论著

宫颈锥切术后高危型人乳头瘤病毒持续感染的高危因素

  • 付溪娜 ,
  • 许新 ,
  • 李天杰 ,
  • 金影
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  • 首都医科大学附属北京友谊医院妇产科,北京 100050
金影 E-mail: 13501362591@163.com

收稿日期: 2024-03-09

  录用日期: 2024-08-13

  网络出版日期: 2024-08-25

基金资助

国家自然科学基金青年基金项目(82201825)

Study on the risk factors for persistent infection of high-risk human papillomavirus after cervical conization

  • FU Xina ,
  • XU Xin ,
  • LI Tianjie ,
  • JIN Ying
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  • Department of Obstetrics and Gynecology,Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Received date: 2024-03-09

  Accepted date: 2024-08-13

  Online published: 2024-08-25

摘要

目的:分析宫颈锥形切除术后高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)持续感染的高危因素,从而识别宫颈锥切术后宫颈病变残留、复发高危人群。方法:收集2017年1月1日至2022年5月31日期间术前至少有1种HR-HPV阳性,且在我院门诊或病房行宫颈锥切手术的患者共467例。将宫颈锥切术后6个月内HR-HPV阳性者纳入HR-HPV持续感染组,HR-HPV阴性者纳入HR-HPV清除组。比较2组间的年龄、绝经状态、术前HR-HPV感染情况、术前液基薄层细胞学(thinprep cytologic test,TCT)、宫颈活检病理级别、锥切切缘状态、是否累腺、锥切手术的方式等差异。其中,年龄差异比较采用秩和检验,其他指标比较采用卡方检验。采用多因素Logistic回归分析,寻找宫颈锥切术后HR-HPV持续感染的高危因素。结果:宫颈锥切术后6个月内HR-HPV清除率为64.0%。年龄≥46岁(P<0.001)、绝经(P<0.001)、术前存在HPV 16、HPV 52、HPV 58中任一型别感染者(P=0.002)、术前多重HR-HPV感染者(P<0.001)、术前TCT<高级别上皮内瘤变(high-grade squamous intraepithelial lesion,HSIL)(P=0.005)、宫颈活检病理<HSIL(P=0.020)、切缘不净(P=0.003)、累及腺体(P=0.008)或采用宫颈环形电切术(loop electrosurgical excision procedure, LEEP)(P<0.001)者,在宫颈锥切术后发生HR-HPV持续感染的概率更高。多因素Logistic回归分析显示,绝经(OR=3.453, P<0.001)、术前HR-HPV多重感染(OR=2.683, P<0.001)、术前TCT<HSIL(OR=1.884, P=0.015)、切缘不净(OR=1.479, P=0.048)以及采用LEEP术式(OR=2.330, P=0.013),是宫颈锥切术后HR-HPV持续感染的独立危险因素。锥切术后6~24个月宫颈病变的残留、复发率为12.2%,相较于HR-HPV清除组,术后HR-HPV持续感染组在宫颈锥切术后6~24个月发生宫颈病变残留、复发的风险更高(28.6%比3.0%,χ2=65.585, P<0.001),宫颈残留、复发病变的病理级别为HSIL的风险亦更高(Fisher检验, P=0.027)。结论:本研究纳入较大样本量,识别出绝经、术前HR-HPV多重感染、术前TCT<HSIL、切缘不净、采用LEEP术式者是宫颈锥切术后HR-HPV持续感染的高危人群,此类人群术后发生宫颈病变(特别是HSIL病变)残留、复发风险更高。

本文引用格式

付溪娜 , 许新 , 李天杰 , 金影 . 宫颈锥切术后高危型人乳头瘤病毒持续感染的高危因素[J]. 诊断学理论与实践, 2024 , 23(04) : 416 -423 . DOI: 10.16150/j.1671-2870.2024.04.010

