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目的:了解TCT结合HR-HPV-HC2对CIN2/3术后复发监测和预测的临床价值及年龄、术前HPV负荷、切缘情况与CIN2/3术后复发的相关性。方法病理检查确认的203例CIN2/3患者行宫颈leep术或锥切术治疗,术后TCT、HR-HPV-HC2和多点锥切活检随访6个月。CIN2/3术后复发与年龄、术前HPV负荷、切缘情况进行Logistic回归分析。HR-HPV-HC2、TCT经ROC曲线作图进行CIN2/3术后复发监测和预测的临床价值分析。SPSS 10.0及Medcalc 9380软件进行统计学分析。结果1203例CIN2/3患者术后随访累积6个月复发36例,累积复发率为17.7%。2CIN2/3术后复发与术前HPV负荷和切缘情况相关,而与年龄无相关性。较小于103组相比,术前HPV-DNA大于103组术后复发率高4倍之多。阳性切缘患者CIN2/3术后易复发,复发率高达33.3%。3TCT、HR-HPV-HC2单独预测CIN2/3术后复发特异性较高,但敏感性低。二者组合预测CIN2/3术后3、6个月复发,曲线下面积(AUC)分别为0.951、0.919,敏感性、特异性分别在85%和95%以上。其中TCT与HR-HPV-HC2组合预测CIN2/3术后6个月复发的阳(阴)性预测价值高达95%左右。结论:CIN2/3术后易复发,复发原因与术前HPV负荷、切缘情况密切相关,而与年龄无关,故各年龄组术后均应进行跟踪随访。TCT与HR-HPV-HC2结合检测不仅可以评价CIN2/3治疗效果,而且也可以作为CIN2/3治疗后随访和预测复发的有效手段。
OBJECTIVE: To investigate the clinical value and age of preoperative recurrence of CIN2 / 3 with TCT combined with HR-HPV-HC2 and the correlation between preoperative HPV load, margins and CIN2 / 3 recurrence. Methods Totally 203 patients with CIN2 / 3 confirmed by pathology underwent cervical leptomy or conization. The patients were followed up for 6 months after TCT, HR-HPV-HC2 and multipoint cone biopsy. Logistic regression analysis of CIN2 / 3 recurrence and age, preoperative HPV load and margins were performed. HR-HPV-HC2, TCT by ROC curve mapping CIN2 / 3 postoperative recurrence monitoring and prediction of clinical value analysis. SPSS 10.0 and Medcalc 9380 software for statistical analysis. Results A total of 1203 cases of CIN2 / 3 patients were followed up for 6 months and 36 cases were recurred. The cumulative recurrence rate was 17.7%. The recurrence of 2CIN2 / 3 was related to the preoperative HPV load and margins, but not to the age. Preoperative HPV-DNA greater than 103 groups, the recurrence rate was 4 times higher than 103 groups. Positive margin of patients CIN2 / 3 easy to relapse after surgery, the recurrence rate as high as 33.3%. 3TCT, HR-HPV-HC2 alone predict CIN2 / 3 recurrence specificity higher, but the sensitivity is low. The combination of the two predicted the recurrence of CIN2 / 3 at 3 and 6 months after operation. The areas under the curve (AUC) were 0.951 and 0.919, respectively. The sensitivity and specificity were above 85% and 95% respectively. Among them, the combination of TCT and HR-HPV-HC2 predicted the positive (negative) predictive value of recurrence of CIN2 / 3 6 months after operation up to 95%. Conclusions: The recurrence of CIN2 / 3 is easy to recur after surgery. Reasons of recurrence are closely related to the preoperative HPV load and margins, but not to age. Therefore, all the age groups should be followed up after operation. The combination of TCT and HR-HPV-HC2 can not only evaluate the effect of CIN2 / 3, but also be an effective measure for follow-up and prediction of recurrence after CIN2 / 3 treatment.