女性生殖道高危型HPV感染临床自然转归和影响因素研究

发布时间：2018-06-23 04:51

本文选题：高危人乳头瘤病毒 + 自动清除　；参考：《天津医科大学》2014年硕士论文

【摘要】：目的探讨高危型人乳头状瘤病毒(High-risk human papillomavirus, HR-HPV)检测为阳性,但宫颈细胞学检查(liquid-based cytologic test, LCT)结果阴性或者宫颈病理结果正常的妇女的HR-HPV感染的临床自然转归,分析影响HR-HPV自然转归的相关影响因素。为HR-HPV阳性,但宫颈细胞学检查结果阴性或者宫颈病理结果正常的妇女的临床处理方案提供实验依据。方法采用第二代杂交捕获试验(Hybrid Capture Ⅱ, HC-Ⅱ)进行HR-HPV检测；采用宫颈液基细胞学(LCT)进行宫颈病变的筛查；同时进行淋病奈瑟菌、衣原体、支原体、外阴阴道假丝酵母菌病(vulvovaginal Candida disease, VVC)、阴道毛滴虫和细菌性阴道病(bacterial vaginosis, BV)病原学检查；对于LCT检查异常者进行阴道镜检查,阴道镜下在病变最严重处及四象限多点取活检进行病理检查。根据宫颈三阶梯诊断方案对2008年天津市滨海新区大港医院门诊852位女性进行检查,HR-HPV阳性共176例,其中9例HR-HPV感染患者宫颈病理结果为高度病变接受手术治疗,另外167例HR-HPV阳性而LCT结果阴性或者宫颈病理结果正常的患者,自愿参加本随访研究。对这些妇女进行问卷调查,并填写问卷调查表。然后进行随访,随访间隔为6个月。在随访过程中,有19位患者未按要求随访,予以剔除本研究。根据随访方案,最终共148例患者纳入本研究,严格记录自然转归情况。随访期间宫颈均未用药物治疗。每次随访时均同时进行LCT、HR-HPV检测,调查宫颈HR-HPV感染患者自然清除影响因素,探讨各因素与宫颈HR-HPV自然清除的关系。全部病例随访3年。结果最终纳入本研究的148位妇女的初始LCT检查结果中89例正常,59例不典型鳞状上皮细胞(atypical squamous cell of undeterminded significance, ASCUS)或低度上皮内瘤变(low-grade squamousintrapithliallision, LSIL),但阴道镜病理结果正常。至本研究随访结束,在148位妇女中,共有103位HR-HPV检测在随访期间转为阴性,即HR-HPV感染自然清除率为69.59%(103/148),有22.30%(33/148)仍持续阳性。至本研究随访结束,148位妇女中有12位发展为宫颈上皮内瘤变(cervical intraepithelial neoplasia, CIN),即8.11%(12/148),其中CINⅠ5人, C1N Ⅱ5人,C1NⅢ2人,均为HR-HPV持续阳性的患者,转入其他随访组。即：本随访研究结束时,高级别CIN(CIN Ⅱ和CINⅢ)共7人,即4.73%(7/148)。经单因素分析及多因素分析结果提示,年龄、职业、最初病毒负荷量、性伴侣个数、配偶性伴侣个数、避孕方式以及生殖道炎症与HR-HPV感染自然清除呈负相关,即年龄越大,病毒清除的可能性越小；最初病毒负荷量越高,病毒清除的可能性越小。性伴侣个数多,非避孕套避孕以及生殖道炎症病毒清除可能性减小,是影响HPV自然清除的影响因素(P0.01)。与是否吸烟、受教育程度及初次性生活年龄无明显相关性(P0.05)。所有病例目前均在继续随访中。结论在宫颈细胞学检查正常或者宫颈病理结果正常的妇女中, HR-HPV感染的自然清除率为69.59%,清除时间为6个月到3年。年龄、最初病毒负荷量和生殖道炎症是影响女性生殖道HR-HPV感染自然清除的影响因素,提示根据HR-HPV的病毒负载量、亚型及感染时间和合并其他生殖道炎症的情况来综合制定适合的治疗方案,可避免过度治疗。同时对年龄较大妇女、非避孕套避孕、性伴侣数目多者、反复发作的生殖道炎症或高病毒负荷量的HR-HPV感染自然清除率低的高风险人群,应该严密随访。
[Abstract]:objective
To explore the clinical natural outcome of High-risk human papillomavirus (HR-HPV) detection and cervical cytology (liquid-based cytologic test, LCT) negative or normal cervical pathological results in women, and analyze the related factors affecting the natural prognosis of HR-HPV. It is HR-HPV. Positive, but the cervical cytology test negative or cervical pathological results of normal clinical treatment plan to provide experimental basis.
Method
The second generation hybrid capture test (Hybrid Capture II, HC- II) was used for HR-HPV detection, cervical fluid based cytology (LCT) was used to screen the cervical lesions, and Neisseria gonorrhoeae, chlamydia, mycoplasma, vulvovaginal candidiasis (vulvovaginal Candida disease, VVC), Trichomonas vaginalis and bacterial vaginosis (bact) were performed at the same time. Erial vaginosis, BV) aetiology examination; colposcopy for abnormal LCT examination, colposcopy under the colposcopy in the most serious and four quadrant biopsy for pathological examination. 