中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2015年
4期
258-262
,共5页
李宁%佐晶%黄婴%安菊生%姚洪文%李晓光%张蓉%李斌%张询%郭会芹%吴令英
李寧%佐晶%黃嬰%安菊生%姚洪文%李曉光%張蓉%李斌%張詢%郭會芹%吳令英
리저%좌정%황영%안국생%요홍문%리효광%장용%리빈%장순%곽회근%오령영
宫颈上皮内瘤样病变%乳头状瘤病毒科%锥形切除术%肿瘤复发,局部
宮頸上皮內瘤樣病變%乳頭狀瘤病毒科%錐形切除術%腫瘤複髮,跼部
궁경상피내류양병변%유두상류병독과%추형절제술%종류복발,국부
Cervical intraepithelial neoplasia%Papillomaviridae%Conization%Neoplasm recurrence,local
目的:评价HPV分型检测在子宫颈高级别鳞状上皮内病变[HSIL;指子宫颈上皮内瘤变(CIN)Ⅱ和Ⅲ]行子宫颈锥切术后随访中的临床意义。方法对2006年12月至2009年1月在中国医学科学院肿瘤医院诊治的238例行子宫颈锥切术治疗的HSIL患者进行前瞻性观察分析,术后每6个月随访1次,共3次(或至活检组织病理检查证实病变复发),分别于术后6、12、18个月时进行,随访内容包括妇科检查、细胞学检查和HPV分型检测。采用PCR技术进行HPV分型检测,可检测21种HPV亚型。随访截止时间为2010年7月31日,中位随访时间为28.3个月(6.5~43.0个月)。采用Kaplan-Meire法计算中位复发时间;HPV感染状态与病变复发的相关性分析,单因素分析采用log-rank分析法,多因素分析采用Cox风险比例模型。结果238例HSIL患者中,子宫颈锥切术后任1次HPV分型检测阳性者110例(46.2%,110/238),常见的HPV感染亚型为HPV16(45.6%)、58(26.5%),其单一亚型感染与病变复发之间无相关性(P>0.05)。238例患者中,术后复发17例(7.1%,17/238),复发的中位时间为14.9个月(6.0~32.1个月)。单因素分析显示,3次HPV分型检测中至少1次阳性、HPV持续感染、HPV多重感染、同一HPV亚型持续感染、术后18个月HPV仍然阳性与病变复发相关(P<0.01)。多因素分析显示,HPV多重感染(HR=8.6,95%CI为1.8~41.7,P=0.008)和同一HPV亚型持续感染(HR=5.1,95%CI为1.0~24.8,P=0.042)是病变复发的独立危险因素。结论 HSIL患者锥切术后存在HPV多重感染和同一亚型持续感染提示病变复发的风险增高。术后18个月内HPV转阴者复发风险较小。
目的:評價HPV分型檢測在子宮頸高級彆鱗狀上皮內病變[HSIL;指子宮頸上皮內瘤變(CIN)Ⅱ和Ⅲ]行子宮頸錐切術後隨訪中的臨床意義。方法對2006年12月至2009年1月在中國醫學科學院腫瘤醫院診治的238例行子宮頸錐切術治療的HSIL患者進行前瞻性觀察分析,術後每6箇月隨訪1次,共3次(或至活檢組織病理檢查證實病變複髮),分彆于術後6、12、18箇月時進行,隨訪內容包括婦科檢查、細胞學檢查和HPV分型檢測。採用PCR技術進行HPV分型檢測,可檢測21種HPV亞型。隨訪截止時間為2010年7月31日,中位隨訪時間為28.3箇月(6.5~43.0箇月)。採用Kaplan-Meire法計算中位複髮時間;HPV感染狀態與病變複髮的相關性分析,單因素分析採用log-rank分析法,多因素分析採用Cox風險比例模型。結果238例HSIL患者中,子宮頸錐切術後任1次HPV分型檢測暘性者110例(46.2%,110/238),常見的HPV感染亞型為HPV16(45.6%)、58(26.5%),其單一亞型感染與病變複髮之間無相關性(P>0.05)。238例患者中,術後複髮17例(7.1%,17/238),複髮的中位時間為14.9箇月(6.0~32.1箇月)。單因素分析顯示,3次HPV分型檢測中至少1次暘性、HPV持續感染、HPV多重感染、同一HPV亞型持續感染、術後18箇月HPV仍然暘性與病變複髮相關(P<0.01)。多因素分析顯示,HPV多重感染(HR=8.6,95%CI為1.8~41.7,P=0.008)和同一HPV亞型持續感染(HR=5.1,95%CI為1.0~24.8,P=0.042)是病變複髮的獨立危險因素。結論 HSIL患者錐切術後存在HPV多重感染和同一亞型持續感染提示病變複髮的風險增高。術後18箇月內HPV轉陰者複髮風險較小。
목적:평개HPV분형검측재자궁경고급별린상상피내병변[HSIL;지자궁경상피내류변(CIN)Ⅱ화Ⅲ]행자궁경추절술후수방중적림상의의。방법대2006년12월지2009년1월재중국의학과학원종류의원진치적238례행자궁경추절술치료적HSIL환자진행전첨성관찰분석,술후매6개월수방1차,공3차(혹지활검조직병리검사증실병변복발),분별우술후6、12、18개월시진행,수방내용포괄부과검사、세포학검사화HPV분형검측。채용PCR기술진행HPV분형검측,가검측21충HPV아형。수방절지시간위2010년7월31일,중위수방시간위28.3개월(6.5~43.0개월)。채용Kaplan-Meire법계산중위복발시간;HPV감염상태여병변복발적상관성분석,단인소분석채용log-rank분석법,다인소분석채용Cox풍험비례모형。결과238례HSIL환자중,자궁경추절술후임1차HPV분형검측양성자110례(46.2%,110/238),상견적HPV감염아형위HPV16(45.6%)、58(26.5%),기단일아형감염여병변복발지간무상관성(P>0.05)。238례환자중,술후복발17례(7.1%,17/238),복발적중위시간위14.9개월(6.0~32.1개월)。단인소분석현시,3차HPV분형검측중지소1차양성、HPV지속감염、HPV다중감염、동일HPV아형지속감염、술후18개월HPV잉연양성여병변복발상관(P<0.01)。다인소분석현시,HPV다중감염(HR=8.6,95%CI위1.8~41.7,P=0.008)화동일HPV아형지속감염(HR=5.1,95%CI위1.0~24.8,P=0.042)시병변복발적독립위험인소。결론 HSIL환자추절술후존재HPV다중감염화동일아형지속감염제시병변복발적풍험증고。술후18개월내HPV전음자복발풍험교소。
