Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ)
Factors associated with HPV persistence after treatment for high-grade cervical intra-epithelial neoplasia with large loop excision of the transformation zone (LLETZ)
复制标题
DOI：
10.1016/j.jcv.2004.05.012
复制
发表时间：
2004-12-01
影响因子：
8.8
通讯作者：
Rabelo-Santos, SH
中科院分区：
文献类型：
--
作者：
Sarian, LOZ;Derchain, SFM;Rabelo-Santos, SH
背景和目的：高度宫颈上皮内瘤样病变（CIN）切除后人乳头瘤病毒（HPV）持续存在可能与残留病变或疾病复发风险相关。关于CIN治疗后HPV持续存在相关因素的知识仍然有限。这项纵向研究的主要目的是评估患者的特征与其宫颈病变与高危HPV型持续性之间的相关性，在CIN 2和CIN 3采用转化区大环切除术（LLETZ）治疗后，通过市售Hybrid Capture II（HC II）检测。研究设计：在这项队列研究中，共纳入了2001年3月至2002年9月期间提交给LLETZ的94名妇女。仅考虑在6个月或12个月时至少有一次随访访视且锥孔标本中证实CIN 2或3的女性。在每次访问中，妇女回答了调查问卷，并进行巴氏涂片和HC II标本采集。单变量分析采用McNemar检验、卡方检验和Fisher检验。采用广义估计方程（GEE）进行多变量分析。所有计算均在95%置信区间（95% CI）内进行。结果：病理学检查显示CIN 12例（13%），CIN 3级2例，CIN 3级82例（87%），锥切边缘受损27例（29%）。87（92%）名妇女在LLETZ之前显示HC II试验阳性。在最初HPV阴性的妇女中，没有一个在随访期间有阳性HC II。LLETZ治疗后HPV阳性率从92%下降到20%（P < 0.01），第二次下降到22%（P < 0.01）。多因素分析显示，吸烟和年龄大于35岁（不考虑边缘状态）与随访期间HPV阳性密切相关。结论：LLETZ后HPV持续存在与吸烟以及年龄和锥切边缘之间的相互作用有关。(C)2004年由Elsevier B.V.出版
Background and objective: Human Papillomavirus (HPV) persistence after high-grade cervical intra-epithelial neoplasia (CIN) removal may be associated with residual lesions or risk of disease recurrence. Knowledge regarding the factors associated with HPV persistence following CIN treatment is still limited. The main purpose of this longitudinal study was to assess the association between characteristics of the patients and their cervical lesions with high-risk HPV-type persistence, detected by commercially available Hybrid Capture II (HC II), after CIN 2 and 3 treatment with large loop excision of the transformation zone (LLETZ). Study design: For this cohort study, a total of 94 women submitted to LLETZ between March 2001 and September 2002 were included. Only women with at least one follow-up visit at 6 or 12 months and confirmed CIN 2 or 3 in the cone specimen were considered. In each visit women answered to a questionnaire and undertook Pap smear and HC II specimens collection. McNemar's, chi-square and Fisher tests were used for univariate analysis. Generalized Estimating Equations (GEE) were used for multivariate analysis. All calculations were performed within 95% confidence intervals (95% CI). Results: Histological evaluation showed 12 (13%) women with CIN, 2 and 82 (87%) with CIN 3 and conization margins were compromised in 27 (29%) cases. Eighty-seven (92%) women showed positive HC II tests prior to LLETZ. Of women initially HPV negative, none had a positive HC II during follow-up. The proportion of positive HPV tests was reduced from 92% to 20%(P < 0.01) at the first visit and to 22% (P < 0.01) at the second visit after LLETZ. Multivariate analysis showed that smoking and age above 35 years (irrespective of margin status) were strongly associated with positive HPV during follow-up. Conclusion: HPV persistence following LLETZ was associated with smoking and with the interaction between age and conization margins. (C) 2004 Published by Elsevier B.V.