TCT联合HPV检测诊断宫颈病变的临床价值分析

目的:探讨新柏氏液基细胞学技术(TCT)联合人乳头瘤病毒(human papilloma virus,HPV)检测诊断宫颈病变的临床价值。方法:选择哈尔滨医科大学附属第一医院妇科门诊收治的6752例患者,采集其宫颈脱落细胞进行TCT检测,登记患者的年龄及宫颈外观。分别随机选取TCT阳性和阴性结果的患者144例进行HPV检测及阴道镜下活检,分析和比较TCT单独及联合HPV检测诊断宫颈病变的敏感性和特异性。结果:宫颈柱状上皮细胞的外移程度及患者的年龄与宫颈TCT结果均无显著相关性。单独TCT检测诊断宫颈病变的灵敏度为87.04%,特异性为58.55%;单独HPV检测诊断宫颈病变的灵敏度为62.96%,特异性为81.62%;而联合测诊断宫颈病变的灵敏度为100%,特异度为48.29%。结论:TCT联合HPV检测可显著降低宫颈病变的漏诊率。     

HPV16感染检测和TCT筛查联用的临床应用

目的评估人乳头瘤病毒(Human papillomavirus,HPV)16感染和液基薄层细胞学(thinprep cytologic test,TCT)筛查在预测宫颈病变中的临床价值。方法以门诊537例高危型HPV感染疑似宫颈病变女性为对象,进行HPV16感染分析、液基薄层细胞学和阴道镜病理检查,以病理活检为金标准,比较HPV16感染筛查方法、TCT筛查方法以及二者联用在筛查中的敏感度、特异度等指标,判断其临床应用价值。结果 HPV16感染筛查方法的敏感度为62.9%,特异度为83.5%,阳性预测值为53.4%,阴性预测值为88.2%;TCT筛查方法的敏感度为41.2%,特异度为92.7%,阳性预测值为62.9%,阴性预测值为84.0%;二者联合筛查,以HPV16感染或TCT异常为阳性,敏感度为84.7%,特异度为75.8%,阳性预测值为51.2%,阴性预测值为94.3%。结论 HPV16感染联合TCT异常筛查可以提高筛查的灵敏度,特异度也在可接受范围内,可以作为宫颈防癌初筛方法。     

宫颈上皮内瘤变治疗前后人乳头状瘤病毒载量的临床研究

目的:探讨宫颈上皮内瘤变(CIN)治疗前后人乳头状瘤病毒(HPV)载量与预后的意义.方法:从2006年6月～2009年9月间在新疆维吾尔自治区人民医院妇科门诊和妇科病房就诊的190例CIN患者,经宫颈环形电切术(LEEP)或宫颈冷刀锥切术治疗后进行1年随访,检测治疗前后HPV的载量,对病灶持续存在和复发进行分析.结果:CIN患者经LEEP或宫颈冷刀锥切术治疗后HPV平均载量较治疗前均显著降低(P＜0.01).随着HPV病毒载量持续时间越长,病变的持续存在率、复发率越高.结论:LEEP或宫颈冷刀锥切能显著降低CIN患者HPV载量,病毒载量影响疾病预后,其研究对随访和预后都有指导意义.     