Abstract

Objective To analyze the risk factors of persistent infection of high-risk human papillomavirus (HR-HPV) after cervical conization, so as to identify the high-risk population of residual and recurrent cervical lesions after cervical conization. Method A total of 467 patients with one more HR-HPV infection and underwent cervical conization in the outpatient clinic and ward of our hospital from January 1,2017 to May 31,2022 were collected. After cervical conization,HR-HPV-positive patients within 6 months were included in the HR-HPV persistent infection group, and HR-HPV-negative patients were included in the HR-HPV clearance group. The differences in age, menopausal status, preoperative HR-HPV infection, preoperative thinprep cytologic test (TCT), pathological grade of cervical biopsy, conization margin status, glandular involvement, and conization surgery were compared between the two groups. Among them, the age difference was processed by rank sum test, and other indicators were compared by chi-square test. Multivariate Logistic regression analysis was used to find the high risk factors for HR-HPV persistent infection after cervical conization. Result The HR-HPV clearance rate was 64.0% within 6 months after cervical conization. Patients with age ≥ 46 years old (P<0.001 ), menopause (P<0.001), preoperative infection of any type of HPV 16, HPV 52 or HPV 58 (P=0.002), preoperative multiple HPV infection (P<0.001), preoperative TCT < high grade squamous intraepithelial lesion (HSIL) (P=0.005), cervical biopsy pathology < HSIL (P=0.020), unclean margin (P=0.003), gland involvement (P=0.008) or loop electrosurgical excision procedure (LEEP) (P<0.001), had a higher probability of HR-HPV persistent infection after cervical conization. Multivariate Logistic regression analysis showed that menopause (OR=3.453, P<0.001), preoperative HR-HPV multiple infection (OR=2.683, P<0.001), preoperative TCT < HSIL (OR=1.884, P=0.015), unclean margin (OR=1.479, P=0.048) and LEEP (OR=2.330, P=0.013) were independent risk factors for HR-HPV persistent infection after cervical conization.The residual and recurrence rate of cervical lesions at 6-24 months after conization was 12.2%. Compared with HR-HPV clearance group, HR-HPV persistent infection group had a higher rate of residual and recurrent cervical lesions at 6-24 months after cervical conization (28.6% vs 3.0%, χ2=65.585, P<0.001), and the risk of HSIL was also higher (Fisher test, P=0.027). Conclusions In this study, a large sample size is included, and menopause, preoperative HR-HPV multiple infection, preoperative TCT < HSIL, unclean margin, and LEEP are identified as high-risk factors for HR-HPV persistent infection after cervical conization, and a higher risk of residual and recurrent cervical lesions (especially HSIL lesions) after cervical conization.

