摘要
目的探讨妊娠合并子宫上皮内瘤变患者高危型人乳头瘤病毒(HR-HPV)感染的临床特点。方法选取2015年9月至2018年6月间上海市复旦大学附属中山医院青浦分院收治的132例妊娠合并宫颈上皮内瘤变(CIN)患者,CINⅠ期36例,CINⅡ期49例,CINⅢ期47例。同期选取62例正常妊娠期女性体检者为对照组。观察并比较两组参与研究者孕期及产后HPV阳性感染率、载量和种类。结果CINⅠ组、Ⅱ组和Ⅲ组患者单一感染率为75.0%、83.7%和97.9%,均显著高于对照组的11.3%,差异均有统计学意义(均P<0.05)。CINⅡ组和Ⅲ组患者单一感染率显著高于CINⅠ组单一感染率,CINⅢ组患者显著高于CINⅡ组患者,差异均有统计学意义(均P<0.05)。CINⅠ组、Ⅱ组和Ⅲ组患者多重感染率为8.3%、10.2%和14.9%,均显著高于对照组的1.6%,差异均有统计学意义(均P<0.05)。CINⅠ组、Ⅱ组和Ⅲ组患者单一感染率为41.7%、59.2%和89.4%,显著高于对照组的1.6%,差异均有统计学意义(均P<0.05)。CINⅡ组和Ⅲ组患者的单一感染率显著高于CINⅠ组,CINⅢ组患者的单一感染率显著高于CINⅡ组患者,差异均有统计学意义(均P<0.05)。CINⅠ组、Ⅱ组和Ⅲ组患者的多重感染率为5.6%、8.2%和12.8%,显著高于对照组的0.0%,差异均有统计学意义(均P<0.05)。CINⅡ组患者多重感染率显著高于CINⅠ组,CINⅢ组患者多重感染率显著高于CINⅡ组,差异均有统计学意义(均P<0.05)。CINⅠ组、Ⅱ组自然转阴率显著高于CINⅢ组和对照组,差异均有统计学意义(均P<0.05)。CINⅠ组、Ⅱ组和Ⅲ组患者孕期HRHPV DNA载入量显著高于对照组,差异均有统计学意义(均P<0.05)。且CINⅡ组和Ⅲ组患者孕期HR-HPV DNA载入量显著高于CINⅠ组,CINⅢ组显著高于Ⅱ组患者,差异均有统计学意义(均P<0.05)。CINⅠ组、Ⅱ组和Ⅲ组患者产后6个月HR-HPV DNA载入量显著高于对照组,CINⅡ组和Ⅲ组患者孕期HR-HPV DNA载入量显著高于CINⅠ组,CINⅢ组显著高于CINⅡ组患者,差异均有统计学意义(均P<0.05)。CINⅡ组和Ⅲ组患者产后6个月时的HR-HPV DNA载入量显著高于孕期,差异均有统计学意义(均P<0.05)。结论随着妊娠合并CIN患者的宫颈病变级别的升高,HR-HPV阳性率和荷载量随之升高,呈正相关,而产后HPV自然转阴率随之降低,HPV阳性率和荷载量可作为妊娠合并CIN患者的早期诊断指标。
Objective To analyze the correlation between pregnancy and cervical intraepithelial neoplasia(CIN)and high risk human papillomavirus infection(HR-HPV)infection.Methods A total of132 pregnant patients with CIN admitted to Fudan University Affiliated Zhongshan Hospital from September2015 to June 2018 were enrolled.Among them,36 patients were CIN I,49 patients were CIN II,and 47 patients were CIN III.Another 62 healthy pregnant women were selected as a control group.HPV positive infection rate,load and types were observed during and after the pregnancy.Results The single infection rate was 75.0%,83.7%and 97.9%,respectively in patients with CIN I,CIN II and CIN III,which was higher than 11.3%of the control group(all P<0.05).The single infection rate was higher in patients with CIN II and CIN III than in patients with CIN I(all P<0.05).The single infection rate was higher in patients with CIN III than in patients with CIN II(all P<0.05).The incidence of multiple infections was8.3%,10.2%and 14.9%,respectively in patients with CIN I,CIN II and CIN III,which was significantly higher than 1.6%of the control group(all P<0.05).The single infection rate was 41.7%,59.2%and 89.4%,respectively in patients with CIN I,CIN II and CIN III,which was significantly higher than1.6%of the control group(all P<0.05).The multiple infection rate was 5.6%,8.2%and 12.8%,respectively in patients with CIN I,CIN II and CIN III,which was significantly higher than 0.0%of the control group(all P<0.05).The multiple infection rate was higher in patients with CIN II than in patients with CIN I and in patients with CIN III than in patients with CIN II(all P<0.05).The negative conversion rate was higher in patients with CIN I and CIN II than in patients with CIN III and in the control group(all P<0.05).The HR-HPV DNA load was higher in patients with CIN I,CIN II and CIN III than in the control group(all P<0.05).The HR-HPV DNA load was also higher in patients with CIN I and CIN III than in patients with CIN III(all P<0.05).At 6 months after the pregnancy,HR-HPV DNA load was higher in patients with CIN I,CIN II and CIN III than in the control group with patients with CIN II and CIN III higher than patients with CIN I and patients with CIN III higher than patients with CIN III(all P<0.05).The HR-HPV DNA load was higher in patients with CIN II and CIN III at 6 month after the pregnancy than during the pregnancy(all P<0.05).Conclusion The HR-HPV DNA load is positively associated with the grade of cervical lesions in pregnant patients with CIN.The HR-HPV DNA load increase and negative conversion rate decrease with the increased grade of CIN.HPV positive rate and load can be considered as indicators in the early diagnosis of CIN in pregnant women.
作者
沈晶
黎俊
SHEN Jing;LI Jun(Department of Obstetrics,Fudan University Affiliated Zhongshan Hospital Qingpu Branch,Shanghai 201799,China;Department of Gynecology,Fudan University Affiliated Zhongshan Hospital Qingpu Branch,Shanghai 201799,China)
出处
《中国肿瘤临床与康复》
2020年第1期16-19,共4页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
妊娠合并子宫上皮内瘤变
高危型人乳头瘤病毒
HR-HPV
DNA
阳性率
Pregnancy complicated with cervical intraepithelial neoplasia
High-risk human papillomavirus infection
HR-HPV DNA
Positive rate