852 women were examined in Dagang hospital, Tianjin Binhai New District Hospital in 2008 according to the cervical three ladder diagnosis scheme, and HR-HPV was positive in 176 cases, of which 9 The cervical pathological results of HR-HPV infected patients were treated with surgical treatment for high lesions. The other 167 patients with positive HR-HPV and negative LCT or normal cervical pathological results were voluntarily participated in this follow-up study. The women were investigated with a questionnaire and questionnaire questionnaire. Followed up, the follow-up interval was 6 months. The follow-up process was followed up. In this study, 19 patients were excluded according to the required follow-up. According to the follow-up program, a total of 148 patients were included in the study, and the natural prognosis was strictly recorded. During the follow-up period, the cervix was not treated with drugs. At the same time, LCT and HR-HPV were carried out at the same time, and the factors of natural clearance of the patients with HR-HPV infection in the cervix were investigated, and the various factors were investigated. The relationship between factors and natural clearance of cervical HR-HPV was observed. All cases were followed up for 3 years.
Result
In the final LCT examination of 148 women in this study, 89 cases were normal, 59 cases of atypical squamous cells (atypical squamous cell of undeterminded significance, ASCUS) or low degree intraepithelial neoplasia (low-grade squamousintrapithliallision, LSIL), but the pathological results of the colposcopy were normal. To this study, the end of the study was 14. Of the 8 women, 103 HR-HPV tests were turned negative during the follow-up period, that is, the natural clearance rate of HR-HPV infection was 69.59% (103/148) and 22.30% (33/148) remained positive. 12 of the 148 women developed cervical intraepithelial neoplasia (cervical intraepithelial neoplasia, CIN), 8.11% (12/148), CIN I 5. People, C1N II 5, C1N III and 2 people were HR-HPV persistent positive patients and were transferred to other follow-up groups. At the end of the follow-up study, high grade CIN (CIN II and CIN III) were 7, that is, 4.73% (7/148). Age, occupation, initial viral load, number of sexual partners, number of sexual partners, contraception, birth control, contraception, and contraception were indicated by the results of single factor analysis and multivariate analysis. The higher the age, the smaller the possibility of virus clearance, the higher the age of the virus, the smaller the possibility of the virus clearance, the smaller the initial viral load, the less possible, the more sexual partners, the non condom contraception and the diminishing possibility of the viral clearance of the genital tract, which affect the natural clearance of the HR-HPV. There was no significant correlation between P0.01 and smoking, education level and age of first sexual life (P0.05).
conclusion
In women with normal cervical cytology or normal cervical pathology, the natural clearance rate of HR-HPV infection was 69.59%, and the clearance time was 6 months to 3 years. Age, initial viral load and genital tract inflammation were the factors affecting the natural clearance of HR-HPV infection in female genital tract, suggesting that the virus load of HR-HPV, subtype At the same time, the high risk population of older women, the non condom contraception, the number of sexual partners, the recurrent episodes of genital tract inflammation or the high viral load of the high risk of HR-HPV infection should be closely related to the high risk population. Follow up.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

【引证文献】