宫颈癌前病变程度、高危型HPV病毒负荷量及HPV清除率关系的研究

摘要

目的:探讨宫颈癌前病变程度、高危型人乳头瘤病毒(hr HPV)病毒负荷量以及HPV清除率之间的关系.方法:选取2013年1月至2014年12月南方医科大学附属深圳市龙华新区人民医院收治的354例宫颈癌前病变患者,均为不同级别的宫颈上皮内瘤变(CIN)(hr HPV均为阳性),分析不同病变程度与h>HPV病毒载量关系,对hr-HPV阳性患者行2年的跟踪检查,研究HPV清除率与宫颈癌前病变程度及HPV病毒载量之间的关系.结果:CIN Ⅰ期患者术前hr-HPV病毒载量低于CINⅡ期、CINⅢ期患者(P＜0.05).Spearman等级相关性分析结果显示,宫颈癌前病变患者病变级别与其术前hr-HPV病毒载量无相关关系(r =0.421,P=0.23).不同CIN分期的患者术后3个月、6个月、12个月及24个月hr-HPV清除率比较,差异均无统计学意义(均P＞0.05);不同术前病毒载量的CIN患者术后3个月、6个月hr-HPV持续感染率组间两两比较差异均有统计学意义(均P ＜0.05),hr-HPV持续感染率随病毒载量的升高而升高,术前病毒载量≥1 000 RLU/CO的患者术后3个月、6个月、12个月hr-HPV持续感染率显著高于1～99 RLU/CO和100～999 RLU/CO的患者(P＜0.05),术后24个月不同术前病毒载量的CIN患者hr-HPV持续感染率比较差异无统计学意义(P＞0.05).结论:宫颈癌前病变患者病变级别与其术前hr-HPV病毒载量及术后hrHPV清除率无关,但高病毒载量宫颈癌前病变患者术后hr-HPV持续感染率较高.%Objective:To study the relevance of high-risk human papillomavirus (hr-HPV) viral load,HPV clearance rate and the degree of cervical cancer precancerous lesions.Methods:354 patients with different grades of cervical intraepithelial neoplasias (CIN) (all positive with hr-HPV) treated in our hospital from January 2013 to December 2014 were selected.The relationship between the severity of lesions and hr-HPV viral load were analyzed.After a two-year follow-up for these positive hr-HPV patients,the relationships of HPV clearance rate with hr-HPV viral load and precancerous lesions degree were analyzed.Results:Patients with CIN grade Ⅰ had lower hr-HPV viral load than those with CIN grade Ⅱ and Ⅲ at preoperation (P ＜0.05).Spearman's rank correlation analysis showed that the CIN grade was not associated with preoperational hr-HPV viral load (r =0.421,P =0.23).No significant differences were found in hr-HPV clearance rates at 3,6,12 and 24 months postoperation among patients with different CIN grades (P ＞0.05).There were statistical differences in hr-HPV continuous infection rates at 3 and 6 months postoperation among patients with different preoperative hr-HPV viral load (P ＜0.05).The hr-HPV continuous infection rates were increased concurrently with the elevated hr-HPV viral load.Patients with preoperative hr-HPV viral load ≥1000 RLU/CO had higher hr-HPV continuous infection rates at 3,6 and 12 months postoperation than those with 1-99 RLU/CO and 100-999 RLU/CO (P ＜0.05).There was no significant difference in hr-HPV continuous infection rates at 24 months postoperation among patients with different preoperative hr-HPV viral load (P ＞0.05).Conclusion:Patients with different CIN grads were not correlated with their preoperative hr-HPV viral load and postoperative hr-HPV clearance rates,but those with high hr-HPV viral load might have high postoperative hr-HPV continuous infection rate.