宫颈特殊染色法、液基薄层细胞学及人乳头瘤病毒检测对宫颈癌前病变的应用价值分析

目的:探讨宫颈特殊染色法(FRD)、液基薄层细胞学(TCT)及人乳头瘤病毒(HPV)检测对宫颈癌前病变筛查的应用价值。方法:选取2015年1月～2018年1月于我院行宫颈癌筛查的1794例妇女作为研究对象,所有研究对象均接受FRD、TCT、HPV检测,以经阴道镜取样活检结果为阳性标准,对比分析三种不同检测方法以及联合检测的诊断效能。结果:病理科活检检出阳性111例,检出率为6.19%;FDR检测检出阳性114例,检出率为6.35%,漏诊率为16.22%;TCT检测检出阳性115例,检出率为6.41%,漏诊率为19.82%;HPV检测检出阳性108例,检出率为6.02%,漏诊率为19.82%;FRD检测与TCT、HPV检测的检出率比较差异无统计学意义(P0.05)。FRD检测敏感度为83.78%,特异度为98.75%,阳性预测值为81.58%,阴性预测值为98.93%;TCT检测敏感度为80.18%,特异度为98.46%,阳性预测值为77.39%,阴性预测值为98.69%;HPV检测敏感度为80.18%,特异度为98.87%,阳性预测值为82.41%,阴性预测值为98.70%;FRD、TCT、HPV联合检测敏感度为93.69%,特异度为99.52%,阳性预测值为92.86%,阴性预测值为99.58%;FRD、TCT、HPV联合检测与FRD、TCT、HPV单独检测的敏感度、阳性预测值比较差异具有统计学意义(P0.05)。结论:FRD、TCT、HPV检测对宫颈癌前病变的诊断效能相当,而FRD、TCT、HPV联合检测的诊断效能优于各方法单独检测。     

宫颈上皮内瘤变Ⅲ级术后随诊情况及其临床结局分析

目的:探讨宫颈上皮内瘤变Ⅲ级患者宫颈冷刀锥切术后的随访情况,并行TCT及HR-HPV监测对随诊情况进行分析。方法:选择我院2013年6月至2015年6月收治的宫颈冷刀锥切术后诊断为宫颈高级别上皮内瘤变(CINIII,HR-HPV阳性)的患者共计150例,分别于锥切术后3、6、12个月进行HR-HPV检测、宫颈液基细胞学(TCT)检查,并分析其随访情况。结果:不同年龄段患者正规随访比例分别为73.91%、78.05%、68.09%、75%,差异无统计学意义(P0.05)。正规随访患者术后3、6、12个月,HR-HPV的转阴率分别为57.27%、77.27%、89.09%,不同年龄段HR-HPV的转阴率分别为94.12%、93.75%、87.5%、66.67%,随着年龄的增长HR-HPV转阴率逐渐下降,而大于56岁的患者HR-HPV转阴率最低,与其他各年龄段比较,差异具有统计学意义(P0.05),各组正规随访患者TCT检查在随访期间均为阴性。结论:宫颈锥切术能够切除宫颈病变组织,但不能完全清除HR-HPV病毒,术后对各年龄段人群均需严密随诊。     

人乳头瘤病毒感染与宫颈高级别病变关系的研究

目的探讨人乳头状瘤病毒(human papillomavirus,HPV)感染与宫颈高级别病变(highgrade squamous intraepithelial lesion,HSIL)的关系。方法选取2003年1月到2016年8月在首都医科大学附属北京天坛医院行宫腔镜辅助宫颈冷刀锥切术的患者181例,患者行宫腔镜辅助宫颈冷刀锥切术前均有HPV检测、薄层液基细胞学(TCT)以及阴道镜活检及免疫组化的结果。依据病检结果分析HPV感染与宫颈高级别病变的关系。结果在181例宫颈高级别病变中,HPV感染165例,HPV检测阳性率为91.16%。其中高危型HPV感染160例,阳性率为88.40%,占阳性标本的96.97%。HPV16阳性率57.46%,占高危型HPV感染的63.03%。40~49岁高危型HPV检测阳性率最高,但各年龄组比较差异均无统计学意义(各年龄组P值均0.05)。HPV感染在宫颈高级别病变和子宫颈癌中差异均有统计学意义(P0.05)。结论 HPV感染在宫颈高级别病变的发生和发展中起关键作用。高危型HPV基因分型诊断在宫颈癌筛查及防治过程中具有重要意义。     

