宫颈环形电切术治疗宫颈病变对宫颈感染人乳头瘤病毒负荷的影响  

The Effect of Cervical Loop Electrosurgical Excision Procedure on Load of Cervical HPV Infection

作　　者：李长东[1] 刘芸[2] 王建东[3] 张为远[3] 

机构地区：[1]首都医科大学附属北京妇产医院计划生育科,北京100006 [2]首都医科大学附属北京妇产医院妇科微创中心,北京100006 [3]首都医科大学附属北京妇产医院妇科肿瘤科,北京100006

出　　处：《医学综述》2014年第10期1859-1861,共3页Medical Recapitulate

基　　金：北京市"十百千"卫生人才百层级项目;北京市卫生系统高层次卫生人才项目(2013-3-029)

摘　　要：目的 研究宫颈环形电切术（LEEP）治疗宫颈病变对宫颈感染高危型人乳头瘤病毒（HPV）负荷的影响.方法 选择2007年7月至2012年6月首都医科大学附属北京妇产医院收治的宫颈上皮内瘤变（CIN）患者509例,所有患者行LEEP治疗后,行宫颈液基细胞学检查（TCT）和高危型HPV负荷的杂交捕获法Ⅱ检查.观察宫颈细胞学结果及HPV病毒负荷变化.结果 不同CIN级别患者的术前高危型HPV阳性率随病变级别的升高而升高,差异有统计学意义（x2 =2.316,P＜0.01）.509例患者中有9例患者术后1年TCT异常,包括非典型鳞状细胞4例、低度鳞状上皮内病变4例、高度鳞状上皮内病变1例,再次阴道镜下活检为慢性宫颈炎2例,宫颈CIN-Ⅰ 6例,CIN-Ⅱ1例.术后1年22例患者为HPV持续阳性,9例TCT再次发现异常的患者均为HPV持续阳性,且病毒负荷下降＜50％.结论 LEEP术后6～12个月高危型HPV持续阳性甚至负荷升高,再次发生宫颈病变的风险增加.Objective To study the influence of cervical loop electrosurgical excision procedure （LEEP） on load changes of cervical HPV infection.Methods A total of 509 cases of cervical intraepithelial neoplasia（CIN） from Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical L niversity during J ul.2007 and J un.2012 were included in the study,who received LEEP,cervical liquid based cytology（TCT） examination and high-risk HPV load（HC Ⅱ） examination.The cervical cytological results and HPV load changes were observed.Results Pre-operative HPV load increased with the increasing lesion level of CIN（x2 =2.316,P 〈 0.01）.In 509 cases,TCT of 9 cases at 1 year after surgery were abnormal,including 4 cases of ASC,4 cases of LSIL,1 case of HSIL,which were reexamined by biopsy under colposcopy：2 cases of chronic cervicitis,6 cases of cervical CIN-Ⅰ,1 case of CIN-Ⅱ.After 1 year there were 22 patients with persisting positive HPV,9 cases of abnormal TCT were all HPV positive,and viral load drop was 〈 50%.Conclusion 6-12 months after LEEP,high-risk HPV continues positive and the viral load even increases,and the risk of second time cervical lesions increases.

关 键 词：宫颈上皮内瘤变 人乳头瘤病毒感染 病毒负荷 宫颈锥切 

分 类 号：R71[医药卫生—妇产科学]