张艳,向兵
ZHANG Yan,XIANG Bing

• 1:武汉科技大学妇产科

摘要(Abstract)：

目的:探讨宫颈上皮内瘤变(CIN)患者手术后疾病复发的主要危险因素。方法:160例CIN手术患者,根据宫颈锥切术后6个月时随访复查结果分为CIN复发组(n=80)和未复发组(n=80),分析2组患者个体因素、术前CIN病理特征及术后6个月时的辅助检查指标对术后患者CIN复发的影响;以术后患者CIN复发为因变量,采用拟合二分类Logistic回归分析术后患者CIN复发的影响因素。结果:复发组绝经人数、年龄>45岁人数显著高于未复发组,差异有统计学意义(P<0.05);复发组人群CIN病理分级为CIN2～3级、CIN病变区域为3～4个象限人数显著高于未复发组,差异有统计学意义(P<0.05);复发组HPV阳性、TCT阳性、P16inkta阳性人数显著高于未复发组,差异有统计学意义(P<0.05);回归分析结果显示,术后6月HPV阳性(OR=5.419,95%CI介于1.321～22.225)、TCT阳性(OR=4.759,95%CI介于1.357～16.683)、P16inkta阳性(OR=3.975,95%CI介于1.301～12.148)、病理分级(OR=3.857,95%CI介于1.190～12.503)、CIN病变区域(OR=3.127,95%CI介于1.220～8.011)、绝经(OR=2.801,95%CI介于1.160～6.767)、年龄(OR=2.560,95%CI介于1.124～5.831)、吸烟史(OR=2.484,95%CI介于1.134～5.441)是CIN患者术后复发的影响因素。结论:术后6月HPV、TCT及P16inkta阳性情况是CIN患者术后复发的主要影响因素。
Objective: To explore the major risk factors for recurrence of disease after operation in patients with cervical intraepithelial neoplasia. Methods: 160 patients with CIN were divided into CIN recurrence group(n=80) and non-repetition group(n=80)according to the results of follow-up review at 6 months after cervical conectomy. The effects of individual factors, pathological features of preoperative CIN and auxiliary examination indexes on recurrence of CIN were analyzed. Recurrence of CIN in postoperative patients was used as dependent variable to analyze the influencing factors of CIN recurrence in postoperative patients by fitting two-class Logistic regression. Results: The number of menopause, age >45 years in the recurrent group was significantly higher than that in the unrepeated group, and the difference was statistically significant(P<0.05). In the recurrent group, the CIN pathological grade was CIN2～3, and the number of patients with CIN lesion was 3～4 quadrants higher than that in the group without recurrence. The difference was statistically significant(P<0.05). The HPV positive, TCT positive and P16 inkta positive in the recurrent group were significantly higher than those in the unrepeated group, and the difference was statistically significant(P<0.05). The results of regression analysis showed that HPV positive at 6 months postoperative(OR=5.419, 95%CI between 1.321 and 22.225), TCT positive(OR=4.759, 95%CI between 1.357 and 16.683), P16 inkta positive(OR=3.975,95%CI between 1.301 and 12.148), pathological grade(OR=3.857,95%CI between 1.190 and 12.503), CIN lesion region(OR=3.127,95%CI between 1.220 and 8.011), menopause(OR=2.801,95%CI between 1.160 and 6.767), age(OR=2.560,95%CI between 1.124 and 5.831), history of smoking(OR=2.484,95%CI between 1.134 and 5.441) were the influencing factors of recurrence of CIN patients. Conclusion: HPV, TCT and P16 inkta are the main factors affecting recurrence after operation in patients with CIN.

关键词(KeyWords)： 宫颈上皮内瘤变;手术;复发;危险因素;回归分析
cervical intraepithelial neoplasia;surgery;recurrence;risk factors;regression analysis