恒温扩增HPV检测技术应用于子宫颈癌筛查的效果评价研究

为了评价人乳头状瘤病毒(Human papillomavirus,HPV)恒温DNA扩增检测技术用于高危型HPV检测和宫颈癌早期及癌前病变筛查的准确性和可行性。本研究于2016年6月至8月,在我国内蒙古地区招募2 774例30-64岁有性生活史的妇女进行宫颈癌筛查;采用薄层液基细胞学技术完成细胞学诊断。采用恒温DNA扩增HPV检测技术(Isomega)和第二代杂交捕获技术(Hybrid Capture 2,HC2)平行检测宫颈标本;对于Isomega检测为HPV16/HPV18阳性的标本和两种方法检测不一致的标本,使用线性探针法(INNO-LiPA)进行分型验证。以病理诊断为金标准,评价Isomega用于筛查宫颈上皮内瘤变(Cervical Intraepithelial Neoplasia,CIN)2级及以上患者的灵敏度和特异度。结果表明,Isomega与HC2检测高危型HPV的总一致率为92.72%(Kappa=0.74),阳性一致率为86.78%,阴性一致率为93.77%;以INNO-LiPA分型结果为标准,Isomega检出HPV16和HPV18的准确率分别为96.97%和86.11%。以病理诊断为金标准,Isomega筛查CIN2+的灵敏度和特异度分别为87.76%和82.94%。Isomega能准确检测HPV16、HPV18和其他高危型别HPV,有较高的筛查灵敏度和特异度。     

细胞学结合高危型HPV-DNA检测在宫颈病变筛查中的应用

目的:评价现行3种子宫颈癌及癌前病变筛查方法的诊断效果.方法:对我院2009年1月～12月105位24～71岁妇女,均实施宫颈刮片细胞学和液基细胞学检查(TCT)、杂交捕获2代实验(HC2)检测高危型人乳头瘤病毒(HR-HPVDNA)、阴道镜取宫颈组织做病理检查,以病理检查结果为标准,≥中度官颈上皮内瘤变(CIN2)为阳性,检测各筛查方法的灵敏度及特异度.结果:各筛查方法的灵敏度及特异度分别为:宫颈刮片细胞学检查(≥巴氏Ⅲ级为阳性)(0.829,0.615)、TCT(≥ASCUS/AGUS为阳性)(0.845,0.594)、HR.HPV DNA(≥1.00为阳性)(0.902,0.400)、宫颈刮片细胞学与HR-HPV DNA联合检测(二项均阳性)(0.780,0.677)、TCT与HR-HPVDNA联合检测(二项均阳性)(0.805,0.692).宫颈刮片细胞学检查、TCT、宫颈刮片细胞学检查联合HR-HPV DNA、TCT联合HR-HPV DNA受试者工作特征(receiver operating characteristic,ROC)曲线下面积、可信区间(confidence interval)分别为0.719(0.620-0.819),0.724(0.625-0.822),0.729(0.629-0.828),0.749(0.652.0.849),各筛查方法筛查效率间差异无统计学意义.结论:宫颈刮片细胞学检查、液基细胞学检查(TCT)以及HR-HPVDNA检测是目前宫颈癌筛查有价值的方法,宫颈刮片细胞学检查与TCT检查相比筛查效率相似,分别联合HR-HPVDNA检测后筛查效率无明显增加.     

