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目的:探讨HR-HPV和TCT检测在高度CIN行LEEP治疗后检测病变残余或复发的价值。方法:98例CINⅡ和CINⅢ患者行LEEP治疗后第3、6、12、24个月均检测HR-HPV和TCT及阴道镜,病理证实存在CIN视为残留或复发。结果:①术后第6个月HR-HPV转阴率较术后3月明显升高(P<0.05),且术后第6个月时HR-HPV检测诊断病变残留/复发的指标均较术后第3、12、24个月时高。②术后第6个月HR-HPV阳性23例,其中发病14例,阴性患者无发病;HR-HPV诊断病变残留或复发的敏感度、特异度、阳性预测值、阴性预测值、一致率、Youden值分别为100.00%、89.29%、60.87%、100.0%、90.82%、0.892 9,TCT检测分别为64.29%、94.05%、64.29%、94.05%、89.80%、0.583 4;HR-HPV敏感度和阴性预测值优于TCT。③术后病理切缘阳性16例(16.33%),术后24个月残留/复发28例(28.57%),切缘阳性残留/复发率(56.3%)较阴性患者(23.2%)发生率明显升高(P=0.013),发生风险是阴性患者的4.3倍;切缘阳性术后6月HPV阳性率(50.0%)较切缘阴性者(18.3%)亦明显升高(P=0.011),风险是阴性患者的4.5倍;而手术切缘阳性和术后6月TCT阳性率之间无明显相关性(P=0.695)。结论:术后第6个月HR-HPV检测是LEEP术后病变残留/复发的敏感指标,与TCT联合应用可提高敏感度,降低漏诊率。此外手术切缘阳性者术后病变残留/复发和HPV阳性发生率明显增高。
OBJECTIVE: To investigate the value of HR-HPV and TCT in the detection of residual or recurrence of lesions after LEEP treatment at a high degree of CIN. Methods: The HR-HPV, TCT and colposcopy were detected in 98 cases of CINⅡ and CINⅢ patients at 3, 6, 12 and 24 months after LEEP treatment. The pathology confirmed the existence of CIN as residual or recurrence. Results: ① The HR-HPV negative conversion rate at 6 months after operation was significantly higher than that at 3 months after operation (P <0.05), and the indexes of HR-HPV testing at the 6th month 3,12,24 months after the high. ② HR-HPV was positive in 23 cases at 6 months after operation, of which 14 cases were found and no negative disease was found. The sensitivity, specificity, positive predictive value, negative predictive value, concordance rate, Youden values were 100.00%, 89.29%, 60.87%, 100.0%, 90.82%, 0.892 9, TCT test was 64.29%, 94.05%, 64.29%, 94.05%, 89.80%, 0.583 4; Negative predictive value is better than TCT. ③Postoperative pathologic margins were positive in 16 cases (16.33%), residual / recurrence in 28 months (28.57%) and positive margins / recurrence rate (56.3%) were significantly higher in the 24 months after operation than those in the negative cases (23.2%) (P = 0.013), and the risk was 4.3 times higher than that in negative patients. The HPV positive rate (50.0%) in June after positive margins was significantly higher than that in negative margins (18.3%) (P = 0.013) The risk was 4.5 times that of negative patients. There was no significant correlation between the positive surgical margin and the positive rate of TCT after 6 months (P = 0.695). Conclusion: The detection of HR-HPV in the 6th month after operation is a sensitive indicator of residual / recurrence of LEEP. Combined with TCT can increase the sensitivity and reduce the rate of misdiagnosis. In addition surgical margin positive postoperative residual disease / recurrence and HPV positive rate was significantly higher.