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目的:探讨宫颈脱落细胞人乳头瘤病毒(HPV)分型检测在宫颈病变诊断和宫颈上皮内瘤变(CIN)行宫颈环形电切(LEEP)术后随访中的意义。方法:选择本院因宫颈病变行宫颈病理检查的患者1280例(包括宫颈炎症870例,CINⅠ115例,CINⅡ102例,CINⅢ109例,宫颈癌84例),均采用导流杂交基因芯片技术行HPV分型检测。对其中304例行LEEP治疗后的CIN患者于术后6个月、1～2年行HPV分型检测。结果:(1)随宫颈病变程度的增高,HPV感染率、高危型HPV(HR-HPV)感染率、HPV单一感染率均呈增高趋势,而多重感染率与宫颈病变级别无关。(2)本组中304例CIN患者在我院行LEEP治疗后6个月和1～2年定期随访。术前、术后6个月、术后1～2年HR-HPV感染率(81.3%、22.4%、5.6%)逐渐降低(P<0.05)。CINⅠ、CINⅡ、CINⅢ患者术后6个月HPV感染率分别为16.8%、21.9%、28.0%(P>0.05),术后1～2年HPV感染率分别为3.0%、5.2%、8.4%(P>0.05)。(3)术后1～2年HPV阴性组、HR-HPV阳性组、低危型HPV(LR-HPV)阳性组复发率分别为0.7%(2/281)、41.2%(7/17)、16.7%(1/6)(P<0.05)。结论:HPV分型检测为早期发现和预测宫颈病变转归提供了可靠警示,可作为CIN患者LEEP术后监测预后的重要指标。
Objective: To investigate the significance of HPV type typing in cervical exfoliated cells in the diagnosis of cervical lesions and the follow-up of cervical ring excision (LEEP) after cervical intraepithelial neoplasia (CIN). Methods: A total of 1280 patients (870 cases of cervical inflammation, 115 cases of CINⅠ, 102 cases of CINⅡ, 109 cases of CINⅢ, 84 cases of cervical cancer) undergoing cervix pathological examination in our hospital were selected. Detection. Of 304 cases of CIN patients treated with LEEP after 6 months, 1-2 years of detection of HPV typing. Results: (1) With the increase of cervical lesions, HPV infection rate, HR-HPV infection rate and HPV single infection rate all showed an increasing trend, while the multiple infection rate had no relation with the grade of cervical lesions. (2) 304 patients with CIN in our hospital were followed up regularly for 6 months and 1 to 2 years after LEEP treatment in our hospital. The HR-HPV infection rates (81.3%, 22.4%, 5.6%) decreased gradually from preoperative to postoperative 6 months and 1-2 years after operation (P <0.05). The HPV infection rates in patients with CINⅠ, CINⅡ and CINⅢ at 6 months after operation were 16.8%, 21.9% and 28.0% respectively (P> 0.05). HPV infection rates were 3.0%, 5.2% and 8.4% P> 0.05). (3) The recurrence rates in HPV-negative group, HR-HPV positive group and LR-HPV positive group were 0.7% (2/281), 41.2% (7/17) 16.7% (1/6) (P <0.05). Conclusion: HPV typing test provides a reliable warning for the early detection and prognosis of cervical lesions, which can be used as an important index for monitoring prognosis after LEEP in patients with CIN.