门诊276例高危型人乳头瘤病毒阳性妇女的长期随访研究

摘要

Objective To explore the long-term follow-up results of 276 high-risk human papillomavirus( HR-HRV) posi-tive women in outpatient clinic. Methods 985 cases with abnormal results of cervical carcinoma and precancerous lesion screen-ing in outpatient department of gynaecology between February,2010 and February,2012,were selected. 276 patients with positive results of HR-HPV DNA fluorescent quantification,negative results of TCT or normal results of cervical pathological examination received long-term follow-up observation. Results After 2-years follow-up,in 276 cases of HR-HPV positive patients,HR-HPV negative conversion rate was 68. 47% and HR-HPV persistent positive rate was 31. 52%. Pathological results of 28 cases were more than or equal to CIN grade I,accounting for 10. 14%,among which 14 patients graded CIN II to III accepted surgical treat-ment. The viral load after treatment ( 14. 36 ± 3. 52 ) RLU/CO was significantly lower than that before treatment of ( 342. 61 ± 76. 69)RLU/CO,the difference having statistical significance(P<0. 05). HR-HPV negative conversion rate 12 months after oper-ation was 85. 71%. HR-HPV clearance rates of patients equal to or less than 35 years old,having 1 or 2 sex partners,with no repro-ductive tract inflammation and initial viral load being 1 ~99 RLU/CO were 88. 98%,81. 82%,60. 33% 83. 20%,respectively, which were significantly higher than those of patients more than 36 years old,having equal to or more than 3 sex partners,with geni-tal tract inflammation and initial virus load being 100~1000 RLU/CO,the difference being statistically significant(P<0. 05). Non conditional logistic regression analysis showed that age,multiple sexual partners and genital tract inflammation,high viral load had significant correlation with HR-HPV clearance rate. Conclusion Age,number of sexual partners,genital tract inflammation,viral load have significant correlation with HR-HPV clearance rate. We should regularly follow up,pay close attention to HR-HPV nega-tive conversion and if necessary,give intervention.%目的：探讨门诊276例高危型人乳头瘤病毒( HR-HRV)阳性妇女的长期随访结果。方法病例选择于2010年2月至2012年2月医院妇科门诊行宫颈癌及癌前病变筛查异常的妇女985例,对定量HR-HPV DNA荧光定量结果阳性,TCT为阴性或宫颈病理检查正常的276例患者行长期随访观察。结果随访2年,276例HR-HPV阳性患者转阴率为68．47%,HR-HPV持续阳性率为31．52%；28例病理结果≥CINⅠ级,占10．14%；其中14例CINⅡ~Ⅲ患者接受手术治疗,治疗后病毒载量(14．36±3．52) RLU/CO显著低于治疗前(342．61±76．69) RLU/CO,差异有统计学意义( P<0．05)；术后12个月HR-HPV转阴率为85．71%。年龄≤35岁、个人性伴侣1~2个、无生殖道炎症、最初病毒载量为1~99 RLU/CO患者HR-HPV清除率分别为88．98%、81．82%、60．33%、83．20%,显著高于年龄>36岁、个人性伴侣≥3个、生殖道炎症、最初病毒载量为100~1000RLU/CO,差异有统计学意义(P<0．05)；非条件Logistic回归分析结果显示年龄、多个性伴侣、生殖道炎症、高病毒载量与HR-HPV清除率存在显著相关性。结论年龄、性伴侣个数、生殖道炎症、病毒载量与HR-HPV清除率存在显著相关性,临床定期随访,密切关注HR-HPV转阴情况,必要时给予干预治疗。