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目的探讨高危型人乳头瘤病毒(HPV)的病毒负荷量与宫颈病变的发生及进展的关系,宫颈病变经LEEP或冷刀锥切手术后疗效评估。方法选择妇产科门诊就诊宫颈病变患者4712例,采用HC-Ⅱ方法检测其HPV-DNA含量,阴道镜下定位活检,病理学结果为确诊标准。其中CINⅠ～Ⅲ263例先后进行LEEP或冷刀锥切治疗手术,术后6、12月对所有HC-Ⅱ阳性患者进行随访HC-Ⅱ及细胞学检查,并以HC-Ⅱ阳性宫颈炎患者行同期相检查为对照进行疗效评价。结果4712例患者中高危型病毒负荷量随着宫颈病变程度增高而增高,它们之间显著正相关(H=1984.714,P<0.05),慢性宫颈炎与其他3个组差异有统计学意义(P<0.05),而CIN组间差异无统计学意义(P>0.05)。CIN患者经LEEP或冷刀锥切手术后术前HC-Ⅱ阳性CINⅠ、CINⅡ、CINⅢ的术后HPV平均持续感染率分别为0%、0.8%、15.21%,较之保守治疗的慢性宫颈炎组HPV平均感染率36.2%,疗效差异有统计学意义(P<0.05)。结论高病毒负荷量尤其是持续性高病毒负荷量与宫颈病变发生及进展呈正相关;经LEEP或冷刀锥切术后的宫颈病变患者,疗效明显优于持续性高病毒负荷量而采取保守治疗的患者。
Objective To investigate the relationship between the viral load of high-risk human papillomavirus (HPV) and the occurrence and progression of cervical lesions, and evaluate the curative effect of cervical lesions by LEEP or cold-knife conization. Methods 4712 cases of cervical lesions in obstetrics and gynecology clinic were selected. The content of HPV-DNA was detected by HC-Ⅱ method. The results of colposcopy biopsy and pathology were confirmed as the diagnostic criteria. Among them, CINⅠ ~ Ⅲ 263 cases were treated with LEEP or cold knife conization successively, all patients with HC-Ⅱ positive were followed up for HC-Ⅱ and cytology in 6 and 12 months after operation, and patients with HC- Phase examination for the control efficacy evaluation. Results The load of high-risk type virus in 4712 patients increased with the increase of cervical lesions, and there was a significant positive correlation between them (H = 1984.714, P <0.05). The difference between chronic cervicitis and other three groups was statistically significant (P <0.05), but there was no significant difference between CIN groups (P> 0.05). Preoperative HC-Ⅱpositive CINⅠ, CINⅡ, CINⅢin CIN patients after operation of LEEP or cold knife conization had an average continuous infection rate of 0%, 0.8% and 15.21%, respectively, compared with the conservative treatment of chronic cervicitis group The average infection rate of HPV was 36.2%, the difference was statistically significant (P <0.05). Conclusions The high viral load, especially persistent high viral load, is positively correlated with the incidence and progression of cervical lesions. The patients with cervical lesions after LEEP or cold-knife conization are superior to those with sustained high viral load and conservative treatment Of patients.