不同介质标本中人乳头瘤病毒E6癌蛋白检测效果对比研究

高危型人乳头瘤病毒(HR-HPV)E6癌蛋白在宫颈癌发生发展中起重要作用。本研究旨在评估一种新型、快速、低成本的HPV E6癌蛋白检测技术(OncoE6TM,AVC,Sunnyvale,CA,USA)在棉签和液基细胞学(Liquidbased cytology,ThinPrep)两种不同采样和储存介质宫颈标本中对HPV E6癌蛋白检测结果的一致性和对宫颈上皮内瘤变2/3(CIN2/3)及以上病变检出准确性。依托于1999年在山西省建立的宫颈癌筛查队列,对2014年随访中HPV DNA检测(第二代杂交捕获技术,HC2)阳性妇女的棉签和ThinPrep标本均进行E6癌蛋白检测,并用线性反向探针杂交技术(LiPA,Innogenetics)进行HPV基因分型。在294例HPV阳性妇女的棉签和ThinPrep标本中,E6癌蛋白阳性率相当(11.2%vs 7.8%,P=0.16);两者一致率为96.6%、Kappa值0.8。E6癌蛋白检测和LiPA基因分型对HPV16和HPV18型别的检测结果在两种标本中的一致性均较高(90%)。E6癌蛋白检测对CIN2+的检出效果如下:在棉签标本中,其灵敏度50.0%、特异度93.9%、阳性预测值51.6%;而ThinPrep标本中,灵敏度46.9%、特异度97.1%、阳性预测值68.2%;两者ROC曲线下面积同样为0.72;各项指标间无统计学差异(P0.05)。同样,对CIN3+的检出效果也相当,各指标间无统计学差异(P0.05)。E6蛋白检测在不同检测条件下可重复性较好,且两种标本有其不同的优势,应当根据不同地区卫生资源,适当选择标本类型,进行宫颈癌筛查。     

高危型人乳头瘤病毒检测在宫颈病变筛查中的临床意义

目的:探讨高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)检测在宫颈病变筛查中的应用价值.方法:采用液基细胞学(TCT)对1175例妇女宫颈癌及其癌前病变进行初筛,细胞学异常者或TCT正常、HR-HPV DNA阳性且高度怀疑宫颈病变患者进行阴道镜和宫颈多点活检组织病理学检查,结合病理结果分析宫颈病变.用二代杂交捕获法(hybird captureⅡ,HC-Ⅱ)对所有标本进行高危型HPV DNA的检测,对结果进行回顾性分析.结果:1175例样本中TCT检测结果正常或炎症968例,ASC-US(未明确诊断意义的不典型鳞状上皮细胞)62例,ASC-H(不典型鳞状上皮细胞,不能除外高度鳞状上皮内病变)39例,LSIL(低度鳞状上皮内病变)87例,HSIL(高度鳞状上皮内病变)19例.207例细胞学异常者经阴道镜下多点组织活检证实炎症116例,宫颈上皮内瘤变(CIN)Ⅰ级27例,Ⅱ级34例,Ⅲ级19例,浸润癌5例,湿疣6例.HC-Ⅱ法检测HR-HPV DNA发现207例细胞学异常者HPV感染率分别为:正常或炎症17.24%,CIN I 22.22%,CIN Ⅱ32.35%,CIN Ⅲ61.39%,浸润癌100.10%,湿疣30.23%.82例TCT正常、HR-HPV DNA阳性患者病理结果显示炎症67例,CIN Ⅰ 11例,CIN Ⅱ 6例.结论:随着病变的加重,HR-HPV感染率逐渐增高,其感染与宫颈病变级别相关,HR-HPV检测可辅助筛查宫颈病变,与细胞学联合检测为较好的宫颈癌筛查方案.     

高危型HPV筛查与TCT 联合检查在宫颈癌筛查中的临床应用

目的:探究液基薄层细胞学检测(TCT)与高危人乳头瘤病毒(HR-HPV)筛查联合检查在宫颈癌(CC)筛查中的临床价值。方法:选择2013年4月~2015年4月期间我院就诊疑似CC患者318例为研究对象;研究对象均进行HR-HPV筛查、TCT检查及阴道镜下病理活检,评价三种筛查结果的临床应用价值。结果:318例可疑CC患者中,病理学诊断炎症患者162例(50.94%),宫颈上皮内瘤样变(CIN)患者151例(47.48%),鳞癌(SCC)患者5例(1.57%);HR-HPV、TCT及HPV+TCT联合对诊断结果与病理诊断的符合率分别为78.30%、85.22%和99.37%;HR-HPV与TCT单独检测的符合率随患者病情进展呈现升高趋势(P0.05);TCT、HR-HPV检测单独进行诊断的敏感度、特异度均低于联合诊断(P0.05);HR-HPV与TCT联合检测诊断CC的敏感度为98.71%、特异度100%。结论:TCT检查HR-HPV筛查联合检查CC的敏感性、特异性及准确性高,为CC筛查的有效方式,值得在临床应用推广。     

