上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

妊娠晚期宫颈高危型人乳头状瘤病毒感染及自然转归状况分析

王丹丹，杨慧琳，杨伶俐   

  1. 上海市浦东新区妇幼保健院妇科， 上海 201206
  • 出版日期:2013-11-28 发布日期:2013-12-03
  • 作者简介:王丹丹（1978—）， 女， 主治医师， 硕士; 电子信箱: dandan215512@126.com。
  • 基金资助:

    上海市卫生局青年科研基金（2008Y007）

Prevalence and spontaneous regression of cervical high risk human papillomavirusinfection of women in final or third trimester pregnancy stage

WANG Dan-dan, YANG Hui-lin, YANG Ling-li   

  1. Department of Gynecology, Maternal and Child Health Hospital of Pudong New Area, Shanghai 201206, China
  • Online:2013-11-28 Published:2013-12-03
  • Supported by:

    Foundation for Young Scientists of Shanghai Municipal Health Bureau, 2008Y007

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摘要：

目的 分析妊娠晚期妇女宫颈高危型人乳头状瘤病毒（HR-HPV）感染及产后自然转归状况。方法 选取2010年1月—2011年12月接受孕期产检及分娩的病例3 382例，孕前1年曾接受液基细胞学检测，孕妇于分娩前进行人乳头瘤病毒杂交捕获Ⅱ代（HPV HC-Ⅱ）法检测，产后1年随访HR-HPV阳性病例，仍为阳性者进一步行细胞学、阴道镜及病理学检查。结果 3 382名妊娠晚期妇女宫颈HR-HPV感染率为18.4%（623/3 382），怀孕3次及3次以上者HR-HPV感染率升高（P=0.016），年龄及产次与妊娠晚期HR-HPV感染无明显关系。530名产妇于产后1年随访HR-HPV，仍为阳性的为140例，阳性率为26.4%（140/530）。140例HR-HPV持续阳性者行细胞学检查，正常/炎症90例，非典型鳞状上皮细胞40例，低度上皮内病变6例，高度鳞状上皮内病变4例，50例阴道镜下活检炎症/湿疣变22例，宫颈上皮内瘤变（CIN）Ⅰ16例，CINⅡ4例，CIN Ⅲ 8例。结论 孕3次以上妊娠晚期HR-HPV感染率升高；孕期HR-HPV感染产后转阴率高，分娩方式与HR-HPV感染转阴无关；产后HR-HPV感染持续存在应密切随访，进一步行细胞学、阴道镜及病理学检查。

关键词: 人乳头状瘤病毒, 子宫颈, 宫颈上皮内瘤变, 妊娠晚期, 产后

Abstract:

Objective To investigate prevalence and spontaneous regression of cervical high risk human papillomavirus (HR-HPV) infection of women in final or third trimester pregnancy stage. Methods Form January 2010 to December 2011, a total of 3 382 women with 37 to 42 gestational weeks were enrolled in the study. The women were given ThinPrep cytology test (TCT) before pregnancy and HPV hybrid capture Ⅱ (HPV HC-Ⅱ) before delivery. The infection status of HPV was monitored during one-year-long follow-up after delivery, and those positive cases received cytological test, colposcope and pathological examinations. Results The HR-HPV infection rate was 18.4% (623/3 382). The infection rate was significantly higher in women with 3 or over times of pregnancy, whereas age and gravidity had no significant correlation with HR-HPV infection. In 530 positive cases, 140 were still positive in the end of follow-up, whose cytological test findings were 90 cases of normal/inflammation, 40 cases of atypical squamous cells, 6 cases of low grade squamous intraepithelial lesion, and 4 cases of high grade squamous intraepithelial lesion. And 50 cases were given colposcope examination, who were 22 cases of inflammation/HPV, 16 cases of cervical squamous intraepithelial lesion (CIN) Ⅰ, 4 cases of CIN Ⅱ, and 8 cases of CIN Ⅲ. Conclusion Women with 3 or over times of pregnancy had significantly high infection rate of HR-HPV. HR-HPV infection during pregnancy would spontaneously regress, which had no correlation with delivery mode. Patients with continued HR-HPV infection after delivery should undergo cytological test, colposcope and pathological examinations.

Key words: human papillomavirus, cervix uteri, cervical intraepithelial neoplasia, final or third trimester pregnancy stage, postpartum