影响宫颈病变患者HPV转归的多因素分析  

A multi-factor analysis of HPV prognosis of patients with cervical lesions

作　　者：宋建东[1] 宋静慧[1] 于聪祥 乔峤[1] 郑晶晶[1] 王菲[1] .SONG Jian-dong;SONG Jing-hui;YU Cong-xiang;QIAO Qiao;ZHENG Jing-jing;WANG Fei(Department of Obstetrics and Gynecology,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院妇产科,内蒙古呼和浩特010050

出　　处：《中国实用妇科与产科杂志》2018年第8期892-897,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：中国公益性行业科研专项经费(201402010);国家自然科学基金(81260059)

摘　　要：目的探讨影响人乳头瘤病毒(HPV)转归的影响因素。方法选取2014年11月至2017年12月内蒙古医科大学附属医院妇科收治的经病理检查确诊的低级别宫颈鳞状上皮内病变(LSIL)136例、高级别宫颈鳞状上皮内病变(HSIL)263例和宫颈鳞状细胞癌(CSCC)33例为研究组;同期在门诊体检的高危型HPV阴性的健康妇女100例为对照组。对HSIL和CSCC按临床常规予以治疗,LSIL和HPV感染未行治疗。调查各组一般社会人口学情况,检测对照组和研究组治疗前、治疗后3、6、12个月HPV、阴道微生态及免疫因子情况。结果 LSIL、HSIL和CSCC三组入组基线时HPV阴性率分别为20.58%、18.63%和9.09%,随访3个月三组HPV阴性率分别为67.19%、61.64%和53.85%,随访6个月时三组HPV阴性率分别为78.79%、66.91%和60.87%,随访3个月和6个月三组HPV阴性率均优于基线,但各组间差异无统计学意义(P>0.05)。随访12个月后三组HPV阴性率由高到低为LSIL(91.30%)>HSIL(73.33%)>CSCC(65.00%),差异有统计学意义(P<0.05)。绝经、曾患妇科病、线索细胞、滴虫、菌群密集度异常、菌群失调、HSIL、CSCC等是影响HPV转阴的危险因素。较高水平的sIgA、IL-2和IL-10是HPV转阴的保护因素。结论宫颈病变严重程度、阴道微生态平衡及局部免疫可能是影响HPV转归的重要因素。Objective To explore the influencing factors of HPV prognosis.Methods A total of 136 patients with lowgrade squamous intraepithelial lesions（LSIL）,263 patients with high-grade squamous intraepithelial lesion（HSIL）and33 patients with cervical squamous cell carcinoma（CSCC）in Inner Mongolia Medical University Affiliated Hospital from November 2014 to December 2017 were selected as the research group.One-hundred healthy women with negative HPV,who underwent physical examinations,were selected as the control group.The general socio-demographic status was investigated in each group.HPV test,vaginal micro-ecology and immune factors before treatment and at 3,6 and 12 months after treatment were detected in both the control and research groups.Results HPV negative rate baseline of LSIL,HSILand CSCC was 20.58%,18.63% and 9.09%,followed up for 3 months,three groups of HPV negative rate was67.19%,61.64% and 53.85% respectively,followed up for 6 months in three groups of HPV negative rate were 78.79%,66.91% and 60.87%,followed up for 3 months and 6 months HPV negative rate of three group were better than the baseline,but there was no statistically significant difference between the groups（P〉0.05）.Follow-up of 12 months after the three groups of HPV negative rate from high to low for LSIL（91.30%）〉 HSIL（73.33%） 〉CSCC（65.00%）,the difference was statistically significant（P〈0.05）.Pausimenia,gynecological history,clue cells,trichomoniasis,abnormal flora density,flora,HSIL and CSCC were all risk factors for HPV negative conversion.SIgA,IL-2 and IL-10 at high levels were the protective factors of HPV negative conversion.Conclusion Cervical lesion severity,vaginal microecological balance,and local immunity may be crucial factors that could influence the prognosis of HPV.

关 键 词：宫颈病变 HPV转归 阴道微生态 局部免疫 

分 类 号：R711.74[医药卫生—妇产科学]