發(fā)布時(shí)間：2018-06-23 04:51

  本文選題：高危人乳頭瘤病毒 + 自動(dòng)清除�。� 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 探討高危型人乳頭狀瘤病毒(High-risk human papillomavirus, HR-HPV)檢測(cè)為陽性,但宮頸細(xì)胞學(xué)檢查(liquid-based cytologic test, LCT)結(jié)果陰性或者宮頸病理結(jié)果正常的婦女的HR-HPV感染的臨床自然轉(zhuǎn)歸,分析影響HR-HPV自然轉(zhuǎn)歸的相關(guān)影響因素。為HR-HPV陽性,但宮頸細(xì)胞學(xué)檢查結(jié)果陰性或者宮頸病理結(jié)果正常的婦女的臨床處理方案提供實(shí)驗(yàn)依據(jù)。 方法 采用第二代雜交捕獲試驗(yàn)(Hybrid Capture Ⅱ, HC-Ⅱ)進(jìn)行HR-HPV檢測(cè)；采用宮頸液基細(xì)胞學(xué)(LCT)進(jìn)行宮頸病變的篩查；同時(shí)進(jìn)行淋病奈瑟菌、衣原體、支原體、外陰陰道假絲酵母菌病(vulvovaginal Candida disease, VVC)、陰道毛滴蟲和細(xì)菌性陰道病(bacterial vaginosis, BV)病原學(xué)檢查；對(duì)于LCT檢查異常者進(jìn)行陰道鏡檢查,陰道鏡下在病變最嚴(yán)重處及四象限多點(diǎn)取活檢進(jìn)行病理檢查。根據(jù)宮頸三階梯診斷方案對(duì)2008年天津市濱海新區(qū)大港醫(yī)院門診852位女性進(jìn)行檢查,HR-HPV陽性共176例,其中9例HR-HPV感染患者宮頸病理結(jié)果為高度病變接受手術(shù)治療,另外167例HR-HPV陽性而LCT結(jié)果陰性或者宮頸病理結(jié)果正常的患者,自愿參加本隨訪研究。對(duì)這些婦女進(jìn)行問卷調(diào)查,并填寫問卷調(diào)查表。然后進(jìn)行隨訪,隨訪間隔為6個(gè)月。在隨訪過程中,有19位患者未按要求隨訪,予以剔除本研究。根據(jù)隨訪方案,最終共148例患者納入本研究,嚴(yán)格記錄自然轉(zhuǎn)歸情況。隨訪期間宮頸均未用藥物治療。每次隨訪時(shí)均同時(shí)進(jìn)行LCT、HR-HPV檢測(cè),調(diào)查宮頸HR-HPV感染患者自然清除影響因素,探討各因素與宮頸HR-HPV自然清除的關(guān)系。全部病例隨訪3年。 結(jié)果 最終納入本研究的148位婦女的初始LCT檢查結(jié)果中89例正常,59例不典型鱗狀上皮細(xì)胞(atypical squamous cell of undeterminded significance, ASCUS)或低度上皮內(nèi)瘤變(low-grade squamousintrapithliallision, LSIL),但陰道鏡病理結(jié)果正常。至本研究隨訪結(jié)束,在148位婦女中,共有103位HR-HPV檢測(cè)在隨訪期間轉(zhuǎn)為陰性,即HR-HPV感染自然清除率為69.59%(103/148),有22.30%(33/148)仍持續(xù)陽性。至本研究隨訪結(jié)束,148位婦女中有12位發(fā)展為宮頸上皮內(nèi)瘤變(cervical intraepithelial neoplasia, CIN),即8.11%(12/148),其中CINⅠ5人, C1N Ⅱ5人,C1NⅢ2人,均為HR-HPV持續(xù)陽性的患者,轉(zhuǎn)入其他隨訪組。即：本隨訪研究結(jié)束時(shí),高級(jí)別CIN(CIN Ⅱ和CINⅢ)共7人,即4.73%(7/148)。經(jīng)單因素分析及多因素分析結(jié)果提示,年齡、職業(yè)、最初病毒負(fù)荷量、性伴侶個(gè)數(shù)、配偶性伴侶個(gè)數(shù)、避孕方式以及生殖道炎癥與HR-HPV感染自然清除呈負(fù)相關(guān),即年齡越大,病毒清除的可能性越小；最初病毒負(fù)荷量越高,病毒清除的可能性越小。性伴侶個(gè)數(shù)多,非避孕套避孕以及生殖道炎癥病毒清除可能性減小,是影響HPV自然清除的影響因素(P0.01)。與是否吸煙、受教育程度及初次性生活年齡無明顯相關(guān)性(P0.05)。所有病例目前均在繼續(xù)隨訪中。 結(jié)論 在宮頸細(xì)胞學(xué)檢查正�；蛘邔m頸病理結(jié)果正常的婦女中, HR-HPV感染的自然清除率為69.59%,清除時(shí)間為6個(gè)月到3年。年齡、最初病毒負(fù)荷量和生殖道炎癥是影響女性生殖道HR-HPV感染自然清除的影響因素,提示根據(jù)HR-HPV的病毒負(fù)載量、亞型及感染時(shí)間和合并其他生殖道炎癥的情況來綜合制定適合的治療方案,可避免過度治療。同時(shí)對(duì)年齡較大婦女、非避孕套避孕、性伴侶數(shù)目多者、反復(fù)發(fā)作的生殖道炎癥或高病毒負(fù)荷量的HR-HPV感染自然清除率低的高風(fēng)險(xiǎn)人群,應(yīng)該嚴(yán)密隨訪。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 胡海蓉;陳曉輝;譚秋梅;;生殖道病原菌感染、HPV感染與婦女不孕癥的相關(guān)性探索[J];數(shù)理醫(yī)藥學(xué)雜志;2016年05期

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本文編號(hào)：2055854