女性外阴尖锐湿疣患者宫颈HPV和沙眼衣原体感染的流行病学调查及重组人干扰素α-2b阴道泡腾胶囊治疗HPV感染的效果观察

发布时间：2018-08-28 10:29

【摘要】：[目的]尖锐湿疣(Condyloma acuminate,CA)和泌尿生殖道沙眼衣原体(Chlamydia trachomatis,Ct)感染是常见的性传播疾病,但两者共同发病的资料尚不清楚。高危型人乳头瘤病毒(human papillomavirus,HPV)持续感染是宫颈癌发生的必要条件。有报道,高危HPV和沙眼衣原体共同感染在宫颈上皮内瘤变及宫颈癌发生中起到重要作用。本研究旨在获得天津医科大学总医院性病门诊女性外阴尖锐湿疣患者宫颈HPV合并沙眼衣原体共同感染的流行病学资料,了解该部分人群宫颈有无HPV感染及HPV基因分型,探讨对该部分人群进行常规宫颈HPV和沙眼衣原体筛查、及时治疗并随访的意义,以在一定程度上降低宫颈癌。同时观察重组人干扰素ɑ-2b阴道泡腾胶囊治疗宫颈HPV感染的疗效,为治疗HPV感染积累临床经验。[方法]1.收集自2015年6月至2016年6月期间就诊于天津医科大学总医院性病门诊,初次确诊为外阴尖锐湿疣的女性患者的宫颈脱落细胞样本,PCR法检测样本HPV基因及分型和沙眼衣原体的DNA;同时记录由妇科转诊我科的确诊为外阴尖锐湿疣女性患者宫颈HPV的检测结果,并统计感染率。2.将上述HPV阳性者随机分成治疗组和对照组,治疗组患者给予重组人干扰素ɑ-2b阴道泡腾胶囊80万IU治疗,其中,仅有低危型HPV感染者每月连续应用12天,有高危型HPV感染者每月连续应用20天,规律治疗3个月,停药4周后复查宫颈HPV,记录结果对比观察疗效。对照组不使用干扰素治疗。[结果]1.123例初次确诊外阴尖锐湿疣的女性患者中,宫颈样本HPV感染,沙眼衣原体感染及两者共同感染的百分率分别是88.6%(109/123),22.7%(20/88)及22.7%(20/88)。其中75.6%(93/123)的女性宫颈感染了高危型HPV,所有Ct阳性者均表现为宫颈HPV-DNA阳性。2.123例女性尖锐湿疣患者宫颈样本中,65.0%(80/123)表现为混合HPV基因型感染,13.0%(16/123)仅有LR-HPV感染,10.6%(13/123)仅有HRHPV感染。最常见的HR-HPV亚型为HPV 16(31/109),52(16/109),18(14/109),51(13/109),58(13/109),最常见的LR-HPV的亚型为HPV 11(41/109),6(63/109)。3.20例宫颈HPV阳性患者接受重组人干扰素ɑ-2b的阴道泡腾胶囊规律治疗后并接受回访,发现用药后三个月治疗组清除率为:HR-HPV的清除率为61.5%,LR-HPV的清除率为70.4%,总清除率为65.2%,;20例对照组患者4个月后HPV感染无明显变化。[结论]外阴尖锐湿疣女性患者22.7%宫颈合并沙眼衣原体感染,88.6%合并宫颈HPV感染,其中高危型达75.6%,65.0%表现为宫颈混合HPV基因型感染。因此,在尖锐湿疣女性患者中开展沙眼衣原体及宫颈HPV检测很有必要,以及时发现和治疗沙眼衣原体感染及HPV感染,争取在一定程度上降低C A的复发率和宫颈癌的发生风险,但仍需要大样本数据,长期的随访研究证实。20例应用重组人干扰素ɑ-2b阴道泡腾胶囊治疗的患者HPV均有不同程度转阴,总清除率为65.2%。重组人干扰素ɑ-2b阴道泡腾胶囊可作为治疗宫颈HP V感染的候选药物之一。
[Abstract]:[objective] Condyloma acuminatum (Condyloma acuminate,CA) and urogenital chlamydia trachomatis (Chlamydia trachomatis,Ct) infection are common sexually transmitted diseases, but the data of both are not clear. Persistent infection of high-risk human papillomavirus (human papillomavirus,HPV) is a necessary condition for cervical cancer. It is reported that high risk HPV and chlamydia trachomatis co-infection play an important role in cervical intraepithelial neoplasia and cervical cancer. The purpose of this study was to obtain the epidemiological data of cervical HPV co-infection with chlamydia trachomatis in female vulvar condyloma acuminatum outpatient clinic of General Hospital of Tianjin Medical University, and to find out whether there was HPV infection and HPV genotyping in the cervix. To explore the significance of routine cervical HPV and chlamydia trachomatis screening, timely treatment and follow-up, in order to reduce cervical cancer to a certain extent. To observe the efficacy of recombinant human interferon-2b vaginal effervescent capsule in the treatment of cervical HPV infection and to accumulate clinical experience in the treatment of HPV infection. [methods] 1. Collected from June 2015 to June 2016, the STD clinic of General Hospital of Tianjin Medical University, Detection of HPV gene and typing of cervical exfoliated cells in female patients with vulvar condyloma