Persistence of human papillomavirus as a predictor for treatment failure after loop electrosurgical excision procedure
Persistence of human papillomavirus as a predictor for treatment failure after loop electrosurgical excision procedure
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DOI：
10.1111/j.1525-1438.2007.00945.x
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发表时间：
2007-11-01
影响因子：
4.8
通讯作者：
Park, J. S.
中科院分区：
文献类型：
--
作者：
Bae, J. H.;Kim, C. J.;Park, J. S.
我们的目的是研究宫颈锥化后人类乳头瘤病毒(HPV)DNA检测是否可以预测治疗失败，并提高高级别宫颈上皮内瘤变(CIN)患者常规随访的准确性。2001年3月至2005年10月，120名确诊为CIN 2或3的患者接受了环形电刀切除术(LEEP)并纳入研究。6名患者在随访中失去了联系。术后第1年每3~6个月随访1次，然后每年随访1次。使用混合捕获2(Digene Co，Gaithersburg，MD)和HPV DNA芯片(Mygene Co，首尔，韩国)检测样本中是否存在HPV。持续性HPV感染定义为初诊时HPV持续(两次或两次以上)阳性，且具有相同HPV亚型(S)。22例(19.3%)锥切术后治疗失败。锥切术后CIN再发展的唯一显著危险因素是持续存在相同的HPV亚型(P<；0.0001)。CIN复发或残留的妇女在术后6个月的随访中HPV载量较高。总而言之，LEEP锥切术后同一HPV亚型的持续存在是治疗失败的重要预测因素。宫颈锥切术后的随访方案应包括宫颈细胞学和HPV检测，并需要HPVDNA芯片检测以检测持续的HPV感染。
We aimed to investigate whether postconization human papillomavirus (HPV) DNA testing can predict treatment failure and improve the accuracy of conventional follow-up in women with high-grade cervical intraepithelial neoplasia (CIN). Between March 2001 and October 2005, 120 patients with confirmed CIN 2 or 3 were treated with loop electrosurgical excision procedure (LEEP) and were enrolled. Six patients were lost to the follow-up. Postconization follow-up was performed at every 3-6 months during the first year and then annually. Specimens were tested for the presence of HPV, using the Hybrid Capture 2 (Digene Co, Gaithersburg, MD) and HPV DNA chip (Mygene Co, Seoul, Korea) test. Persistent HPV infection was defined as persistently (two times or more) positive HPV tests with the same HPV subtype(s) at initial diagnosis. Twenty-two (19.3%) patients showed treatment failure after conization. The only significant risk factor for redevelopment of CIN after conization was persistence of the same HPV subtype (P < 0.0001). And women with recurrent or residual CIN had higher HPV load during the 6-month follow-up postconization. In conclusion, the persistence of the same HPV subtype after LEEP conization was an important predictor of treatment failure. The follow-up protocol after conization of CIN should include both cervical cytology and HPV test, and HPV DNA chip test is needed to detect a persistent HPV infection.