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目的:探讨各级别宫颈上皮内瘤变(CIN)经宫颈环切术(LEEP)治疗前后高危型人乳头瘤病毒(HR-HPV)的变化规律及临床意义。方法:各级别CIN且HR-HPV阳性患者155例,行LEEP术后6个月再次行膜式液基细胞学检查(TCT)并测定HR-HPV负荷量。结果:(1)CINⅠ、CINⅡ、CINⅢ病变HR-HPV负荷量(RLU/CO)分别为333.23±911.83,303.88±795.30及220.72±680.92,三者差异无统计学意义(P=0.6868);(2)术后6个月HPV总转阴率为62.58%(97/155)。术前HPV负荷量≤300者术后转阴率为71.60%(58/81),>300者转阴率为52.70%(39/74),差异有统计学意义(P=0.0294)。并且术后病灶残留与术前高病毒负荷量相关。HPV清除率与年龄及病变程度无相关性;(3)术后6个月HPV负荷量≥10的患者中43.75%(14/32)的患者仍存在不同程度的CIN,而HPV<10的患者中只有0.81%(1/123)的患者存在CIN,以10为阈值判断病灶残留的敏感性达93.33%,特异性达87.14%。结论:(1)HPV负荷量高低与病变程度无关,但与术后病毒清除相关;(2)在切缘阴性的前提下,若术前高病毒负荷量,发生病灶残留的风险增高;(3)术后6月宫颈病变的转归与同期检测的病毒负荷量相关。
Objective: To investigate the changes and clinical significance of high-risk human papillomavirus (HR-HPV) before and after cervical intraepithelial neoplasia (LEEP) at all levels of cervical intraepithelial neoplasia (CIN). Methods: A total of 155 CIN-positive and HR-HPV-positive patients were enrolled in this study. Membrane-based liquid-based cytology (TCT) and HR-HPV loading were performed 6 months after LEEP. Results: (1) The HR-HPV load (RLU / CO) in CINⅠ, CINⅡ and CINⅢ lesions were 333.23 ± 911.83, 303.88 ± 795.30 and 220.72 ± 680.92 respectively, with no significant difference (P = 0.6868) ) After 6 months, the total negative conversion rate of HPV was 62.58% (97/155). The preoperative negative rate of HPV load ≤300 was 71.60% (58/81) and the rate of> 300 was 52.70% (39/74), the difference was statistically significant (P = 0.0294). And postoperative residual lesions and preoperative high viral load related. (3) 43.75% (14/32) of patients with HPV load≥10 still had different degrees of CIN after 6 months, while those with HPV <10 Only 0.81% (1/123) of patients had CIN, the threshold of 10 to determine the residual sensitivity of 93.33%, specificity of 87.14%. Conclusion: (1) The level of HPV load has nothing to do with the severity of the disease, but it is related to the postoperative virus clearance. (2) If the preoperative high viral load, the risk of residual lesions increases; (3) ) The outcome of cervical lesions at 6 months after surgery was correlated with the viral load at the same period.