人乳头状瘤病毒DNA检测在宫颈病变筛查中的应用研究

目的：探讨高危型人乳头状瘤病毒（HR-HPV）DNA检测方法在宫颈病变筛查中的应用意义。方法：580例妇女同时进行薄层液基细胞学（TCT）、第2代杂交捕获法（HC Ⅱ）和阴道镜下宫颈组织活检,并以病理组织学检查结果作为确诊标准进行对比分析。结果：①580例受检者中病理诊断为炎症207例（35.69%）,CIN Ⅰ 224例（38.62%）,CIN Ⅱ 96例（16.55%）,CIN Ⅲ 38例（6.55%）,浸润癌15例（2.58%）;②TCT检测异常者中炎症52例（25.12%）,CIN Ⅰ 177例（79.02%）,CIN Ⅱ 85例（88.54%）,CIN Ⅲ36例（94.74%）,浸润癌15例（100%）,其中CIN Ⅱ和CIN Ⅲ组间差异无统计学意义（P〉0.05）,但显著高于炎症组和CIN Ⅰ组,低于湿润癌组（P〈0.01或0.05）;③HPV DNA检测阳性者中炎症66例（31.88%）,CIN Ⅰ 152例（67.86%）,CIN Ⅱ 83例（86.46%）,CINIII 35例（92.11%）,浸润癌组15例（100%）,除CIN Ⅱ和CIN Ⅲ组间差异无显著性外（P〉0.05）,其余各组间差异均有统计学意义（P〈0.05或0.01）,且HPV-DNA检测阳性组CIN和浸润癌发病率明显高于阴性组（P〈0.01）;④30岁以下高危险型HPV感染率（65.53%）显著高于30岁以上34.47%感染率（P〈0.01）;⑤联合应用TCT、HPV-DNA检测诊断宫颈癌及癌前病变的敏感度和特异度分别为96.14%和69.28%,高于TCT或HPV-DNA的单独检测。结论：宫颈高危险型HPV感染是CIN及宫颈癌的主要发病因素,并与病变严重程度密切相关,而HPV-DNA和TCT联合应用可提高宫颈癌及癌前病变的检出率。     

HPV Testing by cobas HPV Test in a Population from Catalonia

Background

HPV testing in cervical cancer screening has been proposed as an alternative or complementary to cytology in women older than 30 years. However, adequate clinical sensitivity and specificity are crucial for a new test to be implemented. Hybrid Capture 2 (HC2) has proved good clinical performance in selecting women at risk for high-grade intraepithelial lesions with a high sensitivity and specificity. cobas HPV Test has been recently launched and its performance in different clinical settings needs to be determined.

Objectives

The aim of this study was to evaluate the cobas HPV Test for the detection of cervical HPV infection in a population of women in Catalonia (Spain) using HC2 as a reference.

Materials and Methods

Cervical liquid cytology samples from 958 women have been studied. Sensitivity was analyzed in 60 samples from patients with a high-grade intraepithelial lesion (≥CIN2) on histology and specificity was determined in 898 samples from women with no ≥CIN2. All cases had HC2 and cobas HPV Test performed. Statistical analyses of sensitivity, specificity and comparison between HC2 and cobas HPV Test by a non-inferiority test were applied.

Results

Sensitivity of HC2 and cobas HPV Test for detecting ≥CIN2 proved identical (98.3%) while specificity was 85.3% and 86.2% respectively. The non-inferiority test demonstrated that cobas HPV Test surpassed 90% sensitivity and 98% specificity of HC2.

Conclusion

The cobas HPV Test results fulfilled sensitivity and specificity requirements for HPV based cervical cancer screening and for the triage of minor cytological abnormalities, allowing its introduction in clinical settings.     

