子宫颈上皮内瘤变患者淋巴细胞亚群的初步分析及子宫颈HPV感染药物治疗的效果观察
发布时间：2019-01-06 13:56
【摘要】：[目的]子宫颈上皮内瘤变(CIN)是宫颈癌的癌前病变,是由持续的高危型人乳头瘤病毒(HPV)感染引起。妇女一生中感染HPV的机会高达80%,但多数妇女可在数月之内清除病毒,仅少数演变为持续感染,进而发展成为CIN甚至宫颈癌。免疫系统被认为在HPV清除的过程中起关键性作用。本研究分为两部分：第一部分了解CIN患者全身细胞免疫功能及树突状细胞的数量变化,第二部分是比较两种局部用干扰素制剂对宫颈HPV感染的治疗效果,并探讨影响治疗效果的因素。 [方法]第一部分用特异性荧光标记素,通过流式细胞术对38例CIN患者及20例健康对照组的外周血中T淋巴细胞亚群进行检测。第二部分回顾性收集我院门诊就诊的宫颈HPV感染的患者资料,并用多因素回归分析探究影响药物治疗效果的因素。 [结果]第一部分：随着病变级别加重,CIN患者的CD4+T细胞比例逐渐下降,而CD8+T细胞比例逐渐增加,但是结果均没有统计学意义。与健康对照相比,CIN2患者和CIN3患者的CD4+T细胞/CD8+T细胞的比值下降,分别是1.46±0.43、1.05±0.52和0.99±0.58,结果有统计学意义。CD8+T细胞的激活亚群,CD4+T细胞和CD8+T细胞的纯真亚群、记忆亚群在各组之间没有明显的统计学差异。而CIN3患者的CD4+T细胞中的激活亚群(17.8%±6.1%)与健康对照组(11.5%±5.4%)有显著性差异。CIN1-3患者的树突状细胞亚群与对照组无显著性差异。第二部分：符合入组条件的患者共有308名,其中凝胶组为174名,胶囊组为134名。凝胶组的治疗失败率略低(26.4%vs.35.1%,P=0.102),但无统计学意义；凝胶组的治疗显效率略高(65.5%vs.51.5%,P=0.01)；而凝胶组的转阴率低于胶囊组(23.0%vs.34.3%,P=0.03)。多因素分析显示影响药物显效的因素是用药前阴道镜活检(OR=1.926,95%CI1.062-3.494)、年龄(OR=1.730,95%CI1.065-2.812)、第一次HC2检查数值(OR=1.948,95%CI1.191-3.187),影响HPV转阴的因素是用药种类(OR=4.586,95%CI2.692-7.812)、年龄(OR=0.579,95%CI0.348-0.936)、两次检查的间隔(OR=1.203,95%CI1.056-1.371)。 [结论]第一部分：CIN患者的全身细胞免疫功能出现异常,为免疫治疗干预宫颈癌前病变发展提供了可能。第二部分：凝胶制剂和胶囊制剂治疗宫颈HPV感染的显效率尚可,但转阴率较低,但结论需要进一步的前瞻性研究验证。
[Abstract]:Objective: cervical intraepithelial neoplasia (CIN) is a precancerous lesion of cervical cancer and is caused by persistent high risk human papillomavirus (HPV) infection. Women have 80 chances of contracting HPV in their lifetime, but most women can remove the virus within a few months, and only a few develop persistent infections, which can lead to CIN and even cervical cancer. The immune system is thought to play a key role in the process of HPV clearance. This study was divided into two parts: the first part was to understand the systemic cellular immune function and the changes of dendritic cells in patients with CIN. The second part was to compare the therapeutic effect of two kinds of interferon preparations on cervical HPV infection. The factors influencing the therapeutic effect were also discussed. [methods] in the first part, T lymphocyte subsets in peripheral blood of 38 patients with CIN and 20 healthy controls were detected by flow cytometry with specific fluorescein. In the second part, the data of cervical HPV infection in outpatient clinic were collected retrospectively, and the factors influencing the efficacy of drug therapy were analyzed by multivariate regression analysis. [results] the first part: with the severity of the lesion, the proportion of CD4 T cells in patients with CIN decreased gradually, but the proportion of CD8 T cells increased gradually, but the results were not statistically significant. The ratio of CD4 T cells to CD8 T cells in CIN2 patients and CIN3 patients was 1.46 卤0.43 卤1.05 卤0.52 and 0.99 卤0.58, respectively. The results were statistically significant. There was no significant difference in the pure subsets of CD4 T cells and CD8 T cells and the memory subsets among the groups. The activation subsets of CD4 T cells in CIN3 patients (17.8% 卤6.1%) were significantly different from those in healthy controls (11.5% 卤5.4%), but there was no significant difference in dendritic cell subsets between CIN1-3 patients and controls. The second part: 308 patients met the criteria of admission, including 174 patients in gel group and 134 patients in capsule group. The treatment failure rate in the gel group was slightly lower (26.4vs.35.1P 0.102), but there was no significant difference between the gel group and the gel group (65.5 vs.51.5). The negative conversion rate in the gel group was lower than that in the capsule group (23.0vs.34.3and 0.03). Multivariate analysis showed that the factors influencing drug efficacy were colposcopy biopsy (OR=1.926,95%CI1.062-3.494), age (OR=1.730,95%CI1.065-2.812), first HC2 value (OR=1.948,95%CI1.191-3.187). The factors influencing HPV negative were OR=4.586,95%CI2.692-7.812, age (OR=0.579,95%CI0.348-0.936) and the interval between two examinations (OR=1.203,95%CI1.056-1.371). [conclusion] the first part: the systemic cellular immune function of CIN patients is abnormal, which provides the possibility for immunotherapy to interfere with the development of cervical precancerous lesions. The second part: the effective rate of gel preparation and capsule preparation in the treatment of cervical HPV infection is fair, but the negative rate is low, but the conclusion needs further prospective study to verify.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
