HPV基因分型检测在宫颈高级别病变治疗后的应用进展

摘要

高危型人乳头瘤病毒(high risk human papillomavirus,HR-HPV)持续性感染是宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)和宫颈癌发生的主要原因.宫颈高级别病变患者在标准治疗后疾病进展风险仍高于正常人群.治疗后HR-HPV阳性、细胞学异常、切缘阳性等是宫颈高级别病变残留/复发的预测因子.HPV基因分型检测能明确治疗后HR-HPV的不同感染状态,有助于检出高风险人群.相较治疗后HR-HPV新发感染和再发感染,同一亚型HR-HPV持续感染与宫颈高级别病变治疗后的疾病残留/复发密切相关.HPV16/18型是宫颈高级别病变患者治疗后最常见的持续感染型别,有更高的疾病残留/复发风险,临床上应加强随访力度.与单纯细胞学、HR-HPV检测相比,随访HR-HPV基因分型能提高预测宫颈高级别病变治疗后疾病残留/复发的敏感度,同时保持相似甚至更高的特异度.%High risk human papillomavirus (HR-HPV) persistent infection is the major cause of cervical intraepithelial neoplasia (CIN) and cervical cancer. Women after standard treatment for high-grade CIN (HG-CIN) are at higher risk of subsequent disease compared to the general population. After treatment, HR-HPV positive, cytological abnormalities, positive margins were the predictors of residual/recurrent disease after treatment of cervical high-grade lesions. HPV genotyping can be used to identify the different infection status of HR-HPV after treatment, which is helpful for detecting the high-risk groups. The persistent infection of the same type HR-HPV was closely associated with the residual lesions or recurrence after treatment of HG-CIN compared with the HR-HPV new infection or recurrent infection. HPV16/18 is the most common type of persistent infection in patients with HG-CIN, which has a higher risk of residual lesions or recurrent disease and need to closely follow-up. HPV genotyping increases sensitivity for the detection of residual or recurrent disease after treatment for HG-CIN than cytology and HR-HPV testing, remains equal or better sensitivity.