in HPV persistent women （P = 0. 01 ） and also there was no cytologic abnormality in case of HPV DNA negativity. Conclusion LEEP does not seem to decrease HPV DNA incidence for CIN 1 at least for 6 months. But HPV DNA used in addition to cytology might help to detect recurrences.

关 键 词：宫颈上皮内瘤样病变 宫颈环形电切 HPV持续感染 

分 类 号：R737.33[医药卫生—肿瘤]