子宮頸上皮內(nèi)瘤變患者淋巴細(xì)胞亞群的初步分析及子宮頸HPV感染藥物治療的效果觀察
發(fā)布時(shí)間：2019-01-06 13:56
【摘要】：[目的]子宮頸上皮內(nèi)瘤變(CIN)是宮頸癌的癌前病變,是由持續(xù)的高危型人乳頭瘤病毒(HPV)感染引起。婦女一生中感染HPV的機(jī)會(huì)高達(dá)80%,但多數(shù)婦女可在數(shù)月之內(nèi)清除病毒,僅少數(shù)演變?yōu)槌掷m(xù)感染,進(jìn)而發(fā)展成為CIN甚至宮頸癌。免疫系統(tǒng)被認(rèn)為在HPV清除的過程中起關(guān)鍵性作用。本研究分為兩部分：第一部分了解CIN患者全身細(xì)胞免疫功能及樹突狀細(xì)胞的數(shù)量變化,第二部分是比較兩種局部用干擾素制劑對(duì)宮頸HPV感染的治療效果,并探討影響治療效果的因素。 [方法]第一部分用特異性熒光標(biāo)記素,通過流式細(xì)胞術(shù)對(duì)38例CIN患者及20例健康對(duì)照組的外周血中T淋巴細(xì)胞亞群進(jìn)行檢測(cè)。第二部分回顧性收集我院門診就診的宮頸HPV感染的患者資料,并用多因素回歸分析探究影響藥物治療效果的因素。 [結(jié)果]第一部分：隨著病變級(jí)別加重,CIN患者的CD4+T細(xì)胞比例逐漸下降,而CD8+T細(xì)胞比例逐漸增加,但是結(jié)果均沒有統(tǒng)計(jì)學(xué)意義。與健康對(duì)照相比,CIN2患者和CIN3患者的CD4+T細(xì)胞/CD8+T細(xì)胞的比值下降,分別是1.46±0.43、1.05±0.52和0.99±0.58,結(jié)果有統(tǒng)計(jì)學(xué)意義。CD8+T細(xì)胞的激活亞群,CD4+T細(xì)胞和CD8+T細(xì)胞的純真亞群、記憶亞群在各組之間沒有明顯的統(tǒng)計(jì)學(xué)差異。而CIN3患者的CD4+T細(xì)胞中的激活亞群(17.8%±6.1%)與健康對(duì)照組(11.5%±5.4%)有顯著性差異。CIN1-3患者的樹突狀細(xì)胞亞群與對(duì)照組無顯著性差異。第二部分：符合入組條件的患者共有308名,其中凝膠組為174名,膠囊組為134名。凝膠組的治療失敗率略低(26.4%vs.35.1%,P=0.102),但無統(tǒng)計(jì)學(xué)意義；凝膠組的治療顯效率略高(65.5%vs.51.5%,P=0.01)；而凝膠組的轉(zhuǎn)陰率低于膠囊組(23.0%vs.34.3%,P=0.03)。多因素分析顯示影響藥物顯效的因素是用藥前陰道鏡活檢(OR=1.926,95%CI1.062-3.494)、年齡(OR=1.730,95%CI1.065-2.812)、第一次HC2檢查數(shù)值(OR=1.948,95%CI1.191-3.187),影響HPV轉(zhuǎn)陰的因素是用藥種類(OR=4.586,95%CI2.692-7.812)、年齡(OR=0.579,95%CI0.348-0.936)、兩次檢查的間隔(OR=1.203,95%CI1.056-1.371)。 [結(jié)論]第一部分：CIN患者的全身細(xì)胞免疫功能出現(xiàn)異常,為免疫治療干預(yù)宮頸癌前病變發(fā)展提供了可能。第二部分：凝膠制劑和膠囊制劑治療宮頸HPV感染的顯效率尚可,但轉(zhuǎn)陰率較低,但結(jié)論需要進(jìn)一步的前瞻性研究驗(yàn)證。
[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 鹵0.43 鹵1.05 鹵0.52 and 0.99 鹵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% 鹵6.1%) were significantly different from those in healthy controls (11.5% 鹵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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33
本文編號(hào)：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 鹵0.43 鹵1.05 鹵0.52 and 0.99 鹵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% 鹵6.1%) were significantly different from those in healthy controls (11.5% 鹵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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33
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