宮頸癌術(shù)后人乳頭瘤病毒的轉(zhuǎn)歸及其臨床意義
發(fā)布時(shí)間：2019-03-08 18:39
【摘要】：目的:人乳頭瘤病毒(human papillomavirus,HPV)的持續(xù)感染已被證實(shí)是宮頸癌(cervical cancer)的主要病因。手術(shù)是早期宮頸癌(FIGO分期I-IIA)的主要治療方法,既可以達(dá)到切除病灶的目的,對(duì)人乳頭瘤病毒的清除也有一定的作用。然而手術(shù)不可能完全清除HPV,術(shù)后HPV轉(zhuǎn)陰受相關(guān)因素的影響,HPV的持續(xù)感染可進(jìn)一步導(dǎo)致某些病變的發(fā)生,如陰道上皮內(nèi)瘤變(vaginal intraepithelial neoplasia,VAIN)等。本文章通過了解宮頸癌術(shù)后HPV轉(zhuǎn)歸的一般情況,分析影響HPV清除的相關(guān)因素,探討HPV轉(zhuǎn)歸對(duì)宮頸癌術(shù)后復(fù)發(fā)、繼發(fā)陰道病變的預(yù)測(cè)作用,指導(dǎo)臨床隨訪。方法:1.納入2012年1月至2013年12月在青島大學(xué)附屬醫(yī)院婦科確診并接受手術(shù)治療的宮頸癌患者375例。2.術(shù)后臨床隨訪3年,第1年每3個(gè)月隨訪1次,HPV轉(zhuǎn)陰后延長(zhǎng)為每6個(gè)月隨訪1次,第2~3年每6個(gè)月隨訪1次。隨訪內(nèi)容包括婦科查體、HPV檢測(cè)(第二代雜交捕獲實(shí)驗(yàn)室技術(shù),HC-II)、液基細(xì)胞學(xué)檢查(TCT)、血清腫瘤標(biāo)記物檢測(cè)及影像學(xué)檢查。3.記錄HPV清除時(shí)間,分析患者年齡、宮頸癌分期、腫瘤分化程度、手術(shù)方式(包括筋膜外全子宮切除術(shù)與廣泛子宮切除術(shù)、開腹手術(shù)與腹腔鏡手術(shù)、術(shù)中是否保留卵巢)以及術(shù)后是否輔助治療等因素對(duì)HPV清除的影響;通過了解HPV轉(zhuǎn)歸,探討術(shù)后HPV檢測(cè)對(duì)宮頸癌復(fù)發(fā)及繼發(fā)陰道病變的預(yù)測(cè)意義。4.HPV清除時(shí)間的分析采用生存函數(shù)Kaplan-Meier法,組間HPV清除時(shí)間的比較采用Log-rank檢驗(yàn),影響HPV清除的相關(guān)因素采用COX比例風(fēng)險(xiǎn)模型進(jìn)行多因素分析,P0.05代表差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.375例宮頸癌患者術(shù)后HPV清除的中位時(shí)間是7個(gè)月(95%CI為6.41~7.59個(gè)月),HPV在1年之內(nèi)轉(zhuǎn)陰者272例(78.39%,272/347),第1~2年內(nèi)轉(zhuǎn)陰者46例(13.26%,46/347),第2~3年內(nèi)轉(zhuǎn)陰者13例(3.75%,13/347)。2.將研究因素行單因素分析,結(jié)果顯示患者年齡(P0.05)、宮頸癌分期(P0.05)、子宮切除范圍(筋膜外全子宮切除或廣泛子宮切除)(P0.05)是影響宮頸癌術(shù)后HPV清除的相關(guān)因素,進(jìn)一步行多因素分析,結(jié)果顯示患者年齡是HPV清除的獨(dú)立危險(xiǎn)因素(P0.05)。3.宮頸癌術(shù)后HPV檢測(cè)預(yù)測(cè)宮頸癌復(fù)發(fā)的特異度為80.3%,靈敏度為88.2%,預(yù)測(cè)陰道病變的特異度為86.8%,靈敏度為93.0%。結(jié)論:1.宮頸癌術(shù)后HPV清除的中位時(shí)間為7個(gè)月,清除率隨著時(shí)間的延長(zhǎng)逐漸增高,大多數(shù)于術(shù)后2年內(nèi)清除。2.患者年齡、宮頸癌分期、子宮切除范圍是術(shù)后HPV清除的影響因素,其中患者年齡是HPV清除的獨(dú)立影響因素,年齡越大,HPV清除所需時(shí)間越長(zhǎng)。3.宮頸癌術(shù)后HPV持續(xù)感染與宮頸癌復(fù)發(fā)及陰道病變有關(guān),術(shù)后HPV檢測(cè)對(duì)預(yù)測(cè)宮頸癌復(fù)發(fā)及繼發(fā)陰道病變有較高的敏感性和特異性。
[Abstract]:Objective: persistent infection of human papillomavirus (human papillomavirus,HPV) has been proved to be the main cause of (cervical cancer) in cervical cancer. Surgery is the main treatment for early cervical cancer (FIGO stage I-IIA), which can not only remove the lesion, but also have a certain effect on the clearance of human papillomavirus (HPV). However, it is not possible to completely remove the negative conversion of HPV after HPV, due to related factors. The persistent infection of HPV may further lead to some pathological changes, such as vaginal intraepithelial neoplasia (vaginal intraepithelial neoplasia,VAIN) and so on. The purpose of this paper is to investigate the general situation of HPV outcome after cervical cancer and to analyze the related factors affecting HPV clearance, and to explore the predictive effect of HPV prognosis on recurrence and secondary vaginal lesion of cervical cancer after operation, so as to guide clinical follow-up. Methods: 1. From January 2012 to December 2013, 375 cervical cancer patients were admitted to Qingdao University affiliated Hospital for Gynecologic diagnosis and Surgical treatment. The clinical follow-up was 3 years after operation, once every 3 months in the first year. After HPV turned negative, it was prolonged to be followed up every 6 months, and once every 6 months in the second to third year. The follow-up included gynecological examination, HPV test (second generation hybridization capture laboratory technique, HC-II), liquid-based cytology examination, detection of serum tumor markers and imaging examination of (TCT),. 