参考文献

[1] 朱学慧, 荣超. 人工智能技术在宫颈癌筛查和精准临床诊疗中的研究进展[J]. 重庆医科大学学报, 2023, 48(12):1477-1482.
  ZHU X H, RONG C. Research progress on artificial intelligence in screening and precise diagnosis and treatment of cervical cancer[J]. J Chongqing Med Univ, 2023, 48(12):1477-1482.
[2] 安国静, 姚文娟, 霍志平, 等. 宫颈癌组织中miR-495-3p的表达及其对癌细胞凋亡、侵袭的影响[J]. 中国临床研究, 2023, 36(7):983-988.
  AN G J, YAO W J, HUO Z P, et al. Expression of miR-495-3p in cervical carcinoma tissue and its impact on carcinoma cell apoptosis and invasion[J]. Chin J Clin Res, 2023, 36(7):983-988.
[3] 付溪娜, 金影. 子宫颈锥切术后高危型人乳头瘤病毒持续感染的研究进展[J]. 中国医刊, 2023, 58(6):608-612.
  FU X N, JIN Y. Research progress on high-risk human papillomavirus persistent infection after cervical conization surgery[J]. Chin J Med, 2023, 58(6):608-612.
[4] 中国抗癌协会妇科肿瘤专业委员会. 子宫颈锥切术后高危型人乳头瘤病毒阳性者规范化管理的专家共识[J]. 中国实用妇科与产科杂志, 2021, 37(6):650-653.
  Committee of Gynecological Oncology of Chinese Anti-Cancer Association. Consensus on the management of positive high-risk human papillomavirus after cervical conization[J]. Chin J Pract Gynecol Obstet, 2021, 37(6):650-653.
[5] PERKINS R B, GUIDO R S, CASTLE P E, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors[J]. J Low Genit Tract Dis, 2020, 24(2):102-131.
[6] 陈香, 董燕, 张丽. 宫颈高级别鳞状上皮内病变锥切术后高危型HPV持续感染的研究进展[J]. 实用医学杂志, 2021, 37(16):2039-2043.
  CHEN X, DONG Y, ZHANG L. Research progress on persistent high-risk human papillomavirus infection after conization of cervical high- grade squamous intraepithelial lesions[J]. J Pract Med, 2021, 37(16):2039-2043.
[7] 周佳怡, 张跃明, 何静, 等. 高级别宫颈鳞状上皮内病变患者宫颈锥切术后高危型人乳头瘤病毒持续感染的相关因素分析[J]. 肿瘤预防与治疗, 2021, 34(5):408-413.
  ZHOU J Y, ZHANG Y M, HE J, et al. Related factors of persistent high-risk human papillomavirus infection after cervical conization in patients with high-grade squamous intraepi-thelial lesions[J]. J Cancer Control Treat, 2021, 34(5):408-413.
[8] ZHANG G, LANG J, SHEN K, et al. High-risk human papillomavirus infection clearance following conization among patients with cervical intraepithelial neoplasm grade 3 aged at least 45 years[J]. Int J Gynaecol Obstet, 2017, 136(1):47-52.
[9] KIM Y T, LEE J M, HUR S Y, et al. Clearance of human papillomavirus infection after successful conization in patients with cervical intraepithelial neoplasia[J]. Int J Cancer, 2010, 126(8):1903-1909.
[10] PIRTEA L, GRIGORA? D, MATUSZ P, et al. Age and HPV type as risk factors for HPV persistence after loop excision in patients with high grade cervical lesions: an observational study[J]. BMC Surg, 2016, 16(1):70.
[11] NAM K, CHUNG S, KIM J, et al. Factors associated with HPV persistence after conization in patients with negative margins[J]. J Gynecol Oncol, 2009, 20(2):91-95.
[12] YUNG T O, HYUN W C, SEONG M K, et al. Risk factors for type-specific persistence of high-risk human papillomavirus and residual/recurrent cervical intraepithelial neoplasia after surgical treatment[J]. Obstetrics & gynecology science, 2020, 63(5):631-642.
[13] SO K A, LEE I H, KIM T J, et al. Risk factors of persistent HPV infection after treatment for high-grade squamous intraepithelial lesion[J]. Arch Gynecol Obstet, 2019, 299(1):223-227.
[14] 汤建利, 金笑天, 潘敏. 宫颈上皮内瘤变患者LEEP术后HPV持续感染的影响因素分析[J]. 现代实用医学, 2020, 32(5):490-492.
  JIN J L, JIN X T, PAN M. Analysis of influencing factors of HPV persistent infection after LEEP in patients with cervical intraepithelial neoplasia[J]. Modern Pract Med, 2020, 32(5):490-492.
[15] LUBRANO A, MEDINA N, BENITO V, et al. Follow-up after LLETZ: a study of 682 cases of CIN 2-CIN 3 in a single institution[J]. Eur J Obstet Gynecol Reprod Biol, 2012, 161(1):71-74.
[16] 陈良湾, 吴媚燕, 曾勇先, 等. 锥切切缘阴性的宫颈高级别鳞状上皮内病变患者复发危险因素分析[J]. 医学理论与实践, 2021, 34(14):2469-2471.
  CHEN L W, WU Y M, ZENG Y X, et al. Analysis of risk factors for recurrence in patients with cervical high-grade squamous intraepithelial lesions with negative conization margin[J]. J Med Theory Pract, 2021, 34(14):2469-2471.
[17] FAN A, WANG C, HAN C, et al. Factors affecting residual/recurrent cervical intraepithelial neoplasia after cervical conization with negative margins[J]. J Med Virol, 2018, 90(9):1541-1548.
[18] SONG S H, LEE J K, OH M J, et al. Persistent HPV infection after conization in patients with negative margins[J]. Gynecol Oncol, 2006, 101(3):418-422.
[19] BAE J H, KIM C J, PARK T C, et al. Persistence of human papillomavirus as a predictor for treatment failure after loop electrosurgical excision procedure[J]. Int J Gynecol Cancer, 2007, 17(6):1271-1277.
[20] ANNA D I, DAVIDE R, MARIA T S, et al. Human papillomavirus same genotype persistence and risk of cervical intraepithelial neoplasia2+ recurrence[J]. Cancers, 2021, 13(15):3664.
[21] 杨扬, 殷新明, 袁霞. 切缘阴性宫颈锥切术后影响宫颈上皮内肿瘤残留/复发的因素[J]. 中国性科学, 2019, 28(8):36-40.
  YANG Y, YIN X M, YUAN X. Factors affecting residual/recurrent cervical intraepithelial neoplasm after conization of cervix with negative cervical margin[J]. Chin J Human Sex, 2019, 28(8):36-40.
[22] 任玉峰, 王兆辉, 段秀芳, 等. 宫颈脱落细胞HPVE6/E7 mRNA检测在宫颈癌早期筛查与HPV分型诊断中的应用[J]. 安徽医学, 2024, 45(3):285-290.
  REN Y F, WANG Z H, DUAN X F, et al. The application research of detection of E6/E7 mRNA of cervical exfoliated cells in early screening and HPV typing of cervical cancer[J]. Anhui Med, 2024, 45(3):285-290.
[23] 罗倩, 陈琳, 丁锦. 分析合肥市某地区4663例体检女性HPV感染情况[J]. 安徽医学, 2024, 45(2):240-243.
  LUO Q, CHEN L, DING J. Analysis of HPV infection status in 4663 women undergoing physical examination in a certain area of Hefei City[J]. Anhui Med, 2024, 45(2):240-243.
[24] 肖瑶, 魏芳. 宫颈癌相关长链非编码RNA及其信号通路的研究进展[J]. 中国临床研究, 2023, 36(7):1087-1091.
  XIAO Y, WEI F. Research progress of cervical cancer associated long non-coding RNA and its signaling pathway[J]. Chin Clin Res, 2023, 36(7):1087-1091.
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