Prediction of recurrent disease by cytology and HPV testing after treatment of cervical intraepithelial neoplasia

Objective: To assess the role of human papillomavirus (HPV) testing and cytology as predictors of residual/recurrent disease after treatment of high‐grade cervical intraepithelial lesions. Methods: One hundred and thirty‐eight women with cervical intraepithelial neoplasia (CIN) grade 2/3 lesion on biopsy were included in a prospective follow‐up study in Belgium and Nicaragua. All women were treated with loop electrosurgical excision procedure (LEEP) and follow‐up visits took place at 6 weeks, 6 months, 1 year and 2 years. During these visits, a Papanicolaou (Pap) smear test was taken, colposcopy was performed and specimens were collected for HPV testing. Cytology, high‐risk (HR) HPV presence, persistent HR HPV infection and combinations of these tests at different time points during follow‐up were correlated with histologically confirmed residual/recurrent disease. Results: Thirteen patients (9%) developed residual/recurrent disease during follow‐up. Abnormal cytology at 6 weeks after treatment was significantly correlated with residual/recurrent disease. Nine of thirty‐seven patients with abnormal cytology at 6 weeks had recurrent disease versus three of seventy with a normal cytology [odds ratio (OR): 7.2; 95% confidence interval (CI): 1.8–28.5; P = 0.003). Sensitivity of this test was 75.0%, specificity 70.5%. Combining abnormal cytology and the presence of HR HPV within the first 6 months after treatment gave the best correlation with residual/recurrent disease: of the 54 women with abnormal cytology and/or HR HPV presence within the first 6 months, 11 developed residual/recurrent disease (OR 10.2; 95% CI: 2.2–48.3). Sensitivity of this combination was 84.6% and specificity 65.0%. Conclusion: Cytology remains the cornerstone in the early follow‐up after LEEP for CIN lesions of the cervix. HPV testing can add value as it increases the sensitivity of cytology in concomitant testing within the first 6 months.     

Positive Surgical Margin,HPV Persistence,and Expression of Both TPX2 and PD-L1 Are Associated with Persistence/Recurrence of Cervical Intraepithelial Neoplasia after Cervical Conization

Objective

To determine the clinicopathologic and immunohistochemical predictors of the persistence/recurrence of cervical intraepithelial neoplasia (CIN) after cervical conization.

Methods

Medical records of 502 patients who received cervical conization treatment of CIN between 2005 and 2012 were reviewed. The clinicopathologic parameters were analyzed using Cox hazard regression. Fifty patients with CIN persistence/recurrence were matched to 50 cases without CIN persistence/recurrence. These 100 cervical specimens were assessed for expression of insulin-like growth factor II messenger RNA (mRNA)-binding protein 3 (IMP3), targeting protein for xenopus kinesin-like protein 2 (TPX2), and programmed cell death-1 ligand-1 (PD-L1) using immunohistochemical staining.

Results

Multivariate analysis found that the independent predictors of CIN persistence/recurrence were positive surgical margin (hazard ratio 5.777, 95% confidence interval 2.334–14.301, p < 0.001) and human papilloma virus persistence for 6 months (hazard ratio 20.685, 95% confidence interval 7.350–57.657, p < 0.001). Co-expression of TPX2 and PD-L1 was significantly higher in CIN persistence/recurrence group than the group without CIN persistence/recurrence (p = 0.013). The depth of glandular involvement (GI) was less than 3mm in about 86.8% (59/68) CIN2-3 lesions, However, No statistically significant associations between GI and persistence/recurrence were observed (P = 0.58).

Conclusion

Positive surgical margin, HPV persistence, and expression of both TPX2 and PD-L1 are associated with persistence/recurrence of cervical intraepithelial neoplasia after cervical conization.     

