高级别宫颈上皮内病变患者环形电切术后HPV持续感染及病变残留复发的危险因素  

Risk factors for persistent HPV infection and residual recurrence in patients with high-grade cervical intraepithelial neoplasia after LEEP surgery

作　　者：蔡礼仲 姚锐 CAI Li-zhong;YAO Rui(Department of Gynecology,Wenzhou Hospital of Integrated Traditional and Western Medicine,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州市中西医结合医院妇科,浙江温州325000

出　　处：《中国妇幼保健》2024年第19期3775-3780,共6页Maternal and Child Health Care of China

基　　金：浙江省温州市基础性科研项目(Y20210374)。

摘　　要：目的 探讨高级别宫颈上皮内病变(HSIL)患者宫颈环形电切(LEEP)术后人乳头瘤病毒(HPV)持续感染和病变残留复发情况及其影响因素。方法 选取2018年12月—2021年12月在温州市中西医结合医院行LEEP术且术后病理诊断为HSIL的148例患者为研究对象,随访至少12个月观察术后HPV转阴率及病变残留或复发情况,采用logistic回归分析其影响因素。结果 在148例行宫颈LEEP术患者中,5例患者(3.4%)在随访期间出现宫颈CIN病变残留/复发,其中4例(16%)发生在HPV持续感染的患者中,3例为HPV16型持续感染。logistic回归分析显示,HPV持续感染患者病变残留或复发OR值为31.218,95%CI为1.396~697.895,差异有统计学意义(P<0.05)。此外,不同年龄、绝经状态、细胞学、腺体受累情况患者的病变残留或复发风险差异无统计学意义(P>0.05)。对宫颈LEEP术后HPV持续感染的危险因素进行分析,发现年龄≥50岁患者HPV持续感染风险增加,OR值为14, 95%CI为1.905~102.895,差异有统计学意义(P<0.05);而绝经后患者HPV持续感染风险增加,OR值为23.333,95%CI为3.075~177.041,差异有统计学意义(P<0.01)。结论 术后HPV持续感染而非其他因素会增加宫颈上皮内瘤变(CIN)残留复发风险。高龄和绝经状态是HPV持续感染的独立危险因素。在LEEP术后随访监测中应着重关注HPV基因型,特别是HPV16型持续阳性患者。术后密切随访和针对性管理对减少CIN复发具有积极作用。Objective To investigate the status and influencing factors of persistent HPV infection and residual recurrence in patients with high-grade cervical intraepithelial neoplasia after cervical circular electrotomy.Methods 148 patients who underwent LEEP surgery in our hospital from December 2018 to December 2021 and were pathologic diagnosed as HSIL after surgery were selected as the study ob⁃jects.The rate of HPV turning negative after surgery and the residual or recurrence of lesions were observed for at least 12 months,and the influencing factors were analyzed by logistic regression.Results Of the 148 patients who underwent LEEP surgery,5(3.4%)developed residual/recurrent cervical CIN lesions during follow-up,of which 4(16%)occurred in patients with persistent HPV infection,and 3 were HPV16 persistent infection.logistic regression analysis showed that the OR value of residual or recurrent lesions in patients with persistent HPV infection was 31.218,95%CI was 1.396-697.895,and the difference was statistically significant(P<0.05).In addition,there were no significant differences in the risk of residual or recurrent lesions among patients with different age,menopausal status,cytology,and glandular involvement(P>0.05).Risk factors for persistent human papillomavirus(HPV)infection after cervical LEEP surgery were analyzed,and it was found that patients aged≥50 years had an increased risk of HPV persistent infection,OR value was 14,95%CI was 1.905-102.895,and the difference was statistically significant(P<0.05).Postmenopausal patients had an increased risk of persistent HPV infection,with an OR value of 23.333 and a 95%CI of 3.075-177.041.The difference was statistically significant(P<0.01).Con⁃clusion Old age and menopause are independent risk factors for HPV persistent infection.Persistent HPV infection after surgery,rather than other factors,increases the risk of residual CIN recurrence.In the follow-up monitoring after LEEP,attention should be paid to HPV genotypes,especially those with persistent positive HP

关 键 词：高级别宫颈上皮内病变 子宫颈环形电切术 HPV持续感染 病变残留复发 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]