高危型HPV在宫颈上皮内瘤变LEEP术后随访的意义  

The significance of high risk HR-HPV in the following up of patients with cervical intraepithelial neoplasia after loop electrosurgical excision procedure

作　　者：宋冬冬[1] 赵婧[1] 李茂珍[1] 

机构地区：[1]广东药学院附属第二医院妇产科,广州510300

出　　处：《国际医药卫生导报》2016年第19期2940-2943,共4页International Medicine and Health Guidance News

摘　　要：目的 探讨高危型HPV在宫颈上皮内瘤变患者经LEEP术后随访中的应用和意义.方法 2009年1月至2013年12月我院妇科因CINⅡ-CINⅢ行宫颈环形电切术的216例患者,采用第二代杂交捕获实验（HC2）检测高危型HPV联合液基细胞学随访2年,观察术后HPV清除情况及宫颈病变残留或者复发情况,比较HPV与TCT在监测CIN术后病变残留或者复发中的意义.结果 术后病理切缘阳性17例（7.9％）,术后24个月残留或者复发31例（14.4％）.HR-HPV DNA转阴率术后第6个月明显升高,和术后第3个月对比,差异有统计学意义.术后第6个月HR-HPV阳性54例,阳性患者中出现病变残留或者复发31例（57.4％）,阴性者无发病.HR-HPV诊断病变残留或复发在LEEP术后第6个月的敏感度、特异度、阳性预测值和阴性预测值分别是100％、88.9％、57.4％、100％,而TCT检查诊断病变残留或者复发的敏感度、特异度、阳性预测值、阴性预测值分别是75.6％、91.1％、53.8％、94.4％,HR-HPV明显优于TCT.结论 HR-HPV是早期监测CIN术后病变残留或者复发的敏感指标,特别是术后6个月HPV持续阳性者,应提高警惕,严密随访.Objective To explore the application and significance of testing high-risk human papilloma virus （HR-HPV） in the following of patients with cervical intraepithelial neoplasia （CIN） after loop electrosurgieal excision procedure （LEEP）.Methods 216 patients with CIN Ⅱ or CIN Ⅲ underwent LEEP in our hospital from Jan.2009 to Dec.2013 were followed up for 2 years.HR-HPV was detected by hybrid capture （HC2） and thinprep cytologic test （TCT） was performed.HPV clearance,the remain of cervical lesion,and the relapse rate were recorded,and the significance of HPV and TCT in monitoring remain and relapse were compared.Results 17 cases （7.9%） had positive surgical margin after the operation,and 31 cases （14.4%） showed remain or relapse after 24 months＇ follow-up.The negative rate of HR-HPV significantly increased at the 6th month after operation,with statistically significant difference compared with that at the 3rd month.54 cases had positive HR-HPV at the 6th month after operation,31 cases （57.4%） of whom showed remain or relapse,there was no remain or relapse in HR-HPV negative patients.The sensitivity,specificity,positive predictive value,and negative predictive value of HR-HPV in diagnosing remain or relapse at the 6th month after LEEP were 100%,88.9%,57.4%,and 100% respectively,while those of TCT were 75.6%,91.1%,53.8%,and 94.4% respectively,those of HR-HPV were superior to those of TCT.Conclusion HR-HPV is a sensitive marker for early monitoring postoperative remain or relapse after CIN surgery.More attention should be paid to postoperative patients with continuously positive HPV over 6 months.

关 键 词：高危型人乳头瘤病毒 宫颈上皮内瘤变 宫颈环形电切术 病变残留或复发 

分 类 号：R737.33[医药卫生—肿瘤]