HPV分型检测在子宫颈高级别鳞状上皮内病变治疗后随访中的临床意义  

The role of HPV genotyping testing in follow-up of high grade squamous intraepithelial lesion after treatment

作　　者：李宁[1] 佐晶[1] 黄婴[1] 安菊生[1] 姚洪文[1] 李晓光[1] 张蓉[1] 李斌[1] 张询[2] 郭会芹[2] 吴令英[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院妇瘤科,100021 [2]中国医学科学院北京协和医学院肿瘤医院病理科,100021

出　　处：《中华妇产科杂志》2015年第4期258-262,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：评价HPV分型检测在子宫颈高级别鳞状上皮内病变[HSIL；指子宫颈上皮内瘤变（CIN）Ⅱ和Ⅲ]行子宫颈锥切术后随访中的临床意义。方法对2006年12月至2009年1月在中国医学科学院肿瘤医院诊治的238例行子宫颈锥切术治疗的HSIL患者进行前瞻性观察分析，术后每6个月随访1次，共3次（或至活检组织病理检查证实病变复发），分别于术后6、12、18个月时进行，随访内容包括妇科检查、细胞学检查和HPV分型检测。采用PCR技术进行HPV分型检测，可检测21种HPV亚型。随访截止时间为2010年7月31日，中位随访时间为28.3个月（6.5-43.0个月）。采用Kaplan-Meire法计算中位复发时间；HPV感染状态与病变复发的相关性分析，单因素分析采用log-rank分析法，多因素分析采用Cox风险比例模型。结果238例HSIL患者中，子宫颈锥切术后任1次HPV分型检测阳性者110例（46.2%，110/238），常见的HPV感染亚型为HPV16（45.6%）、58（26.5%），其单一亚型感染与病变复发之间无相关性（P〉0.05）。238例患者中，术后复发17例（7.1%，17/238），复发的中位时间为14.9个月（6.0-32.1个月）。单因素分析显示，3次HPV分型检测中至少1次阳性、HPV持续感染、HPV多重感染、同一HPV亚型持续感染、术后18个月HPV仍然阳性与病变复发相关（P〈0.01）。多因素分析显示，HPV多重感染（HR=8.6，95%CI为1.8-41.7，P=0.008）和同一HPV亚型持续感染（HR=5.1，95%CI为1.0-24.8，P=0.042）是病变复发的独立危险因素。结论 HSIL患者锥切术后存在HPV多重感染和同一亚型持续感染提示病变复发的风险增高。术后18个月内HPV转阴者复发风险较小。Objective To assess the clinical value of HPV genotyping in follow-up after treatment for cervical high grade squamous intraepithelial lesion （HSIL）. Methods Two hundred and thirty eight patients with HSIL receiving conization in Cancer Hospital, Chinese Academy of Medical Sciences from Dec, 2006 to Jan, 2009 were accrued in our study. All the patients were prospectively observed after conization every 6 months for 3 times or till histologically confirmed recurrence. The items in every visit included pelvic examination, cervical cytology and HPV genotyping. Twenty-one HPV genotypes were detected by PCR-hybridization method. The last follow-up was July 31, 2010, and the median follow-up time was 28.3 months （range 6.5-43.0 months）. Kaplan-Meire method as used for analyzed the median recurrent time, and the relationships between HPV status and recurrent disease were calculated by and log-rank test and Cox-regression model. Results Among the 238 patients, 110 cases （46.2%, 110/238） had positive result of HPV DNA testing at any visit. The most common HPV types detected in follow-up were HPV16 （45.6%）, HPV58 （26.5%）, and HPV52 （16.9%）. There was no correlation between recurrent disease and any individual high risk HPV infections （P〉0.05）. Seventeen recurrent cases （7.1%） were identified in 238 patients within a median recurrent time of 14.9 months （range 6.0-32.1 months）. In univariate analyses, HPV positive at any visit, persistent infection, multiple infection, type specific persistent infection and positive HPV at 18 months after conization were indicators for residual/recurrent disease （P〈0.05）. In multivariate analysis, only multiple HPV infection （HR=8.6, 95%CI：1.8-41.7, P=0.008） and type specific persistent HPV infection （HR=5.1, 95%CI： 1.0-24.8, P=0.042） had an elevated risk of recurrent disease. Conclusions HSIL with multiple HPV infection and type specific persistent HPV infection in follow-up are at high risk of recurrent disease. Patients with HPV tur

关 键 词：宫颈上皮内瘤样病变 乳头状瘤病毒科 锥形切除术 肿瘤复发 局部 

分 类 号：R737.33[医药卫生—肿瘤]