Wright T C, Koulos J, Schnoll F, Swanbeck J, Ellerbrock T V, Chiasson M A, Richart R M
Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, New York 10032.
Gynecol Oncol. 1994 Nov;55(2):253-8. doi: 10.1006/gyno.1994.1286.
Our clinical experience with loop electrosurgical excision as therapy for cervical intraepithelial neoplasia (CIN) in women infected with human immunodeficiency virus is described. Information for this analysis was obtained from a retrospective chart review of all women with biopsy-confirmed CIN treated by loop electrosurgical excision who attended our colposcopy clinic during January 1991 to September 1992. Outcomes in women known to be HIV-seropositive were compared to those in women of unknown HIV serostatus. Patients included in the analysis were followed for at least 6 months or until the documentation of recurrent/persistent CIN, and all had at least one post-treatment colposcopic examination, including endocervical curettage and cervical biopsy of any acetowhite lesions. Recurrent/persistent CIN following loop excision was documented in 56% (19 of 34) HIV-infected women compared with 13% (10 of 80) women of unknown serostatus (OR 8.9, P < 0.001). HIV-infected women had a significantly higher rate of recurrent/persistent CIN than women of unknown serostatus, regardless of grade of CIN. In HIV-infected women, recurrent/persistent CIN following loop excision developed in 20% (1 of 5) with CD4+ T-lymphocyte counts > 500 cells/microliters compared to 61% (11 of 18) with CD4+ counts < or = 500 cells/microliters (P = 0.13). Loop electrosurgical excision has a high failure rate in HIV-infected women, and this failure rate may increase as the level of immunosuppression increases.
本文描述了我们使用环形电外科切除术治疗感染人类免疫缺陷病毒（HIV）的女性宫颈上皮内瘤变（CIN）的临床经验。该分析的信息来自对1991年1月至1992年9月期间在我们阴道镜诊所接受环形电外科切除术治疗且活检确诊为CIN的所有女性进行的回顾性病历审查。将已知HIV血清学阳性的女性的结果与HIV血清学状态未知的女性的结果进行比较。纳入分析的患者随访至少6个月或直至记录到复发性/持续性CIN，并且所有患者至少进行了一次治疗后的阴道镜检查，包括宫颈管刮除术和对任何醋酸白病变进行宫颈活检。环形切除术后，56%（34例中的19例）感染HIV的女性出现复发性/持续性CIN，而血清学状态未知的女性为13%（80例中的10例）（比值比8.9，P<0.001）。无论CIN的分级如何，感染HIV的女性复发性/持续性CIN的发生率均显著高于血清学状态未知的女性。在感染HIV的女性中，CD4 + T淋巴细胞计数>500个细胞/微升的患者环形切除术后复发性/持续性CIN的发生率为20%（5例中的1例），而CD4 +计数≤500个细胞/微升的患者为61%（18例中的11例）（P = 0.13）。环形电外科切除术在感染HIV的女性中失败率较高，并且随着免疫抑制水平的增加，这一失败率可能会升高。
