Ho G Y, Burk R D, Klein S, Kadish A S, Chang C J, Palan P, Basu J, Tachezy R, Lewis R, Romney S
Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
J Natl Cancer Inst. 1995 Sep 20;87(18):1365-71. doi: 10.1093/jnci/87.18.1365.
Cervical dysplasia, also referred to as squamous intraepithelial lesion (SIL) in cytology or cervical intraepithelial neoplasia in histopathology, is thought to have the potential to advance in progressive stages to cervical cancer. However, not all cases of SIL progress, and most of the mild lesions spontaneously regress. Factors that govern regression, persistence, and progression of SIL are poorly understood.
Our analysis sought to identify factors that determined persistence or regression of SIL.
Seventy subjects with histopathologically confirmed cervical dysplasia were followed at 3-month intervals for 15 months. At each visit, the cervix was evaluated by Pap smear and colposcopy, and exfoliated cervicovaginal cells were analyzed for human papillomavirus (HPV) DNA. For each subject, data from every two consecutive visits were grouped as a pair. Persistent SIL was considered present if a lesion was detected at a visit (t) as well as at the next visit (t + 1) and absent if a lesion was detected at visit t but not at visit t + 1. A statistical model for time-dependent data correlated persistent SIL with various risk factors.
Age, ethnicity, education, sexual behavior, smoking, and the use of oral contraceptives did not correlate with persistent SIL. The risk of persistent SIL was associated with continual HPV infection in visits t and t + 1 (HPV positive by Southern blot analysis: odds ratio [OR] = 3.91, and 95% confidence interval [CI] = 1.58-9.65; HPV positive by polymerase chain reaction [PCR]: OR = 2.42, and 95% CI = 1.03-5.67) and a persistent high viral load (OR = 4.07, and 95% CI = 1.35-12.30). When typed by PCR, individuals with type-specific persistent infection in visits t and t + 1, and particularly those with a continual high viral load (OR = 4.97; 95% CI = 1.45-17.02), had the highest risk for persistent SIL compared with those with a low level of type-specific persistent infection or non-type-specific persistent infection. The presence of persistent HPV infection in visits t-1 (the preceding time interval) was also predictive of persistent SIL in visits t and t + 1, although the strength of association was weaker, suggesting that persistent HPV and SIL occur synchronously.
HPV infection and its associated cervical lesions tend to occur concurrently, and type-specific persistent HPV infection, particularly with a high viral load, produces chronic cervical dysplasia.
The natural history of genital HPV infection directly influences the prognosis of cervical dysplasia as measured by persistence of the lesion. Testing for HPV infection may be valuable in the clinical management of women with cervical dysplasia.
宫颈发育异常，在细胞学上也称为鳞状上皮内病变（SIL），在组织病理学上称为宫颈上皮内瘤变，被认为有可能逐步发展为宫颈癌。然而，并非所有SIL病例都会进展，大多数轻度病变会自发消退。目前对决定SIL消退、持续和进展的因素了解甚少。
我们的分析旨在确定决定SIL持续或消退的因素。
对70例经组织病理学确诊的宫颈发育异常患者进行为期15个月的随访，每隔3个月进行一次检查。每次就诊时，通过巴氏涂片和阴道镜检查评估宫颈，并对宫颈阴道脱落细胞进行人乳头瘤病毒（HPV）DNA分析。对于每位受试者，将每两次连续就诊的数据归为一组。如果在就诊时（t）以及下次就诊时（t + 1）均检测到病变，则认为存在持续性SIL；如果在就诊t时检测到病变但在就诊t + 1时未检测到，则认为不存在持续性SIL。使用时间依赖性数据的统计模型将持续性SIL与各种风险因素相关联。
年龄、种族、教育程度、性行为、吸烟和口服避孕药的使用与持续性SIL无关。持续性SIL的风险与就诊t和t + 1时的持续HPV感染相关（Southern印迹分析HPV阳性：比值比[OR] = 3.91，95%置信区间[CI] = 1.58 - 9.65；聚合酶链反应[PCR]检测HPV阳性：OR = 2.42，95% CI = 1.03 - 5.67）以及持续的高病毒载量（OR = 4.07，95% CI = 1.35 - 12.30）。通过PCR分型时，就诊t和t + 1时存在型特异性持续感染的个体，尤其是那些病毒载量持续较高的个体（OR = 4.97；95% CI = 1.45 - 17.02），与型特异性持续感染水平较低或非型特异性持续感染的个体相比，持续性SIL的风险最高。就诊前一个时间间隔（t - 1）存在持续性HPV感染也可预测就诊t和t + 1时的持续性SIL，尽管关联强度较弱，这表明持续性HPV感染和SIL是同步发生的。
HPV感染及其相关的宫颈病变往往同时发生，型特异性持续性HPV感染，尤其是高病毒载量，会导致慢性宫颈发育异常。
生殖器HPV感染的自然史直接影响宫颈发育异常的预后，可通过病变的持续性来衡量。HPV感染检测在宫颈发育异常女性的临床管理中可能具有重要价值。