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张艳,向兵
ZHANG Yan,XIANG Bing

DOI: 10.19367/j.cnki.1000-2707.2020.01.023

参考文献(References)：

• [1] 谢秀梅,徐芳.LEEP刀宫颈锥切术联合重组α-2b干扰素栓治疗宫颈上皮内瘤变疗效观察[J].海南医学,2019,30(3):339-341.
• [2] 张阳,罗美,何鑫,等.高级别宫颈上皮内瘤变及早期宫颈癌子宫切除术后患者高危型人乳头瘤病毒消退规律及相关因素分析[J].首都医科大学学报,2018,39(6):864-870.
• [3] 刘渝,郑秀惠,王婉,等.宫颈癌及宫颈上皮内瘤变患者术后复发与高危型人乳头瘤病毒载量和持续阳性的相关性研究[J].安徽医药,2018,22(11):2102-2105.
• [4] 张会芳.HPV检测在宫颈上皮内瘤变术后复发预测中的意义分析[J].现代诊断与治疗,2018,29(15):2416-2418.
• [5] 董学彩,张梦捷.宫颈上皮内瘤变患者行宫颈锥切术后持续病变或复发的危险因素分析[J].中国妇产科临床杂志,2018,19(3):263-264.
• [6] 梅丽丽,俞冠东.宫颈上皮内瘤变LEEP术后复发的危险因素及预测指标选择[J].现代仪器与医疗,2018,24(2):47-48,58.
• [7] 刘淼,齐跃,刘娟娟,等.宫颈上皮内瘤变宫颈锥切术后二次手术术式探讨及临床疗效分析[J].中国实用妇科与产科杂志,2018,34(3):298-303.
• [8] 郎景和.推行妇科恶性肿瘤的规范化诊治[J].肿瘤预防与治疗,2008,4(4):341-343.
• [9] 周丹丹,潘书惠,吉中磊,等.宫颈上皮内瘤变相关临床指标对LEEP术疗效及预后的预测价值[J].现代肿瘤医学,2018,26(4):584-587.
• [10]李焕香.宫颈环形电切术与宫颈冷刀锥切术治疗宫颈上皮内瘤变患者的近期疗效比较及术后复发相关因素分析[J].中国妇幼保健,2017,32(18):4578-4580.
• [11]WONG E L,CHAN P K,CHOR J S,et al.Evaluation of the impact of human papillomavirus DNA self-sampling on the uptake of cervical cancer screening[J].Cancer Nurs ,2016,8(1):1-11.
• [12]黄珊珊,徐凤娟.高级别宫颈上皮内瘤变LEEP术后24个月内复发与术后6个月HPV感染的关系[J].山东医药,2017,57(11):97-98.
• [13]刘正玲,王增艳,郝长宏,等.宫颈上皮内瘤变患者术后阴道病原体感染的影响因素研究[J].中华医院感染学杂志,2016,26(20):4704-4706.
• [14]宗丽菊,高绍凤,韩赛,等.75例宫颈上皮内瘤变锥切术后病变残留或复发的临床特点及诊治分析[J].实用妇产科杂志,2016,32(9):676-680.
• [15]孔守芳,戴淑真.Stathmin-1和p53蛋白与宫颈上皮内瘤变复发关系研究[J].中国实用妇科与产科杂志,2016,32(5):457-459.
• [16]龙馨,杨君,秦婷婷,等.宫颈上皮内瘤变LEEP术后残留或复发相关因素分析[J].重庆医学,2016,45(3):372-374.
• [17]曾燕,卢爱妮,廖予妹.宫颈上皮内瘤变锥切术后复发的相关预测因素[J].实用医学杂志,2015,31(4):601-603.
• [18]周萍,王沂峰.宫颈上皮内瘤变锥切术后残留或复发相关因素Meta分析[J].中国实用妇科与产科杂志,2014,30(7):546-552.
• [19]郭彦蓉,赵广超,李文华,等.人乳头状瘤病毒感染对宫颈上皮内瘤变宫颈环形电切术预后的相关性分析[J].中华医院感染学杂志,2014,24(12):3046-3048.
• [20]荣春红,杨佳欣,沈铿,等.宫颈上皮内瘤变锥切术后病理切缘阳性患者的处理[J].生殖医学杂志,2010,19(2):112-115.
• [21] YIN X M,ZHU L,TAN W W,et al.Time intervals between prior cervical conization and posterior hysterectomy influence postoperative infection in patients with cervical intraepithelial neoplasia or cancer[J].Med Sci Monit,2018,24(24):9063-9072.
• [22] CHEN J Y,WANG Z L,WANG Z Y,et al.The risk factors of residual lesions and recurrence of the high-grade cervical intraepitheliallesions (HSIL) patients with positive-margin after conization[J].Medicine,2018,97(41):20-23.

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