高级别宫颈上皮内瘤变及早期宫颈癌子宫切除术后患者高危型人乳头瘤病毒消退规律及相关因素分析

doi:10.3969/j.issn.1006-7795.2018.06.013

首都医科大学学报 ›› 2018, Vol. 39 ›› Issue (6): 864-870.doi: 10.3969/j.issn.1006-7795.2018.06.013

• 生殖道HPV感染与宫颈病变 • 上一篇下一篇

高级别宫颈上皮内瘤变及早期宫颈癌子宫切除术后患者高危型人乳头瘤病毒消退规律及相关因素分析

张阳, 罗美, 何鑫, 蒋英, 李卫华, 张雪芳, 王淑珍

首都医科大学附属北京朝阳医院妇产科, 北京 100020

收稿日期:2018-09-30 出版日期:2018-11-21 发布日期:2018-12-19
通讯作者: 王淑珍 E-mail:darrywang2003@163.com
基金资助:
国家重点研发计划项目（2016YF1000605），国家自然科学基金青年基金（31200865）。

Analysis of the regression of high-risk human papillomavirus and related factors in the patients after hysterectomy for high-grade squamous intraepithelial neoplasia and cervical cancer in early stage

Zhang Yang, Luo Mei, He Xin, Jiang Ying, Li Weihua, Zhang Xuefang, Wang Shuzhen

Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Received:2018-09-30 Online:2018-11-21 Published:2018-12-19
Supported by:
This study was supported by National Key Research Program of China (2016YFB1000605),National Natural Science Foundation of China(31200865).

摘要/Abstract

摘要： 目的探讨生殖道高危型人乳头瘤病毒（high risk-human papillomavirus， HR-HPV）感染致高级别宫颈鳞状上皮内病变（high-grade squamous intraepithelial lesion， HSIL）及早期宫颈癌的患者行子宫切除术后，阴道残端HR-HPV的消退规律及相关影响因素。方法采用回顾性队列研究方法对首都医科大学附属北京朝阳医院2013年1月1日至2018年3月31日因HSIL及早期宫颈癌行子宫切除术的术后患者进行随访性研究，应用Kaplan-Meier法计算病毒消退时间、消退相关影响因素及病毒消退曲线；Cox比例风险回归模型分析病毒消退时间的影响因素。结果纳入人群276例，HSIL 85例（30.8%），早期宫颈癌191例（69.2%），平均年龄（49.43±9.80）岁，术前94.9%的患者HR-HPV阳性，术后2年内HSIL及早期宫颈癌HR-HPV消退率分别为78.4%及94.1%， HSIL患者术后消退时间比宫颈癌患者延长，消退比例明显低于宫颈癌，差异有统计学意义（P=0.040），年龄、多种亚型混合感染均与病毒消退无关。阴道残端病毒消退曲线的特征：术后短期内病毒消退较为快速，一定时间后消退明显减慢， HSIL及早期宫颈癌患者对应时间点分别为术后15个月及13个月，且不同亚型其消退时间不同。少部分患者存在同一亚型HR-HPV的持续感染。与消退时间相关的因素为患者的血型（P=0.025）、肿瘤家族史（P=0.007）及体质量指数（body mass index，BMI）分级（P=0.003）。结论因宫颈因素行子宫切除术的患者术后HR-HPV消退率较高，术后较长时间内仍未消退者存在持续感染、病变复发及阴道病变风险，但相关影响因素尚无定论，有待进一步研究。

关键词: 高危型人乳头瘤病毒, 高级别宫颈上皮内瘤变, 早期宫颈癌, 子宫切除术, 阴道残端, 病毒消退

Abstract: Objective To investigate the regression of high-risk human papillomavirus (HR-HPV) and related factors in vaginal stump after hysterectomy for high-grade squamous intraepithelial lesion (HSIL) and cervical cancer in early stage. Methods A retrospective cohort study included data from patients with hysterectomy for HSIL and cervical cancer in early stage at the Beijing Chaoyang Hospital, Capital Medical University from January 1, 2013 to March 31, 2018. The Kaplan-Meier method was used to analyze the virus regression time and related factors, and obtained the virus regression curve. Cox proportional hazard regression model was performed to obtain the factors affecting time of the virus regression. Results A total of 276 patients were enrolled, including 85 patients with HSIL (30.8%) and 191 patients with cervical cancer in early stage (69.2%). The average age of all was (49.43±9.80)years. There were 208 patients (94.9%) appeared positive HR-HPV test before operation. The HPV regression rates of patients with HSIL and cervical cancer were respectively 78.4% and 94.1% during 2 years after operation. There was a statistical difference between the time of viral regression and the main diagnosis of HSIL or cervical cancer(P=0.040), but not the age and the mixed infection of multiple subtypes. The regression curve of the virus in vaginal stump suggested that the virus disappeared rapidly in a short term after operation, and the rate was considerably slowed down after a certain time. The corresponding time points of HSIL and cervical cancer patients were 15 months and 13 months, respectively. Also the time of regression varied between the different types. A small number of patients still had persistent infection with the same subtype. However, the affecting factors are still inconclusive. The factors affecting the regression time were the patient's blood type (P=0.025), family history (P=0.007), and body mass index (BMI) grade (P=0.003). Conclusion Patients with hysterectomy due to cervical factors have a higher rate of HR-HPV regression. There is a risk of persistent infection, recurrence of lesions and vaginal lesions progression in patients without HPV regression for a long time after operation. However, the affecting factors are still inconclusive, further research is needed to determine the affecting factors.

