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目的:探索HPV16型E6、L1变异体对宫颈高度鳞状上皮内病变(HSIL)锥切术后持续感染及复发的预警作用。方法:选取2011年5月到2012年6月于上海市浦东新区人民医院HPV16型阳性、LEEP术后切缘阴性的HSIL患者100例,对其宫颈脱落细胞E6、L1基因测序,随访2年。持续感染及复发者再次测序明确HPV16变异体。结果:100例均检测出变异体,其中81.0%属亚洲原型(As.P),14.0%属欧洲变异体,2.0%属欧洲原型(EP),3.0%非洲1变异体(Af1)。欧洲变异体T350G、A442C有更高的HPV16持续感染及复发相关性(P<0.001)。94.0%的标本中出现L1基因变异H228D、T292A、449ins S,复发组、持续感染组与病毒清除组比较,差异无统计学意义(P>0.05)。结论:HPV16变异体与HSIL发生密切相关。上海浦东地区HPVl6导致的HSIL多属于亚洲型变异体,欧洲变异体E6 T350G/A442C可能有更高的锥切术后HPV16复发及持续感染相关性。L1基因变异可能不影响HSIL锥切术后HPV16病毒的复发及持续感染。
Objective: To explore the early warning effect of HPV16 E6 and L1 variants on the persistent infection and relapse after conization of cervical high grade squamous intraepithelial lesion (HSIL). Methods: From May 2011 to June 2012 in Shanghai Pudong New Area People’s Hospital HPV16 positive, LEEP negative edge of the 100 cases of HSIL patients, their cervical exfoliated cells E6, L1 gene sequencing, followed up for 2 years. Persistent infection and relapse were sequenced again HPV16 variant. Results: All the 100 isolates were detected, of which 81.0% belonged to As.P, 14.0% belonged to European variants, 2.0% belonged to European Prototypes and 3.0% to African 1 variants (Af1). The European variants T350G and A442C have a higher correlation with persistent HPV infection and relapse (P <0.001). There were no significant differences in L1 gene mutation H228D, T292A, 449ins S in 94.0% of the cases, recurrence group, persistent infection group and virus clearance group (P> 0.05). Conclusion: HPV16 variants are closely related to HSIL. HSIL in Shanghai Pudong area mostly belongs to the Asian variant, while the European variant E6 T350G / A442C may have a higher correlation with HPV16 recurrence and persistent infection after conization. L1 gene mutation may not affect the recurrence and persistent infection of HPV16 after HSIL conization.