Objective To assess the clinical value of HPV genotyping in follow-up after treatment for cervical high grade squamous intraepithelial lesion (HSIL). Methods Two hundred and thirty eight patients with HSIL receiving conization in Cancer Hospital, Chinese Academy of Medical Sciences from Dec, 2006 to Jan, 2009 were accrued in our study. All the patients were prospectively observed after conization every 6 months for 3 times or till histologically confirmed recurrence. The items in every visit included pelvic examination, cervical cytology and HPV genotyping. Twenty-one HPV genotypes were detected by PCR-hybridization method. The last follow-up was July 31, 2010, and the median follow-up time was 28.3 months (range 6.5-43.0 months). Kaplan-Meire method as used for analyzed the median recurrent time, and the relationships between HPV status and recurrent disease were calculated by and log-rank test and Cox-regression model. Results Among the 238 patients, 110 cases (46.2%, 110/238) had positive result of HPV DNA testing at any visit. The most common HPV types detected in follow-up were HPV16 (45.6%), HPV58 (26.5%), and HPV52 (16.9%). There was no correlation between recurrent disease and any individual high risk HPV infections (P>0.05). Seventeen recurrent cases (7.1%) were identified in 238 patients within a median recurrent time of 14.9 months (range 6.0-32.1 months). In univariate analyses, HPV positive at any visit, persistent infection, multiple infection, type specific persistent infection and positive HPV at 18 months after conization were indicators for residual/recurrent disease (P<0.05). In multivariate analysis, only multiple HPV infection (HR=8.6, 95%CI:1.8-41.7, P=0.008) and type specific persistent HPV infection (HR=5.1, 95%CI: 1.0-24.8, P=0.042) had an elevated risk of recurrent disease. Conclusions HSIL with multiple HPV infection and type specific persistent HPV infection in follow-up are at high risk of recurrent disease. Patients with HPV turning into negative within 18 months after treatment have a low risk of recurrence.