Key words: high-risk human papillomavirus, high-grade squamous intraepithelial lesion, cervical cancer in early stage, hysterectomy, vaginal stump, virus regression

中图分类号:

R711.74

张阳, 罗美, 何鑫, 蒋英, 李卫华, 张雪芳, 王淑珍. 高级别宫颈上皮内瘤变及早期宫颈癌子宫切除术后患者高危型人乳头瘤病毒消退规律及相关因素分析[J]. 首都医科大学学报, 2018, 39(6): 864-870.

Zhang Yang, Luo Mei, He Xin, Jiang Ying, Li Weihua, Zhang Xuefang, Wang Shuzhen. Analysis of the regression of high-risk human papillomavirus and related factors in the patients after hysterectomy for high-grade squamous intraepithelial neoplasia and cervical cancer in early stage[J]. Journal of Capital Medical University, 2018, 39(6): 864-870.

参考文献

[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018,[Epub ahead of print].
[2] Bosch F X, Lorincz A, Munoz N, et al. The causal relation between human papillomavirus and cervical cancer[J]. J Clin Pathol, 2002,55(4):244-265.
[3] Walboomers J M, Jacobs M V, Manos M M, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide[J]. J Pathol, 1999,189(1):12-19.
[4] 林仲秋. FIGO/IGCS妇科恶性肿瘤分期及临床实践指南之三:宫颈癌[J]. 国际妇产科学杂志, 2008,35(3):226-228.
[5] Massad L S, Einstein M H, Huh W K, et al.2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors[J]. Obstet Gynecol, 2013, 121(4):829-846.
[6] Giannella L, Fodero C, Boselli F, et al. Age-related changes in pre-and post-conization HPV genotype distribution among women with high-grade cervical intraepithelial neoplasia[J]. Int J Gynecol Obstet, 2017, 137(1):72-72.
[7] Siegler E, Goldberg Y, Baruchfinkel T, et al. Positive correlation between clearance of high-risk human papillomavirus and lack of residual disease after loop excision of the transformation zone in early stage cervical cancer[J]. J Low Genit Tract Dis, 2017,21(4):294-298.
[8] 国际生命科学学会中国办事处中国肥胖问题工作组联合数据汇总分析协作组. 中国成人体质指数分类的推荐意见简介[J]. 中华预防医学杂志, 2001, 35(5):349-350.
[9] Nayar R, Wilbur D C. The Pap test and Bethesda 2014[J]. Cancer Cytopathol, 2015,123(5):271-281.
[10] 胥莎莎,罗美, 吴龙, 等. 医院机会性筛查人群高危型人乳头瘤病毒感染患者病毒自然清除的流行病学研究[J]. 医学综述, 2018,24(10):1933-1937, 1942.
[11] 何鑫,陶绘丞, 刘晨, 等. 医院机会性筛查人群HR-HPV感染的流行病学特征及与宫颈癌前病变的关系[J]. 首都医科大学学报, 2015, 36(2):219-225.
[12] 许颖, 李柱南, 陈忆, 等. 全子宫切除术后阴道上皮内瘤变56例临床分析[J]. 上海交通大学学报:医学版, 2017,37(5):661-665.
[13] Guan P, Howell-Jones R, Li N, et al. Human papillomavirus types in 115,789 HPV-positive women:a meta-analysis from cervical infection to cancer[J]. Int J Cancer, 2012,131(10):2349-2359.
[14] 韩钦,郭红燕, 耿力. 宫颈癌机会性筛查人群中高危型HPV感染状况及其与宫颈病变关系的研究[J]. 实用妇产科杂志, 2018,34(3):194-197.
[15] Bruni L, Diaz M, Castellsagué M, et al. Cervical human papillomavirus prevalence in 5 continents:meta-analysis of 1 million women with normal cytological findings[J]. J Infect Dis, 2010,202(12):1789-1799.
[16] 刘虹岚, 兰建, 张晓娟, 等. 高危型人乳头状瘤病毒持续感染病毒清除分析[J]. 中华医院感染学杂志, 2017, 27(20):4751-4753
[17] Syrjänen K. Mechanisms and predictors of high-risk human papillomavirus (HPV) clearance in the uterine cervix[J]. Eur J Gynaecol Oncol, 2007, 28(5):337-351.
[18] 陈颖颖,洪颖. 宫颈上皮内瘤变锥切术后残留或复发高危因素的Meta分析[J].中华临床医师杂志:电子版,2012,6(10):2707-2712.
[19] Du R, Meng W, Chen Z F, et al. Post-treatment human papillomavirus status and recurrence rates in patients treated with loop electrosurgical excision procedure conization for cervical intraepithelial neoplasia[J]. Eur J Gynaecol Oncol,2013, 34(6):548-551.
[20] Kim Y T, Lee J M, Hur S Y, et al. Clearance of human papillomavirus infection after successful conization in patients with cervical intraepithelial neoplasia[J].Int J Cancer,2010,126(8):1903-1909.
[21] Venturoli S, Costa S, Barbieri D, et al. Time to viral clearance after successful conservative treatment for high-risk HPV-infected high-grade cervical intraepithelial neoplasia and early invasive squamous cervical carcinoma.[J]. Diagn Microbiol Infect Dis, 2016, 86(3):270-272.
[22] 王亮, 张高生, 刘安宁,等. 2型糖尿病合并冠心病患者蛋白酪氨酸磷酸酶1B水平的分析研究[J]. 中国医学创新, 2018,15(10):32-35.
[23] Hanyuda A, Ogino S, Qian Z R, et al. Body mass index and risk of colorectal cancer according to tumor lymphocytic infiltrate[J]. Int J Cancer, 2016, 139(4):854-868.

