合肥地区478例宫颈正常患者HR-HPV感染转归及其与宫颈细胞学关系  

The outcome of HR-HPV infection and its relationship with cervical cytology in 478 patients with normal cervix in Hefei area

作　　者：李青[1] 王青元[1] 张婉莹[1] 王文艳[1] Li Qing;Wang Qingyuan;Zhang Wanying;Wang Wenyan(Dept of Obstetrics and Gynecology,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601)

机构地区：[1]安徽医科大学第二附属医院妇产科,合肥230601

出　　处：《安徽医科大学学报》2025年第1期173-179,共7页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:81100412);安徽省自然科学基金(编号:2008085MH283)。

摘　　要：目的探讨合肥地区阴道镜检查宫颈为正常的患者感染高危型人乳头瘤病毒(HR-HPV)后转归的影响因素及持续HR-HPV感染与宫颈细胞学关系。方法收集阴道镜检查的患者资料,选择经阴道镜检查为宫颈正常的478例HR-HPV感染的患者,记录其年龄、性伙伴数目、避孕方式等相关基本信息,随访2年,追踪其阴道使用干扰素、第1年和第2年的HR-HPV感染情况和宫颈液基薄层细胞学检查(LCT)结果,根据基本信息进行单因素和多因素分析,并绘制ROC曲线。结果1年的HR-HPV清除率为59.41%,2年的清除率为66.75%,其他(31、33、35、39、45、51、52、56、58、59、66、68)12种型感染较16型、18型多见。单因素及多因素分析显示,年龄>50岁、性伙伴数目≥2个、宫颈锥切手术史患者HR-HPV持续感染风险均增加(χ_(年龄)^(2)=21.676,P<0.001;χ_(性伙伴数目)^(2)=8.262,P=0.004;χ_(宫颈锥切手术史)^(2)=11.267,P=0.001),使用避孕套避孕及阴道使用干扰素患者HR-HPV感染风险降低,差异有统计学意义(χ_(使用避孕套)^(2)=10.885,P=0.001;χ_(使用干扰素)^(2)=4.099,P=0.043)。利用高危因素构建ROC曲线模型,联合诊断HR-HPV持续感染的ROC曲线下面积(AUC)高于单独诊断的AUC,联合诊断AUC为0.737。HR-HPV持续感染为LCT异常的独立危险因素,模型预测LCT异常的AUC为0.755,HR-HPV持续感染2年未发现癌症患者,LCT异常比例高于HR-HPV转阴患者,差异有统计学意义(χ^(2)=39.64,P<0.001)。结论对年龄>50岁、性伙伴多、有宫颈手术史、未用干扰素、未用避孕套构建的联合ROC模型对预测HR-HPV持续感染有一定价值,持续HR-HPV感染对LCT异常起到预测价值。Objective To investigate the factors affecting the outcome of high-risk human papillomavirus(HRHPV)infection in patients with normal cervix examined by colposcopy in Hefei area and the relationship between persistent HR-HPV infection and cervical cytology.Methods Data of colposcopy patients were collected from 478 HR-HPV infected patients with normal cervix through colposcopy.Their age,number of sexual partners,contraceptive methods and other relevant basic information were recorded.Vaginal interferon use,HR-HPV infection at year 1 and year 2,and cervical liquid-based cytology test(LCT)results were tracked,univariate and multivariate analyses were performed based on basic information,and ROC curves were plotted.Results The HR-HPV clearance rate at 1 year was 59.41%,and the clearance rate at 2 years was 66.75%.The other 12 types of infection(31,33,35,39,45,51,52,56,58,59,66,68)were more common than the 16 and 18 types.Univariate and multivariate analyses showed that age>50 years,number of sexual partners≥2,and history of cervical conectomy increased the risk of persistent HR-HPV infection(χ_( age)^(2)=21.676,P<0.001;χ_( number of sexual partners)^(2)=8.262,P=0.004;χ_(history of cervical conectomy)^(2)=11.267,P=0.001).The risk of HR-HPV infection was significantly lower when condom or vaginal interferon was used(χ_(condom use)^(2)=10.885,P=0.001;χ_(interferon use)^(2)=4.099,P=0.043).The area under the ROC curve(AUC)of combined diagnosis of HR-HPV persistent infection was higher than that of single diagnosis,and the AUC of combined diagnosis was 0.737.Persistent HR-HPV infection was an independent risk factor for abnormal LCT,and the AUC predicted by the model was 0.755.No cancer was found in patients with persistent HR-HPV infection for 2 years,and the proportion of abnormal LCT was higher than that in patients with negative HR-HPV.The difference was statistically significant(χ^(2)=39.64,P<0.001).Conclusion The combined ROC model constructed for patients>50 years old,with multiple sexual partners,history of

关 键 词：HR-HPV 持续感染 阴道镜检查 宫颈细胞学 转归 液基细胞学 

分 类 号：R711[医药卫生—妇产科学]