3. Record the duration of HPV clearance, analyze the age of the patient, stage of cervical cancer, degree of tumor differentiation, and surgical methods (including total fascia hysterectomy and extensive hysterectomy, open surgery and laparoscopic surgery). The influence of ovarian preservation during operation and adjuvant therapy after operation on the clearance of HPV; By understanding the prognosis of HPV, the significance of postoperative HPV detection in predicting the recurrence of cervical cancer and secondary vaginal lesions was discussed. 4. The survival function Kaplan-Meier method was used to analyze the clearance time of HPV, and the Log-rank test was used to compare the time of HPV clearance between groups. The factors related to HPV clearance were analyzed by COX proportional hazard model, and the difference was statistically significant (P0.05). Results: the median time of removal of HPV in 1.375 patients with cervical cancer was 7 months (95%CI = 6.41 to 7.59 months). Within one year,), HPV turned negative in 272 cases (78.39%, 272%), and in 46 cases (13.26%) within 1-2 years. 46 / 347), 13 cases (3.75%, 13 / 347) turned negative within 2 ~ 3 years. Univariate analysis showed that the age of the patients (P0.05) and the stage of cervical cancer (P0.05). The scope of hysterectomy (extrafascial total hysterectomy or extensive hysterectomy) (P0.05) was the related factor affecting the removal of HPV after cervical cancer, and further multivariate analysis was performed. The results showed that age was an independent risk factor for HPV clearance (P0.05). The specificity, sensitivity and sensitivity of HPV were 80.3%, 88.2%, 86.8%, 93.0%, 86.8%, 88.2% and 93.0%, respectively. Conclusions: 1. The median time of removal of HPV after cervical cancer was 7 months, and the clearance rate increased gradually with the prolongation of time, most of which were removed within 2 years after operation. The age of the patient, the stage of cervical cancer and the scope of hysterectomy were the influencing factors of HPV clearance after operation, and the age of the patient was the independent influencing factor of HPV clearance. The older the patient was, the longer it took to remove HPV. The persistent infection of HPV after cervical cancer is related to the recurrence of cervical cancer and vaginal lesion. The detection of HPV after operation has a high sensitivity and specificity for predicting the recurrence of cervical cancer and secondary vaginal lesion.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33
本文編號(hào)：2437095
[Abstract]:Objective: persistent infection of human papillomavirus (human papillomavirus,HPV) has been proved to be the main cause of (cervical cancer) in cervical cancer. Surgery is the main treatment for early cervical cancer (FIGO stage I-IIA), which can not only remove the lesion, but also have a certain effect on the clearance of human papillomavirus (HPV). However, it is not possible to completely remove the negative conversion of HPV after HPV, due to related factors. The persistent infection of HPV may further lead to some pathological changes, such as vaginal intraepithelial neoplasia (vaginal intraepithelial neoplasia,VAIN) and so on. The purpose of this paper is to investigate the general situation of HPV outcome after cervical cancer and to analyze