Original cervical cytology and follow-up biopsy results in positive high risk human papillomavirus DNA tests with high-level resuls

OBJECTIVE: To ascertain Pap test and biopsy results of specimens with high level of human papillomavirus (HPv) DNA and compare atypical squamous cells of undetermined signiqicance (ASC-US) populations with HPV DNA. STUDY DESIGN: Positive HPV tests with relative light unit (RLU) values > or =1000 were identified and original Pap test and follow-up biopsy results recorded. Pap test and biopsy results for ASC-US were compared to positive results with RLU <1000. RESULTS: From 1892 total HPV-positive tests, 156 specimens with high RLU were identified; 145 had biopsies. The interpretations of the corresponding Pap tests were as follows: negative for intraepithelial lesion and malignancy, 3; ASC-US, 87; ASC, cannot exclude high grade squamous intraepithelial lesion, 5; low grade squamous intraepithelial lesion, 40 and high grade squamous intraepithelial lesion, 10. Biopsies showed 60 negative, 58 cervical intraepithelial neoplasia (CIN) 1 and 27 CIN 2+. In the highly positive ASCUS group, biopsy showed higher percentage of CIN 1 (33% vs. 16%) compared to the low-positive group. CONCLUSION: Compared to low-positive results, high-positive results showed more abnormal Pap tests. CIN 1 was a more likely result for high-positive ASCUS. More transient infections may account for these findings. The results do not argue for different management schemes between the categories.     

宫颈冷刀锥切术治疗宫颈上皮内瘤变的疗效观察及术后切缘阳性的危险因素分析

目的:探讨宫颈冷刀锥切术(CKC)治疗宫颈上皮内瘤变(CIN)的疗效,并分析术后切缘阳性的危险因素。方法:回顾性分析2009年1月至2017年12月在广州医科大学附属第三医院接受治疗的509例CIN患者的临床资料,其中行CKC治疗的患者318例记为CKC组,行宫颈环形电切术(LEEP)治疗的患者191例记为LEEP组,对比两组患者的手术指标、术后并发症发生率、切缘阳性率以及复发率,根据所有患者术后病理检查结果将其分为切缘阳性组和切缘阴性组,采用单因素和多因素Logistic回归分析方法分析CIN患者术后切缘阳性的危险因素。结果:CKC组患者的手术时间、住院时间均长于LEEP组患者,术中出血量多于LEEP组患者,组间比较差异有统计学意义(P<0.05)。CKC组患者的术后并发症发生率、切缘阳性率、复发率均低于LEEP组患者,组间比较差异有统计学意义(P<0.05)。单因素分析显示,切缘阳性组的手术方式、人类乳头状瘤病毒(HPV)感染、CIN病变分级、有无宫颈上皮腺体受累与切缘阴性组比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,手术方式为LEEP、HPV感染呈阳性、CIN病变分级为Ⅲ级、有宫颈上皮腺体受累是CIN术后切缘阳性的危险因素(P<0.05)。结论:采用CKC治疗CIN能够降低患者术后切缘阳性率和复发率,安全可靠。手术方式为LEEP、HPV感染呈阳性、CIN病变分级为Ⅲ级、有宫颈上皮腺体受累是CIN术后切缘阳性的危险因素,在治疗过程中应重视以上危险因素,并采取针对性措施以降低CIN术后切缘阳性的发生率。     

宫颈人乳头瘤病毒感染的药物治疗

宫颈癌是妇科三大恶性肿瘤之一。根据GLOBOCAN 2008数据统计,在中国女性所有恶性肿瘤中,发病比占6.3%,死亡比占4.6%。宫颈癌的发生与宫颈HPV感染存在密切关系。2012年NCCN指南提出30岁的女性推荐HPV DNA检查与细胞学检查结合用于宫颈癌的筛查。单纯HPV检测阳性时,患者可以选择继续观察随访。但事实上,妇科医生在临床诊疗过程中发现很多病人心理上无法接受对疾病不进行任何处理。而一些过度治疗方案包括LEEP,冷刀锥切,宫颈局部激光治疗等又有可能会造成宫颈机能不全,继发宫颈管狭窄,早产及低体重出生儿等不良结果。若积极处理的话有多种治疗方案可供选择。但是对于有生育要求的女性在治疗方案的选择上应该尤为慎重。本文对目前相关治疗方案的治疗效果及其能否阻止宫颈病变的进展等方面进行总结。旨在解决临床医生和患者共同关注的问题。