宫颈上皮内瘤变患者术后HR-HPV持续感染影响因素  

Influencing factors of persistent HR-HPV infection in patients with cervical intraepithelial neoplasia

作　　者：董蔼玲 宋晓婕[2] 孔繁丽 吴美琴 雷凤琼 范丽[1] 唐葶婷 胡超群 朱贞 叶蕾[1] DONG Ai-ling;SONG Xiao-jie;KONG Fan-li;WU Mei-qin;LEI Feng-qiong;FAN Li;TANG Ting-ting;HU Chao-qun;ZHU Zhen;YE Lei(Wuhan Children′s Hospital Affiliated to Tongji Medical College of Huazhong University of science and Technology,Wuhan,Hubei 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院手术室,湖北武汉430016 [2]华中科技大学同济医学院附属武汉儿童医院妇科,湖北武汉430016 [3]华中科技大学同济医学院附属武汉儿童医院麻醉科,湖北武汉430016 [4]华中科技大学同济医学院附属武汉儿童医院护理部,湖北武汉430016

出　　处：《中华医院感染学杂志》2021年第20期3191-3195,共5页Chinese Journal of Nosocomiology

基　　金：武汉市卫健委科研基金资助项目(WG15D11)。

摘　　要：目的探讨宫颈上皮内瘤变患者术后高危型人乳头瘤病毒(HR-HPV)持续感染的影响因素。方法选取2018年1月-2019年12月华中科技大学同济医学院附属武汉儿童医院260例宫颈上皮内瘤变(CIN)合并HR-HPV感染患者,所有患者均行宫颈环形电切术(LEEP)治疗,并于手术后1年通过门诊复查的方式,进行HR-HPV复查,观察患者HR-HPV持续感染情况,并分析持续感染的影响因素。结果术后1年发生HR-HPV持续感染31例,发生率为11.92%(31/260),多重感染转阴率为71.79%(28/39)低于单一感染90.95%(201/221),HPV16感染转阴率为69.33%(52/75)低于其他型别95.68%(177/185)(P<0.05);术前HR-HPV负荷量为1~10 RLU/CO、10~100 RLU/CO、100~300 RLU/CO患者,术后1年HR-HPV持续感染发生率低于负荷量300~500 RLU/CO、>500 RLU/CO患者(P<0.05);术前HR-HPV负荷量对术后1年HR-HPV持续感染预测受试者工作特征(ROC)曲线分析结果显示,当以341 RLU/CO作为截点值时,ROC曲线下面积为0.747,敏感度80.00%、特异性70.00%;术前HR-HPV多重感染、术前HR-HPV16感染、术前病毒载量是患者术后1年HR-HPV持续感染发生的影响因素(P<0.05)。结论 LEEP对宫颈HR-HPV清除有一定作用,持续性HR-HPV的发生与单一或多重感染、感染型别、病毒载量有关。OBJECTIVE To investigate the influencing factors of high-risk human papilloma virus(HR-HPV) persistent infection in patients with cervical intraepithelial neoplasia(CIN) after surgery.METHODS A total of 260 patients with CIN combined with HR-HPV infection in Wuhan children′s Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from Jan.2018 to Dec.2019 were selected.All patients underwent loop electrosurgical excision procedure(LEEP),and the HR-HPV re-examination was performed through outpatient re-examination one year after surgery.The persistent HR-HPV infection in patients was observed,and the influencing factors of persistent infection were analyzed.RESULTS 31 cases of persistent HR-HPV infection occurred 1 year after operation,the incidence rate was 11.92%(31/260).The negative conversion ratio of multiple infection was 71.79%(28/39),lower than 90.95%(201/221) of single infection.The negative conversion rate of HPV16 infection was 69.33%(52/75),lower than 95.68%(177/185) of other types(P<0.05).The incidence of persistent HR-HPV infection in patients with preoperative HR-HPV loads of 1-10 RLU/CO,10-100 RLU/CO and 100-300 RLU/CO,respectively,after one year surgery was significantly lower than that of 300-500 RLU/CO and significantly higher than 500 RLU/CO,respectively.(P<0.05).The receiver operating characteristic curve(ROC) analysis results of the preoperative HR-HPV load for the prediction of persistent HR-HPV infection showed that when cut-off value was 341 RLU/CO,the area under the ROC curve(AUC) was 0.747,with the sensitivity and specificity of 80.00% and 70.00%,respectively.Preoperative HR-HPV multiple infection,HR-HPV16 infection and viral load were the influencing factors of the occurrence of persistent HR-HPV infection at 1 year after surgery(P<0.05).CONCLUSION LEEP was of certain effect on the clearance of cervical HR-HPV.The occurrence of persistent HR-HPV was related to single or multiple infection,infection types and viral load.

关 键 词：宫颈上皮内瘤变 宫颈环形电切术 高危型人乳头瘤病毒 持续感染 影响因素 

分 类 号：R711.32[医药卫生—妇产科学]