CAJ | 학술논문

目的：对高危型 HPV 检测如何应用于宫颈癌癌前病变的随访进行探索，比较不同方法治疗宫颈病变患者的临床效果，为临床治疗提供依据。方法：选取在我院进行治疗的高危型 HPV 阳性、通过组织病理学进行确诊的宫颈癌变患者360例，按照患者病变的程度对其进行分组，一组为低度鳞状上皮内瘤变（LSIL），其中包括炎症和 CINⅠ的患者；高度鳞状上皮内瘤变（HSIL），其中包括 CINⅡ－Ⅲ的患者；宫颈 CIN－III 的患者（没有生育要求、年龄偏大者）。对于病变≥CINⅡ或者 CINⅠ中没有随访条件的患者采取手术治疗，在治疗的第3、6、9、12、18、24个月进行随访，随访时均采取 HPV、细胞学检查，并且有必要可以进行活检。结果：所有患者采取不同的治疗方式，其中干扰素栓治疗120例，宫颈锥切术治疗193例，全子宫切除术治疗47例，不同的治疗方式的 HPV 转阴率之间具有统计学意义上的差异。所有患者中，年龄≤35岁的患者的 HPV 转阴率为91.35％，年龄为35～50之间的患者的 HPV 转阴率为90.31％，年龄＞50岁的患者 HPV转阴率为76.54％，并且其之间差异具有统计学意义（P ＜0.05）。HPV 不同程度载量组之间的差异没有统计学意义（P ＞0.05）。三组治疗之后的转阴时间的中位数分别是7、7、4个月，其差异具有统计学意义（P ＜0.05）。321例 HPV 转阴的患者都没有发现病变的残留并且均未复发。结论：高危型 HPV 检测对于不同程度的宫颈病变的随访有着重要的价值。本次研究所采取的不同治疗的方法可以有效清除宫颈病变并且治疗 HPV 感染，其中干扰素栓的治疗效果要比其余两种治疗方式差。在治疗之后患者如果 HPV 继续保持阳性说明患者有病变残留或者复发。
목적：대고위형 HPV 검측여하응용우궁경암암전병변적수방진행탐색，비교불동방법치료궁경병변환자적림상효과，위림상치료제공의거。방법：선취재아원진행치료적고위형 HPV 양성、통과조직병이학진행학진적궁경암변환자360례，안조환자병변적정도대기진행분조，일조위저도린상상피내류변（LSIL），기중포괄염증화 CINⅠ적환자；고도린상상피내류변（HSIL），기중포괄 CINⅡ－Ⅲ적환자；궁경 CIN－III 적환자（몰유생육요구、년령편대자）。대우병변≥CINⅡ혹자 CINⅠ중몰유수방조건적환자채취수술치료，재치료적제3、6、9、12、18、24개월진행수방，수방시균채취 HPV、세포학검사，병차유필요가이진행활검。결과：소유환자채취불동적치료방식，기중간우소전치료120례，궁경추절술치료193례，전자궁절제술치료47례，불동적치료방식적 HPV 전음솔지간구유통계학의의상적차이。소유환자중，년령≤35세적환자적 HPV 전음솔위91.35％，년령위35～50지간적환자적 HPV 전음솔위90.31％，년령＞50세적환자 HPV전음솔위76.54％，병차기지간차이구유통계학의의（P ＜0.05）。HPV 불동정도재량조지간적차이몰유통계학의의（P ＞0.05）。삼조치료지후적전음시간적중위수분별시7、7、4개월，기차이구유통계학의의（P ＜0.05）。321례 HPV 전음적환자도몰유발현병변적잔류병차균미복발。결론：고위형 HPV 검측대우불동정도적궁경병변적수방유착중요적개치。본차연구소채취적불동치료적방법가이유효청제궁경병변병차치료 HPV 감염，기중간우소전적치료효과요비기여량충치료방식차。재치료지후환자여과 HPV 계속보지양성설명환자유병변잔류혹자복발。
Objectives:To explore how to apply high -risk HPV detection in the follow -up of cervical precancer,and compare the clinical effect of different treatment methods of cervical lesions,to provide basis for clinical treatment.Methods:360 high -risk HPV -positive patients that have been confirmed through histopatholo-gy in our hospital were selected and according to the degree of lesion were divided into three groups:low -grade squalors intraepithelial lesions (LSIL)group,including patients with inflammation and CINⅠ;high -grade squal-ors intraepithelial lesions (HSIL)group,including CINⅡ -Ⅲ patients;and cervical CIN -III patients.Patients with lesions  CINⅡ or no follow -up conditions for CINⅠ received surgery,and were followed up at the 3,6,9, 12,18,24 month after treatment by HPV,cytology and biopsy when necessary.Results:All patients received differ-ent treatments,including interferon treatment of 120 cases,conization treatment of 193 cases,hysterectomy treat-ment of 47 cases,with statistically significant difference in HPV negative rates between different treatment methods. For patients aged  35 -year -old,between the age of 35 -50,and >50 years old,the HPV negative rate was 91.35%,90.31% and 76.54% respectively,with statistically significant difference (P <0.05).The difference in different levels of HPV load was not statistically significant (P >0.05).The median clearance time of the three groups after treatment was 7,7,4 months respectively,with statistically significant difference (P <0.05).All the 321 HPV negative patients found no residual lesions and no recurrence.Conclusions:High -risk HPV detection is of important value for follow -up of cervical lesions with varying degrees.Different treatment methods in this study can be taken to effectively remove HPV infection in cervical lesions and for treatment,where the interferon treatment effect is worse than the rest two treatment methods.If the patient is still HPV positive after treatment,there is resid-ual lesion or recurrence potential.