摘要
目的 探讨合并高危人乳头瘤病毒（HR-HPV）阳性低度宫颈上皮内瘤变（CINⅠ）患者转归及适当的治疗方式。方法 回顾分析2007年1月~2012年12月北京妇产医院妇瘤门诊阴道镜指导下宫颈活检病理证实为CINⅠ且HR-HPV阳性的412例患者的临床资料。按治疗方法分为LEEP锥切治疗组（LEEP组）和期待治疗组（期待组）,其中LEEP组200例,期待组212例。随访观察患者病变的转归,分析病变进展危险因素。结果 患者中位随访时间为36个月,LEEP组患者术后病理级别未上升者157例（未上升组）,43例上升者（上升组）,其中CINⅡ34例,CINⅢ9例。未上升组HR-HPV转阴率为68.8%,期待组为62.7%,两组间差异无统计学意义（P=0.227）。未上升组病变进展率为3.18%,期待组为3.77%,两组间差异无统计学意义（P=0.175）。持续HR-HPV阳性是CINⅠ持续和进展的独立危险因素（OR=24.171,95%CI：10.019~58.309,P=0.000）。结论 HR-HPV阳性的CINⅠ患者首选期待观察治疗,持续HR-HPV阳性CINⅠ患者病变进展增加,应严密随访。
Objective To investigate the prognosis and appropriate treatment of low-grade cervical intraepithelial neoplasia（CINⅠ） patients combined with HR-HPV positive. Methods Clinical data of 412 patients with CINⅠ and HRHPV positive who confirmed by the cervical biopsy pathology under the guidance of the colposcopy from January 2007 to December 2012 in Beijing Obstetrics and Gynecology Hospital were retrospective analyzed. They were divided into loop electrical excision procedure treatment group（LEEP group） and looking forward to the treatment group（expectant group） according to the treatment. Risk factors were determined by logistic regression, and 200 cases in the LEEP group, 212 cases in the expectant group. The outcome and pathological changes of patients were followed and the risk factors of disease progress were analyzed. Results Median follow-up time of all patients was 36 months, the postoperative pathological level was risen in 43 cases of the LEEP group（progression group）, and 157 cases were not risen（stationary group）. Disease progression was found in 43（progression group）, among these patients 34 progress to CIN Ⅱ, 9progress to CINⅢ. The negative conversion ratio of the stationary group was 68.8%, the expectant group was 62.7%,the difference of two groups was no statistically significant（P = 0.227）. The disease progression ratio of the stationary group was 3.18%, the expectant group was 3.77%, the difference of two groups was no statistically significant（P =0.175）. HR-HPV persistent infection was an independent risk factor for the persistence and progression of CINⅠ（OR=24.171, 95% CI：10.019-58.309, P = 0.000）. Conclusion Expectant management is the first choice for CIN Ⅰ patients combined with HR-HPV positive, patients with HR-HPV persistent infection should receive close follow-up.
出处
《中国医药导报》
CAS
2014年第36期39-42,46,共5页
China Medical Herald
基金
北京市科技计划课题项目(编号D09050703570902)
关键词
低度宫颈上皮内瘤变
高危人乳头瘤病毒
宫颈环形电切术
期待治疗
Low-grade cervical intraepithelial neoplasia
High risk-human papillomavirus
Loop electrosurgical exci-sion procedure
Expectant management