acuminatum for the first time and DNA; of chlamydia trachomatis simultaneously recorded female patients with vulvar condyloma acuminatum diagnosed by gynecological referral department Cervical HPV test results, And the infection rate. The above HPV positive patients were randomly divided into treatment group and control group. Patients in the treatment group were treated with recombinant human interferon-2b vaginal effervescent capsule for 800000 IU. Among them, only low-risk HPV infected patients were treated continuously for 12 days per month. Patients with high risk HPV infection were treated regularly for 3 months for 20 consecutive days each month. The results of cervical HPV, records were compared and observed after 4 weeks of withdrawal. The control group was not treated with interferon. [results] the rates of HPV infection, chlamydia trachomatis infection and co-infection were 88.6% (109 / 123) and 22.7% (20 / 88) in 1.123 female patients with vulvar condyloma acuminatum for the first time. Among them, 75.6% (93 / 123) of women had cervical infection with high-risk HPV,. All the Ct positive women showed positive HPV-DNA in cervix. 65.0% (80 / 123) of cervix samples of condyloma acuminatum showed mixed HPV genotype infection (13.0% (16 / 123) only LR-HPV infection 10.6% (13 / 123) only HRHPV infection. The most common subtype of HR-HPV was HPV 16 (31 / 109), 52 (16 / 109), 18 (14 / 109), 51 (13 / 109), 58 (13 / 109), and the most common subtype of LR-HPV was HPV 11 (41 / 109) 6 (63 / 109) .3.20 patients with positive cervical HPV received regular treatment with recombinant human interferon-2b vaginal effervescent capsules and were interviewed back. It was found that the clearance rate of the treatment group was 61.5% HR-HPV, the clearance rate of LR-HPV was 70.4, the total clearance rate was 65.2% and 20 cases of control group had no significant change in HPV infection after 4 months. [conclusion] 22.7% of female patients with vulvar condyloma acuminatum combined with chlamydia trachomatis infection 88. 6% of them were associated with cervical HPV infection. Therefore, it is necessary to detect chlamydia trachomatis and cervical HPV in female patients with condyloma acuminatum in order to detect and treat chlamydia trachomatis infection and HPV infection in time, and to reduce the recurrence rate of CA and the risk of cervical cancer to a certain extent. However, large sample data were still needed. Long-term follow-up study confirmed that. 20 patients treated with recombinant human interferon-2b vaginal effervescent capsule had varying degrees of HPV conversion to negative, the total clearance rate was 65.2%. Recombinant human interferon-2b vaginal effervescent capsule can be used as a candidate for the treatment of cervical HP V infection.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R752.53

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