核苷类似物治疗宫颈人乳头瘤病毒感染的疗效  

Nucleoside analogues therapy for cervical high-risk HPV infection

作　　者：邓雨果 黄子健 DENG Yuguo;HUANG Zijian(Department of Gynecology and Obstetrics,Guangzhou Women and Children Medical Centre,Guangzhou 510180,China)

机构地区：[1]广州市妇女儿童医疗中心妇产科,广州510180

出　　处：《广州医药》2021年第2期11-16,共6页Guangzhou Medical Journal

摘　　要：目的评价口服核苷类似物富马酸丙酚替诺福韦治疗宫颈持续性高危型人乳头瘤感染患者的疗效。方法本回顾性研究中,将同一亚型高危型人乳头瘤病毒感染超过1年患者随机分为两组,治疗组给予口服富马酸丙酚替诺福韦,25 mg,每天一次,连续3个月;对照组给予宣教说明,无特殊处理。于入组后第3个及第6个月随诊。检测患者宫颈人乳头瘤病毒感染的变化,同时观察宫颈细胞学、阴道镜Reid评分及宫颈组织病理学变化。结果宫颈持续性高危型人乳头瘤病毒感染者共82例,分为两组:治疗组42例,对照组40例。均完成随访。在治疗结束时、治疗结束后3个月,治疗组清除人乳头瘤病毒的有效率分别为52.38%和61.90%,优于对照组20.00%(P<0.05)和30.00%(P<0.05);治疗结束时、治疗结束后3个月,治疗组细胞学异常的缓解率分别为66.67%和77.78%,优于对照组22.22%(P<0.05)和33.33%(P<0.05);治疗组中Reid评分3分及其以上者例数较对照组少(2 vs 10,P<0.05),且Reid评分较基线明显下降(P<0.05),对照组Reid评分无显著变化(P>0.05)。6个月时治疗组中宫颈上皮内瘤变I级者组织学缓解率优于对照组(72.72%vs 35.00%,P<0.05)。随访期间无严重不良反应。结论口服富马酸丙酚替诺福韦可有效清除宫颈持续性高危型人乳头瘤病毒感染,且安全、临床可行。Objective To investigate the clinical efficacy of nucleoside analogues Tenofovir Alafenamide(TAF)therapy for cervical high-risk HPV(HR-HPV)infection.Methods In this prospective study,a total of 82 patients with persistent cervical HR-HPV infection were randomly divided into two groups.The treatment group(42 patients)administered orally TAF(25mg,once daily,3 months).The control group(40 patients)received no treatment.All patients were followed up for 6 months.HPV testing,ThinPrep cytology test(TCT),and Reid colposcopic index(RCI)grading were performed for both groups.Results HR-HPV remission rates were 52.38%and 61.9%in the treatment group at the 3-and 6-month follow-up,respectively,whereas 20%and 30%in the control group at the 3-and 6-month follow-up visits.Conversion rates of abnormal TCT results were 66.67%and 77.78%in the treatment group at two follow-up visits.In contrast,the control group showed remission rates at 22.2%and 33.3%,respectively.There were 2 and 10 patients with grade of 3-4 or higher at the treatment group and the control group at the 6-month visit,respectively.RCI scoring was declining obviously at 6 months in the treatment group(P<0.05),whereas the control group showed no significantly difference.16 of 22(72.72%)patients with CINⅠin the treatment group were alleviated at 6-month visit compared to 35%in the control group(P<0.05).No serious adverse events happened during the treatment and follow up.Conclusion Tenofovir alafenamide is an effective,safe and accessible treatment for cervical HR-HPV infection.

关 键 词：持续性高危型人乳头瘤病毒 富马酸丙酚替诺福韦 宫颈上皮内瘤变 阴道镜Reid评分 

分 类 号：R737.33[医药卫生—肿瘤]