联合检测高危型人乳头瘤病毒与端粒酶基因扩增在轻度宫颈上皮内瘤变分流管理中的意义  

Combined detection of high- risk human papillomavirus and telomerase gene amplification in a mild cervical intraepithelial neoplasia shunt management role

作　　者：周宇涵[1] 樊伍峰[1] 黄玉琴[1] 董金菊[1] 郭红艳[1] 

机构地区：[1]湖北医药学院附属襄阳医院环形电切妇科,湖北襄阳441000

出　　处：《新乡医学院学报》2015年第11期1032-1035,1040,共5页Journal of Xinxiang Medical University

摘　　要：目的通过联合检测高危型人乳头瘤病毒(HR-HPV)负荷量与人端粒酶基因(h ETRC)扩增情况,探讨针对轻度宫颈上皮内瘤变(CIN)Ⅰ患者施行分流管理的意义。方法选取病理确诊CINⅠ患者75例,分为治疗组(n=30)和对照组(n=45),治疗组患者行宫颈环形电切(LEEP)术;对照组患者不予任何治疗干预,仅按试验要求随访,随访时间2 a。分别于第12个月和第24个月对所有入组对象检测HR-HPV负荷量和h ETRC扩增情况,并在第24个月行阴道镜下宫颈活检,了解转归以结束随访。结果治疗组患者LEEP术前后HR-HPV负荷量和h ETRC扩增差异均有统计学意义(P<0.05),随访2 a,1例病变进展;对照组患者随访2 a,病变进展5例(11.1%);治疗组和对照组比较病变进展情况差异无统计学意义(P>0.05)。对照组患者中h TERC扩增阳性者病变持续和进展显著高于h TERC扩增阴性者(P<0.05),HR-HPV首次感染阳性者病变持续和进展与首次感染阴性者比较差异无统计学意义(P>0.05),HR-HPV持续感染阳性者与阴性者比较病变持续和进展差异有统计学意义(P<0.05)。h TERC扩增阳性者病变持续和进展的相对危险度是阴性者的3.97倍,HR-HPV持续感染阳性者病变持续和进展的相对危险度是阴性者的1.99倍,联合检测HR-HPV和h TERC均阳性者相对危险度是二项均阴性者的4.54倍。结论宫颈CINⅠ的转归并不因施行宫颈LEEP术而完全消退,盲目过度治疗不能完全逆转宫颈CINⅠ;联合检测HR-HPV和h TERC的扩增,对CINⅠ进展风险有一定预测价值,二者联合检测有望成为宫颈CINⅠ患者分流管理中的必要筛查手段。Objective To discuss the significance of triage management for patients with mild cervical intraepithelial neoplasia（ CIN） Ⅰ through combined detection of high-risk human papillomavirus load with the telomerase gene amplification.Methods Seventy-five cases of patients with CINⅠwho were confirmed pathologically were selected and divided into treatment group（ n = 30） and control group（ n = 45）. The patients in treatment group underwent cervical loop electrosurgical excision procedure（ LEEP） surgery while the control group had follow-up only according to the experimental requirements without any therapeutic intervention. The follow-up time was two years. High-risk human papillomavirus（ HR-HPV） load and human telomerase mRNA component gene,h ETRC） amplification of all the patients were detected at the 12 months and 24 months after the beginning of follow-up. And colposcopy and cervical biopsy were implemented at 24 months after the beginning of follow-up in order to understand the outcomes and to end the follow-up. Results There were significant differences of HR-HPV load and h ETRC amplification before and after LEEP surgery in treatment group（ P〈0. 05）. After the follow-up of two years,disease progression happened in one case（ 3. 3%） of treatment group and five cases（ 11. 1%） of control group,which had no significant difference（ P〉0. 05）. The number of cases who had continuing and progress of the lesion in h TERC amplified positive patients was significantly higher than that in h TERC amplified negative patients of the control group（ P〈0. 05）,and there was no significant difference of continuing and progress of the lesion between the cases with HR-HPV positive initial infection and negative initial infection（ P〉0. 05）,while there was significant difference between HR-HPV infection sustained positive and HR-HPV infection sustained negative patients（ P〈0. 05）. h TERC amplified positive relative risk was 3. 97 times of the negative,HR-HPV persistent infec

关 键 词：高危型人乳头瘤病毒 端粒酶基因 轻度宫颈上皮内瘤变 荧光原位杂交 第二代杂交捕获 

分 类 号：R737.33[医药卫生—肿瘤]