机体免疫应答与高级别宫颈上皮内瘤变术后HPV转归的关系  

Relationship between immune response and HPV outcome after high-grade cervical intraepithelial neoplasia

作　　者：段小令 陆琦 DUAN Xiaoling;LU Qi(Department of Obstetrics and Gynecology,Jinshan Hospital,Fudan University,Shanghai 201508,China)

机构地区：[1]复旦大学附属金山医院妇产科,上海201508

出　　处：《中国生育健康杂志》2025年第3期226-234,共9页Chinese Journal of Reproductive Health

摘　　要：目的探讨机体免疫应答与高级别宫颈上皮内瘤变(HSIL)患者术后人乳头状瘤病毒(HPV)转归的关系。方法选择本院在2020年9月—2022年3月期间收治的HSIL患者213例作为研究对象,年龄为28~63岁,平均年龄(39.0±4.8)岁,对比手术前、术后3月、术后6月及术后12月HSIL患者各项血清免疫指标的变化。然后根据术后12月HSIL患者HPV转归情况分为转阴组(n=162)和未转阴组(n=51),对比两组一般资料和临床资料,利用多因素Logistic回归分析,筛选HSIL患者HPV转归的独立影响因素,比较各因素对HPV转归的预测效能,并分析各因素与HPV转归的关联性。结果HSIL患者术后12月复诊时CD3+细胞数、CD4+细胞数、Th/Ts、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平显著升高,CD8+细胞数则显著降低(P均<0.05);未转阴组患者年龄显著高于转阴组,且未转阴组患者有流产史的比例显著高于转阴组(P均<0.05);转阴组患者CD4+和Th/Ts水平显著高于未转阴组,且转阴组患者白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平显著低于未转阴组,两组唾液酸苷酶(SIA)阳性、H2O2阳性及阴道清洁度(CLE)异常的患者数差异具有统计学意义(P均<0.05);多因素Logistic回归分析结果显示,年龄大和TNF-α水平高是HSIL患者术后HPV未转阴的危险因素,CD4+细胞数多和Th/Ts水平高是HSIL患者术后HPV未转阴的保护因素(P<0.05),年龄+CD4++Th/Ts+TNF-α联合检测HSIL患者术后HPV转归情况AUC为0.881,约登指数为0.695、准确性为0.848,均高于其他预测模型;将年龄、CD4+、Th/Ts及TNF-α水平逐层划分,建立Logistic模型逐步排除混杂因素后,年龄、CD4+、Th/Ts及TNF-α水平仍为HSIL患者术后HPV转归的独立影响因素。随着年龄、TNF-α的升高,CD4+细胞数、Th/Ts水平的降低,其关联效应值也相应升高(P趋势<0.05)。结论与术前相比,术后12月HSIL患者细胞免疫应答和体液免疫应答均得到显著改善;年龄�Objective To investigate the relationship between immune response and human papilloma virus(HPV)outcome in patients with high-grade cervical intraepithelial neoplasia(HSIL).Methods 213 patients with HSIL admitted to our hospital from September 2020 to March 2022 were selected as the research subjects.They aged 28-63 years with an average age of(39.0±4.8)years.We compared the changes in various serum immune indicators of HSIL patients before surgery,3 months after surgery,6 months after surgery,and 12 months after surgery.According to the HPV conversion status of HSIL patients 12 months after surgery,they were divided into a negative conversion group(n=162)and a non-negative conversion group(n=51).We compared the general and clinical data of the two groups,and used multiple logistic regression analysis to screen independent influencing factors of HPV conversion in HSIL patients.We also compared the predictive efficacy of each factor for HPV conversion,and analyzed the correlation between each factor and HPV conversion.Results The levels of CD3+,CD4+,Th/Ts,immunoglobulin A(IgA),immunoglobulin G(IgG)and immunoglobulin M(IgM)were significantly increased in patients with HSIL 12 months after surgery,while the levels of CD8+were significantly decreased(P<0.05).The age of patients and the proportion of patients with abortion history in the non-negative conversion group were significantly higher than those in the negative conversion group(P<0.05).The levels of CD4+and Th/Ts in patients with negative conversion were significantly higher than those in patients without negative conversion,and the levels of IL-6 and TNF-αin patients with negative conversion were significantly lower than those in patients without negative conversion.There were significant differences in the number of sialidase(SIA)positive,H2O2 positive and abnormal vaginal cleanliness(CLE)patients between the two groups(P<0.05).Multivariate logistic regression analysis showed that older age and higher TNF-αlevel were risk factors for postoperative HPV non

关 键 词：机体免疫应答 高级别宫颈上皮内瘤变 T淋巴细胞 HPV转归 

分 类 号：R71[医药卫生—妇产科学]