| 郭 珍,赵冬梅,贾漫漫.基线细胞学正常女性高危型人乳头瘤病毒感染与宫颈病变发病风险的3年随访研究[J].中国肿瘤,2022,31(5):394-400. |
| 基线细胞学正常女性高危型人乳头瘤病毒感染与宫颈病变发病风险的3年随访研究 |
| Risk of High Risk Human Papilloma Virus Infection and Cervical Lesions Progress Among Women with Normal Cytology at Baseline： a 3-year Follow-up |
| 投稿时间：2021-11-25 |
| DOI：10.11735/j.issn.1004-0242.2022.05.A012 |
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| 中文关键词: 高危型人乳头瘤病毒 无上皮内病变或恶性病变 宫颈病变 随访研究 |
| 英文关键词:high risk human papilloma virus(HR-HPV) negative for intraepithelial lesion or malignancy(NILM) cervical lesions cohort study |
| 基金项目:国家自然科学基金（81502475)；河南省科技攻关计划项目 (192102310105) |
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| 中文摘要: |
| 摘 要：［目的］ 探讨基线细胞学正常妇女在3年随访过程中感染高危型人乳头瘤病毒（HR-HPV）及发生宫颈病变的情况。［方法］ 选择2017年4月至5月在河南省济源市宫颈癌筛查中细胞学结果正常的3 555名妇女为研究对象。对所有研究对象随访3年，HR-HPV阳性者每年随访1次，HR-HPV阴性者第3年随访1次。随访中以病理诊断结果为宫颈上皮内瘤变2级及以上（CIN2+）为终点，分析HPV感染变化和CIN2＋的发病风险。［结果］（1）HR-HPV阴性者：共2 455名基线细胞学正常且HR-HPV阴性妇女在第3年成功随访，HR-HPV新发阳性率为13.08%（321/2 455），其中HPV 16、18、33、52和58型别的新发阳性率分别为2.00%、0.94%、0.90%、3.50%、1.71%；年龄<45岁者HR-HPV、HPV 16、HPV 52新发阳性率均低于≥45岁者（10.7% vs 14.6%、0.9% vs 2.7%、2.2% vs 4.3%），差异均具有统计学意义（P均<0.05）。细胞学结果为意义不明的不典型鳞状细胞及以上者63例，8例被诊断为CIN1，3例被诊断CIN2，病变进展率为0.45%。（2）HR-HPV阳性者：共573名基线细胞学正常而HR-HPV阳性妇女需要随访，3次随访时HR-HPV转阴率分别为29.68%、39.06%、46.80%，CIN2+检出率分别为2.59%、2.58%、2.43%，3年CIN2+累计发生率为7.53%。年龄<45岁者3次随访HR-HPV转阴率均高于≥45岁者（35.5% vs 26.8%、51.0% vs 33.1%、58.6% vs 40.5%），差异均有统计学意义（P均<0.05）。［结论］ 宫颈癌筛查人群中细胞学正常且HR-HPV阴性妇女，其3年后随访时HR-HPV新发阳性率和CIN2+的发生风险均较低。细胞学正常而HR-HPV阳性妇女中，≥45岁者不仅清除既往HR-HPV感染的能力减弱，且更易出现新发感染或多种型别共感染现象，发生CIN2+的风险也较高。因此，可以适当延长基线细胞学正常且HR-HPV阴性妇女的随访时间间隔，对围绝经期女性人群应加强随访监测。 |
| 英文摘要: |
| Abstract： ［Purpose］ To investigate the risk of high risk human papilloma virus(HR-HPV) infection and cervical lesion progress in women with normal baselinecytology during 3 years of follow-up. ［Methods］ A total of 3 555 women with normal cytology at baseline were enrolled from a cervical screening cohort in Jiyuan City of Henan Province from April to May 2017. All subjects were followed up for 3 years. Cervical cytology was examined every year for women with positive HR-HPV， while for those with negative HR-HPV examined at the third year of follow-up. During the follow-up， the diagnosis of high grade cervical intraepithelial neoplasia(CIN2+) was used as end point. The risk of HR-HPV infection and CIN2+ was analyzed. ［Results］ A total of 2 455 women with normal cytology and negative HR-HPV at baseline were completed the 3-year followed-up. By the end of follow-up， there were 321 with newly infection of HR-HPV(13.08%)； and the infection rates of HPV 16， 18， 33， 52 and 58 was 2.00%， 0.94%， 0.90%， 3.50%， and 1.71%， respectively. The infections rate of HR-HPV， HPV16 and 52 in women <45 years old were lower than those in women ≥45 years old(10.7% vs 14.6%， 0.9% vs 2.7%， 2.2% vs 4.3%， P<0.05). There were 63 women with cyto-logy ≥ASCUS， 8 of whom were diagnosed with CIN1， 3 of whom were diagnosed with CIN2 with a disease progression rate of 0.45%. A total of 573 women with positive HR-HPV at baseline completed the follow-up. The negative conversion rate of HR-HPV was 29.68%， 39.06%， 46.80% and the CIN2+ detection rate was 2.59%， 2.58%， 2.43% in the first， second and third follow-up， respectively. The cumulative incidence of CIN2+ was 7.53% for 3 years follow-up. The negative conversion rates of HR-HPV in women <45 years old were higher than those in women ≥45 years old in each follow-up(35.5% vs 26.8%， 51.0% vs 33.1%， 58.6% vs 40.5%， P<0.05). ［Conclusion］ The infection rate of HR-HPV and the risk of CIN2+ are relatively low in women with normal cytology and negative HR-HPV after 3 years. The ability for clearing HR-HPV infection is weaker in ≥45 years women. And the risk of new infection or multiple infection of HR-HPV and progress to CIN2+ are higher in ≥45 years old women with normal cytology and positive HR-HPV. It is suggested that the time interval of follow-up may be appropriately extended for women with normal cytology and negative HR-HPV at baseline； while perimenopausal women should be focused on in follow-ups. |
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