Department of Obstetrics and Gynaecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Obstetrics and Gynaecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Eur J Obstet Gynecol Reprod Biol. 2021 Nov;266:175-181. doi: 10.1016/j.ejogrb.2021.09.023. Epub 2021 Sep 28.
To evaluate risk factors associated with the persistence of human papillomavirus (HPV) after cervical excision in patients with high-grade squamous intra-epithelial neoplasia (HSIL).
A retrospective cohort study enrolled 550 patients who underwent cervical excision for HSIL between January 2015 and January 2018. The effects of various factors were assessed using univariate and multi-variate analyses.
The mean age of patients was 42.6 [standard deviation (SD) 8.7, range 22-64] years, and the mean duration of follow-up was 29.0 (SD 4.8, range 24-36) months. Persistent HPV infection after cone excision was detected in 78 (14.2%) patients. Univariate logistic regression analysis revealed that advanced age (>35 years), menopausal status, HPV type (HPV16/18), abnormal vaginal micro-ecological morphology, type of excision (loop electrosurgical excision procedure) and positive margin were closely associated with the persistence of HPV. Multi-variate analysis indicated that menopausal status [odds ratio (OR) 4.708, 95% confidence interval (CI) 2.770-8.001; p < 0.001], abnormal vaginal micro-ecological morphology (OR 2.320, 95% CI 1.372-3.922; p = 0.002) and positive margin (OR 3.346, 95% CI 1.261-8.876; p = 0.015) were significant risk factors for the persistence of HPV after treatment. Furthermore, infection with HPV16/18 increased the risk of persistent infection, and a higher rate of HPV persistence was found in patients who were infected with HPV18 (OR 1.020, 95% CI 0.415-2.505) or co-infected with HPV16/18 (OR 2.064, 95% CI 0.272-2.041) compared with HPV16.
Persistent HPV infection after surgical treatment for HSIL is considered to be strictly related to the recurrence and progression of disease. Patients who are at increased risk of HPV persistence should receive intensive follow-up after surgery, especially in the first year.
评估高级别鳞状上皮内病变（HSIL）患者宫颈切除术后人乳头瘤病毒（HPV）持续存在的相关危险因素。
本回顾性队列研究纳入了 2015 年 1 月至 2018 年 1 月间因 HSIL 行宫颈切除术的 550 例患者。采用单因素和多因素分析评估各种因素的影响。
患者的平均年龄为 42.6 [标准差（SD）8.7，范围 22-64] 岁，中位随访时间为 29.0（SD 4.8，范围 24-36）个月。在 78 例（14.2%）患者中检测到宫颈锥切术后 HPV 持续感染。单因素 logistic 回归分析显示，年龄较大（>35 岁）、绝经状态、HPV 类型（HPV16/18）、阴道微生态形态异常、切除类型（环形电切术）和阳性切缘与 HPV 持续存在密切相关。多因素分析表明，绝经状态[比值比（OR）4.708，95%置信区间（CI）2.770-8.001；p<0.001]、阴道微生态形态异常（OR 2.320，95% CI 1.372-3.922；p=0.002）和阳性切缘（OR 3.346，95% CI 1.261-8.876；p=0.015）是治疗后 HPV 持续存在的显著危险因素。此外，HPV16/18 感染增加了持续性感染的风险，与 HPV16 感染相比，HPV18 感染（OR 1.020，95% CI 0.415-2.505）或 HPV16/18 混合感染（OR 2.064，95% CI 0.272-2.041）的患者 HPV 持续感染率更高。
HSIL 手术后 HPV 持续感染被认为与疾病的复发和进展密切相关。HPV 持续感染风险增加的患者应在手术后接受强化随访，尤其是在术后的第一年。