the related factors affecting HPV clearance, and to explore the predictive effect of HPV prognosis on recurrence and secondary vaginal lesion of cervical cancer after operation, so as to guide clinical follow-up. Methods: 1. From January 2012 to December 2013, 375 cervical cancer patients were admitted to Qingdao University affiliated Hospital for Gynecologic diagnosis and Surgical treatment. The clinical follow-up was 3 years after operation, once every 3 months in the first year. After HPV turned negative, it was prolonged to be followed up every 6 months, and once every 6 months in the second to third year. The follow-up included gynecological examination, HPV test (second generation hybridization capture laboratory technique, HC-II), liquid-based cytology examination, detection of serum tumor markers and imaging examination of (TCT),. 3. Record the duration of HPV clearance, analyze the age of the patient, stage of cervical cancer, degree of tumor differentiation, and surgical methods (including total fascia hysterectomy and extensive hysterectomy, open surgery and laparoscopic surgery). The influence of ovarian preservation during operation and adjuvant therapy after operation on the clearance of HPV; By understanding the prognosis of HPV, the significance of postoperative HPV detection in predicting the recurrence of cervical cancer and secondary vaginal lesions was discussed. 4. The survival function Kaplan-Meier method was used to analyze the clearance time of HPV, and the Log-rank test was used to compare the time of HPV clearance between groups. The factors related to HPV clearance were analyzed by COX proportional hazard model, and the difference was statistically significant (P0.05). Results: the median time of removal of HPV in 1.375 patients with cervical cancer was 7 months (95%CI = 6.41 to 7.59 months). Within one year,), HPV turned negative in 272 cases (78.39%, 272%), and in 46 cases (13.26%) within 1-2 years. 46 / 347), 13 cases (3.75%, 13 / 347) turned negative within 2 ~ 3 years. Univariate analysis showed that the age of the patients (P0.05) and the stage of cervical cancer (P0.05). The scope of hysterectomy (extrafascial total hysterectomy or extensive hysterectomy) (P0.05) was the related factor affecting the removal of HPV after cervical cancer, and further multivariate analysis was performed. The results showed that age was an independent risk factor for HPV clearance (P0.05). The specificity, sensitivity and sensitivity of HPV were 80.3%, 88.2%, 86.8%, 93.0%, 86.8%, 88.2% and 93.0%, respectively. Conclusions: 1. The median time of removal of HPV after cervical cancer was 7 months, and the clearance rate increased gradually with the prolongation of time, most of which were removed within 2 years after operation. The age of the patient, the stage of cervical cancer and the scope of hysterectomy were the influencing factors of HPV clearance after operation, and the age of the patient was the independent influencing factor of HPV clearance. The older the patient was, the longer it took to remove HPV. The persistent infection of HPV after cervical cancer is related to the recurrence of cervical cancer and vaginal lesion. The detection of HPV after operation has a high sensitivity and specificity for predicting the recurrence of cervical cancer and secondary vaginal lesion.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33
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