摘要
目的分析热凝治疗对我国女性人乳头瘤病毒(HPV)感染及宫颈上皮内瘤样病变(CIN)的治疗效果。方法纳入2017—2018年在我国农村地区(内蒙古鄂托克县、山西省襄垣县和阳城县)和城市地区(深圳)建立宫颈癌筛查队列中符合标准的20~65岁女性为研究对象,对其中HPV阳性且接受热凝治疗(166例)或未接受任何治疗(2716例)对象进行随访评估。针对热凝治疗患者,采用HPV检测和细胞学检查在其治疗后6个月或更长时间进行随访;针对未接受治疗患者,采用HPV检测进行每年随访,对所有随访过程中HPV和(或)细胞学阳性的女性进行阴道镜检查和(或)活检。比较评估接受热凝治疗组与未接受治疗组对象随访过程中的HPV清除率及热凝治疗对CIN病变的治愈率。结果分别有152例接受热凝治疗对象和2539例未接受治疗对象接受了随访评估,年龄M(Q_(1),Q_(3))分别为42(36,48)和47(41,54)岁,中位随访时间M(Q_(1),Q_(3))分别为23.4(12.4,24.5)和23.5(12.4,24.0)个月。随访结果显示,接受热凝治疗组的HPV清除率(73.0%,111例)高于未治疗组(46.1%,1171例)(P<0.001)。与未治疗组相比,热凝治疗清除HPV16的OR(95%CI)值为2.8(1.3~6.1),HPV52为3.2(1.3~7.9),HPV58为5.8(2.1~15.6)。接受热凝治疗组中基线病理诊断为CIN者的治愈率为77.4%(72例),其中轻度宫颈上皮内瘤样病变(CIN1)和中度及以上宫颈上皮内瘤样病变(CIN2+)的患者其治愈率分别为81.0%(47例)和71.4%(25例)。结论热凝治疗是清除HPV感染和治疗CIN病变的有效方法。特别是针对我国致宫颈癌及癌前病变风险较高的HPV型别,清除率高于未治疗人群。
Objective To evaluate the effectiveness of thermal ablation in the treatment of human papillomavirus(HPV)infection and cervical intraepithelial neoplasia(CIN)in Chinese women.Methods The high-risk HPV-positive women aged 20-65 who were detected through a cervical cancer screening project implemented in three rural sites(Etuoke counties in Inner Mongolia,Xiangyuan and Yangcheng counties in Shanxi Province)and one urban site(Shenzhen)in China were included in this prospective study.Follow up evaluation was performed on HPV positive women who underwent thermal ablation(n=166)as well as received no treatment(n=2716)in cervical cancer screening program.For women with thermal ablation treatment,HPV test and cytology were used for follow-up with the interval of 6 months or longer after treatment.For women without treatment,HPV test was used for annual follow-up.Women with positive results in either of the HPV tests or abnormal cytology were referred for a colposcopy or biopsy if necessary.The HPV clearance rate and the cure rate of CIN were compared between the two groups.Results A total of 152 women treated with thermal ablation and 2539 women without treatment reported for follow-up evaluation with the age M(Q_(1),Q_(3))of 42(36,48)and 47(41,54)years old,and the median time to follow-up time of 23.4(12.4,24.5)and 23.5(12.4,24.0)months,respectively.The HPV clearance rate in women undergoing thermal ablation was significantly higher than that in women with no treatment(73.0%vs 46.1%,P<0.001).The HPV16,HPV52 and HPV58 clearance rates among women receiving thermal ablation were higher than that in women without treatment with the OR(95%CI)of 2.8(1.3-6.1),3.2(1.3-7.9)and 5.8(2.1-15.6).For women with histologically confirmed CIN at baseline,cure rates were 77.4%(n=72)for thermal ablation.Cure rates of the thermal ablation were 81.0%(n=47)for CIN grade one(CIN1)and 71.4%(n=25)for CIN grade two or worse(CIN2+).Conclusions Thermal ablation is effective to clear the HPV infection as well as to treat CIN.Particularly for the HPV genotypes with the paramount attributable proportion to cervical cancer and precancerous in China,the HPV clearance rate was significantly higher than that reported in the women without treatment.
作者
赵雪莲
赵爽
胡尚英
段如菲
刘植华
段仙芝
张询
乔友林
赵方辉
Zhao Xuelian;Zhao Shuang;Hu Shangying;Duan Rufei;Liu Zhihua;Duan Xianzhi;Zhang Xun;Qiao Youlin;Zhao Fanghui(Department of Epidemiology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Gynecology,Affiliated Shenzhen Maternity and Child Healthcare Hospital,Shenzhen,518017,China;Department of Obstetrics and Gynecology,Beijing Tongren Hospital,Beijing 100176,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第24期1875-1881,共7页
National Medical Journal of China
基金
国家自然科学基金(81761128006)
美国中华医学基金会卫生政策与体系科学公开竞标项目(16-255)。
关键词
宫颈上皮内瘤样病变
人乳头瘤病毒
热凝
治愈
随访
Cervical intraepithelial neoplasia
Human papillomavirus
Thermal ablation
Cure
Follow up