高级别宫颈上皮内瘤变及早期宫颈癌子宫切除术后患者高危型人乳头瘤病毒消退规律及相关因素分析

Analysis of the regression of high-risk human papillomavirus and related factors in the patients after hysterectomy for high-grade squamous intraepithelial neoplasia and cervical cancer in early stage

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 9

编辑推荐

Metrics

本文评价

[1]	黄文阳, 何鑫, 李卫华, 张雪芳, 李湛, 谷丽, 路军丽, 王淑珍. 孕期高危型人乳头瘤病毒的流行病学特征及对妊娠结局的影响[J]. 首都医科大学学报, 2018, 39(6): 836-840.
[2]	张雪芳, 何鑫, 黄文阳, 李卫华, 罗美, 张阳, 王淑珍. 中国女性宫颈高危型HPV感染与阴道微生态关系的Meta分析[J]. 首都医科大学学报, 2018, 39(6): 841-848.
[3]	何鑫, 陶绘丞, 王淑珍, 朱志清, 王跃, 刁小莉, 曲久鑫. 高危型人乳头瘤病毒阴性/不典型鳞状细胞和低度鳞状上皮内病变患者的随访观察[J]. 首都医科大学学报, 2015, 36(2): 205-211.
[4]	何鑫, 陶绘丞, 刘晨, 王淑珍, 王跃, 刁小莉, 曲久鑫. 医院机会性筛查人群HR-HPV感染的流行病学特征及与宫颈癌前病变的关系[J]. 首都医科大学学报, 2015, 36(2): 219-225.
[5]	刘英俏, 何鑫, 刘军, 王淑珍, 胥莎莎, 王跃, 刁小莉. 宫颈脱落细胞CA-IX的表达与高危型人乳头瘤病毒感染状态的相关性研究[J]. 首都医科大学学报, 2015, 36(2): 226-231.
[6]	文巧英;韩丹;李斌. 腹腔镜筋膜内子宫切除术36例分析[J]. 首都医科大学学报, 2004, 25(3): 391-393.
[7]	郑萍;王淑兰;高晓秋;熊晓燕. 子宫切除术后卵巢功能的变化[J]. 首都医科大学学报, 2000, 21(4): 335-337.
[8]	王西萍;刘素霞;亢汝梅. 良性病因子宫全切术后盆腔断端的B超与临床监测[J]. 首都医科大学学报, 1998, 19(2): 163-165.
[9]	夏恩兰. 急症产科子宫切除术19例分析[J]. 首都医科大学学报, 1992, 13(2): 128-131.