本文编号：2402879
[Abstract]:Objective: cervical intraepithelial neoplasia (CIN) is a precancerous lesion of cervical cancer and is caused by persistent high risk human papillomavirus (HPV) infection. Women have 80 chances of contracting HPV in their lifetime, but most women can remove the virus within a few months, and only a few develop persistent infections, which can lead to CIN and even cervical cancer. The immune system is thought to play a key role in the process of HPV clearance. This study was divided into two parts: the first part was to understand the systemic cellular immune function and the changes of dendritic cells in patients with CIN. The second part was to compare the therapeutic effect of two kinds of interferon preparations on cervical HPV infection. The factors influencing the therapeutic effect were also discussed. [methods] in the first part, T lymphocyte subsets in peripheral blood of 38 patients with CIN and 20 healthy controls were detected by flow cytometry with specific fluorescein. In the second part, the data of cervical HPV infection in outpatient clinic were collected retrospectively, and the factors influencing the efficacy of drug therapy were analyzed by multivariate regression analysis. [results] the first part: with the severity of the lesion, the proportion of CD4 T cells in patients with CIN decreased gradually, but the proportion of CD8 T cells increased gradually, but the results were not statistically significant. The ratio of CD4 T cells to CD8 T cells in CIN2 patients and CIN3 patients was 1.46 卤0.43 卤1.05 卤0.52 and 0.99 卤0.58, respectively. The results were statistically significant. There was no significant difference in the pure subsets of CD4 T cells and CD8 T cells and the memory subsets among the groups. The activation subsets of CD4 T cells in CIN3 patients (17.8% 卤6.1%) were significantly different from those in healthy controls (11.5% 卤5.4%), but there was no significant difference in dendritic cell subsets between CIN1-3 patients and controls. The second part: 308 patients met the criteria of admission, including 174 patients in gel group and 134 patients in capsule group. The treatment failure rate in the gel group was slightly lower (26.4vs.35.1P 0.102), but there was no significant difference between the gel group and the gel group (65.5 vs.51.5). The negative conversion rate in the gel group was lower than that in the capsule group (23.0vs.34.3and 0.03). Multivariate analysis showed that the factors influencing drug efficacy were colposcopy biopsy (OR=1.926,95%CI1.062-3.494), age (OR=1.730,95%CI1.065-2.812), first HC2 value (OR=1.948,95%CI1.191-3.187). The factors influencing HPV negative were OR=4.586,95%CI2.692-7.812, age (OR=0.579,95%CI0.348-0.936) and the interval between two examinations (OR=1.203,95%CI1.056-1.371). [conclusion] the first part: the systemic cellular immune function of CIN patients is abnormal, which provides the possibility for immunotherapy to interfere with the development of cervical precancerous lesions. The second part: the effective rate of gel preparation and capsule preparation in the treatment of cervical HPV infection is fair, but the negative rate is low, but the conclusion needs further prospective study to verify.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
【参考文献】
相关期刊论文 前5条
1 Finter NB;金新华;;α-干扰素在病毒性感染疾病中的应用[J];国外医药.合成药.生化药.制剂分册;1993年01期
2 朱文静;谢青;陈榕;贾妮娜;项晓刚;林兰意;郭斯敏;王晖;;CD11c~+髓样树突状细胞在慢性乙型肝炎中频数与细胞表型的变化[J];世界华人消化杂志;2008年18期
3 田厚文;冯靖;;人乳头瘤病毒治疗性疫苗及应用前景[J];中国实用妇科与产科杂志;2010年05期
4 陈君石;抗氧化微量营养素的防癌作用[J];中国肿瘤;1994年06期
5 周宪宾;姚成芳;;巨噬细胞M1/M2极化分型的研究进展[J];中国免疫学杂志;2012年10期
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