HPV DNA 检测在宫颈电环切除术（LEEP）后宫颈上皮内瘤变（CIN）随访中的作用。

The role of HPV DNA testing in the follow-up of cervical intraepithelial neoplasia after loop electrosurgical excision procedure.

机构信息

Zekai Tahir Burak Maternity Hospital, Ankara, Turkey.

出版信息

Arch Gynecol Obstet. 2011 Apr;283(4):871-7. doi: 10.1007/s00404-010-1530-1. Epub 2010 Jun 1.

DOI:10.1007/s00404-010-1530-1

PMID:20514490

Abstract

OBJECTIVES

To assess human papilloma viruses (HPV) DNA test for detection of recurrences in cervical intraepithelial neoplasia (CIN) patients after loop electrosurgical excision procedure (LEEP). Also effect of LEEP on the clearance of HPV infection was evaluated for CIN 1 lesions.

METHODS

HPV DNA positive 37 patients (25 CIN 2-3 and 12 CIN 1 cases proven by colposcopic biopsies) were treated with LEEP and followed prospectively with HPV DNA and cytology at third and sixth months.

RESULTS

There were 11 patients with abnormal cytologic results in third month and 4 in sixth month. HPV DNA positivity rate declined in CIN 1 group between third and sixth month but this did not reach to statistical significance (44 vs. 36%, P = 0.41). There were 3 treatment failures out of 37 patients (8.1%). All these three patients had CIN 3 at the beginning and two of them had positive HPV DNA in two controls. There were no recurrence/treatment failure for CIN 1 patients. Regarding 37 patients, decrease in cytologic abnormality incidence between third and sixth-month control was statistically significant (29.7 vs. 10.9%, P = 0.03). All four patients with cytologic abnormality at the sixth month had HPV persistence. Cytologic abnormality was more prevelant in HPV persistent women (P = 0.01) and also there was no cytologic abnormality in case of HPV DNA negativity.

CONCLUSION

LEEP does not seem to decrease HPV DNA incidence for CIN 1 at least for 6 months. But HPV DNA used in addition to cytology might help to detect recurrences.

摘要

目的

评估人乳头瘤病毒（HPV）DNA 检测在宫颈上皮内瘤变（CIN）患者环形电切术后（LEEP）中的复发情况。还评估了 LEEP 对 CIN 1 病变清除 HPV 感染的影响。

方法

HPV DNA 阳性的 37 例患者（25 例 CIN 2-3，12 例经阴道镜活检证实为 CIN 1）接受 LEEP 治疗，并前瞻性随访 HPV DNA 和细胞学检查，分别在第 3 个月和第 6 个月进行。

结果

第 3 个月有 11 例患者细胞学结果异常，第 6 个月有 4 例。CIN 1 组 HPV DNA 阳性率在第 3 个月和第 6 个月之间下降，但未达到统计学意义（44%比 36%，P=0.41）。37 例患者中有 3 例治疗失败（8.1%）。这 3 例患者最初均为 CIN 3，其中 2 例在 2 次对照中 HPV DNA 阳性。CIN 1 患者无复发/治疗失败。37 例患者中，第 3 个月和第 6 个月的细胞学异常发生率下降具有统计学意义（29.7%比 10.9%，P=0.03）。第 6 个月细胞学异常的 4 例患者均存在 HPV 持续感染。HPV 持续感染的女性中细胞学异常更为常见（P=0.01），且 HPV DNA 阴性的患者中无细胞学异常。