HPV16 持续性感染及 LEEP 术后复发。
HPV16 persistent infection and recurrent disease after LEEP.
机构信息
Department of General Surgery and Medical Surgery Specialities, Gynecological Clinic of the University of Catania, Policlinico. Via S. Sofia78, Catania, Italy.
Gynecological Oncology, Humanitas, Catania, Italy.
出版信息
Virol J. 2019 Nov 27;16(1):148. doi: 10.1186/s12985-019-1252-3.
BACKGROUND
About 23% of patients develop CIN2+ after LEEP treatment due to residual or recurrent lesions. The majority of patients with HPV infection were HPV negative before treatment, but 16,4% were still HPV 16 positive after treatment, indicating that conization do not necessarily clear HPV infection rapidly. The aim of this retrospective study was to evaluate the possible correlation existing between the appearance of recurring high-grade lesions and the viral genotype 16, and other risk factors such as residual disease.
METHODS
One hundred eighty-two HPV positive patients underwent LEEP for CIN2+. The follow-up post treatment was carried out every 6 months. Abnormal results during follow-up were confirmed histologically and considered recurrent high-grade intraepithelial cervical lesions (CIN2/CIN3 or CIS). Statistical analysis was performed by using the SPSS software package for Windows (version 15.0, SPSS, Chicago, IL, USA). Descriptive statistics are expressed as frequency, arithmetic mean, standard deviation (S.D.) and percentages. We calculated significance (P < 0.5) with the Easy Fischer Test. We calculated the Odds Ratio (OR) of women with peristent HPV 16 infection and positive margin, to have a recurrence.
RESULTS
In our study, the rate of persistent infection from HPV 16, after LEEP, was 15.9% (29/182) with 94% (17/18) of the recurring disease occurring within 18 months of follow up. From this study it was found that the persistence of genotype 16 is associated with a greater rate of relapse post-conization of CIN 2+ lesions, with respect to other genotypes. Our study further supports those studies that demonstrate that the risk for residual disease or relapse is not to be overlooked, also when the margins are negative, but persistent HPV infection is present. In our case study, 40% of relapses were in women with negative margin, but with persistent HPV 16 infection. Even more so, the margins involved in HPV16 positive subjects is another prediction factor for relapse.
CONCLUSIONS
Our results show the importance of genotyping and that persistent HPV 16 infection should be considered a risk factor for the development of residual/recurrent CIN 2/3.
背景
大约 23%的患者在 LEEP 治疗后出现 CIN2+，这是由于残留或复发病变所致。大多数 HPV 感染患者在治疗前 HPV 为阴性，但治疗后仍有 16.4%为 HPV16 阳性，这表明锥切术不一定能迅速清除 HPV 感染。本回顾性研究旨在评估复发高级别病变与 HPV 基因型 16 之间以及其他危险因素（如残留疾病）之间存在的可能相关性。
方法
182 例 HPV 阳性患者因 CIN2+接受 LEEP。治疗后每 6 个月进行随访。对随访期间的异常结果进行组织学确认，并认为是复发的高级别宫颈上皮内病变（CIN2/CIN3 或 CIS）。使用 Windows 版 SPSS 软件包（版本 15.0，SPSS，芝加哥，IL，美国）进行统计分析。描述性统计以频率、算术平均值、标准差（S.D.）和百分比表示。我们使用 Easy Fischer 检验计算显著性（P<0.5）。我们计算了持续感染 HPV 16 且边缘阳性的女性发生持续性 HPV 感染和阳性边缘的比值比（OR），以评估其复发的可能性。
结果
在我们的研究中，LEEP 后 HPV 16 持续感染的发生率为 15.9%（29/182），94%（17/18）的复发疾病发生在随访 18 个月内。本研究发现，与其他基因型相比，16 型基因型的持续存在与锥切后 CIN2+病变的复发率较高相关。我们的研究进一步支持了那些研究，这些研究表明，即使在边缘阴性时，也不能忽视残留疾病或复发的风险，而持续的 HPV 感染仍然存在。在我们的病例研究中，40%的复发发生在边缘阴性但持续感染 HPV 16 的女性中。更重要的是，HPV16 阳性患者的边缘涉及另一个复发预测因素。
结论
我们的结果表明基因分型的重要性，持续的 HPV 16 感染应被视为残留/复发 CIN2/3 的危险因素。
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