中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2014年
36期
39-42,46
,共5页
低度宫颈上皮内瘤变%高危人乳头瘤病毒%宫颈环形电切术%期待治疗
低度宮頸上皮內瘤變%高危人乳頭瘤病毒%宮頸環形電切術%期待治療
저도궁경상피내류변%고위인유두류병독%궁경배형전절술%기대치료
Low-grade cervical intraepithelial neoplasia%High risk-human papillomavirus%Loop electrosurgical exci-sion procedure%Expectant management
目的：探讨合并高危人乳头瘤病毒(HR-HPV)阳性低度宫颈上皮内瘤变(CINI)患者转归及适当的治疗方式。方法回顾分析2007年1月~2012年12月北京妇产医院妇瘤门诊阴道镜指导下宫颈活检病理证实为CINI且HR-HPV阳性的412例患者的临床资料。按治疗方法分为LEEP锥切治疗组(LEEP组)和期待治疗组(期待组)，其中LEEP组200例，期待组212例。随访观察患者病变的转归，分析病变进展危险因素。结果患者中位随访时间为36个月，LEEP组患者术后病理级别未上升者157例(未上升组)，43例上升者(上升组)，其中CINⅡ34例，CINⅢ9例。未上升组HR-HPV转阴率为68.8%，期待组为62.7%，两组间差异无统计学意义(P=0.227)。未上升组病变进展率为3.18%，期待组为3.77%，两组间差异无统计学意义(P=0.175)。持续HR-HPV阳性是CINI持续和进展的独立危险因素(OR=24.171，95%CI：10.019~58.309，P=0.000)。结论 HR-HPV阳性的CINI患者首选期待观察治疗，持续HR-HPV阳性CINI患者病变进展增加，应严密随访。
目的：探討閤併高危人乳頭瘤病毒(HR-HPV)暘性低度宮頸上皮內瘤變(CINI)患者轉歸及適噹的治療方式。方法迴顧分析2007年1月~2012年12月北京婦產醫院婦瘤門診陰道鏡指導下宮頸活檢病理證實為CINI且HR-HPV暘性的412例患者的臨床資料。按治療方法分為LEEP錐切治療組(LEEP組)和期待治療組(期待組)，其中LEEP組200例，期待組212例。隨訪觀察患者病變的轉歸，分析病變進展危險因素。結果患者中位隨訪時間為36箇月，LEEP組患者術後病理級彆未上升者157例(未上升組)，43例上升者(上升組)，其中CINⅡ34例，CINⅢ9例。未上升組HR-HPV轉陰率為68.8%，期待組為62.7%，兩組間差異無統計學意義(P=0.227)。未上升組病變進展率為3.18%，期待組為3.77%，兩組間差異無統計學意義(P=0.175)。持續HR-HPV暘性是CINI持續和進展的獨立危險因素(OR=24.171，95%CI：10.019~58.309，P=0.000)。結論 HR-HPV暘性的CINI患者首選期待觀察治療，持續HR-HPV暘性CINI患者病變進展增加，應嚴密隨訪。
목적：탐토합병고위인유두류병독(HR-HPV)양성저도궁경상피내류변(CINI)환자전귀급괄당적치료방식。방법회고분석2007년1월~2012년12월북경부산의원부류문진음도경지도하궁경활검병리증실위CINI차HR-HPV양성적412례환자적림상자료。안치료방법분위LEEP추절치료조(LEEP조)화기대치료조(기대조)，기중LEEP조200례，기대조212례。수방관찰환자병변적전귀，분석병변진전위험인소。결과환자중위수방시간위36개월，LEEP조환자술후병리급별미상승자157례(미상승조)，43례상승자(상승조)，기중CINⅡ34례，CINⅢ9례。미상승조HR-HPV전음솔위68.8%，기대조위62.7%，량조간차이무통계학의의(P=0.227)。미상승조병변진전솔위3.18%，기대조위3.77%，량조간차이무통계학의의(P=0.175)。지속HR-HPV양성시CINI지속화진전적독립위험인소(OR=24.171，95%CI：10.019~58.309，P=0.000)。결론 HR-HPV양성적CINI환자수선기대관찰치료，지속HR-HPV양성CINI환자병변진전증가，응엄밀수방。
Objective To investigate the prognosis and appropriate treatment of low-grade cervical intraepithelial neo-plasia (CINⅠ) patients combined with HR-HPV positive. Methods Clinical data of 412 patients with CINⅠ and HR-HPV positive who confirmed by the cervical biopsy pathology under the guidance of the colposcopy from January 2007 to December 2012 in Beijing Obstetrics and Gynecology Hospital were retrospective analyzed. They were divided into loop electrical excision procedure treatment group (LEEP group) and looking forward to the treatment group (expectant group) according to the treatment. Risk factors were determined by logistic regression, and 200 cases in the LEEP group, 212 cases in the expectant group. The outcome and pathological changes of patients were followed and the risk factors of disease progress were analyzed. Results Median follow-up time of all patients was 36 months, the postopera-tive pathological level was risen in 43 cases of the LEEP group (progression group), and 157 cases were not risen (station-ary group). Disease progression was found in 43 (progression group), among these patients 34 progress to CINII, 9 progress to CINⅢ. The negative conversion ratio of the stationary group was 68.8%, the expectant group was 62.7%, the difference of two groups was no statistically significant (P= 0.227). The disease progression ratio of the stationary group was 3.18%, the expectant group was 3.77%, the difference of two groups was no statistically significant (P=0.175). HR-HPV persistent infection was an independent risk factor for the persistence and progression of CINⅠ(OR=24.171, 95%CI10.019-58.309, P = 0.000). Conclusion Expectant management is the first choice for CINⅠpatients combined with HR-HPV positive, patients with HR-HPV persistent infection should receive close follow-up.
