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HPV检测及血清叶酸水平在评估宫颈上皮内瘤变Ⅲ级患者转归中的价值分析
作者:杨敏  马园园  高成英  孙延霞 
单位:延安大学附属医院 妇科, 陕西 延安 716000
关键词:人乳头瘤状病毒 叶酸 宫颈上皮内瘤变Ⅲ级 转归 
分类号:R711.74
出版年·卷·期(页码):2019·47·第八期(973-977)
摘要:

目的:分析HPV及血清叶酸水平检测对评估宫颈上皮内瘤变Ⅲ级患者转归的临床价值。方法:选取本院2015年1月至2017年1月本院就诊的确诊宫颈上皮内瘤变Ⅲ级患者89例纳入研究,采用SPSS 17.0统计软件包分析HPV及血清叶酸水平检测对评估宫颈上皮内瘤变Ⅲ级患者转归的临床价值。结果:研究中受试对象的叶酸以及HPV病毒载量分布如下,可见患者平均叶酸水平为(25.86±5.96)nmol·L-1;以血清叶酸浓度<7 nmol·L-1为叶酸缺乏标准,可见患者中总体叶酸缺乏比例为41.57%;其中<35岁组患者叶酸缺乏者所占比例为64.00%,≥ 35岁组为32.81%,两个年龄段差别有统计学意义(P<0.05)。HPV病毒载量阴性患者占17.98%,低和中低载量患者比例为26.97%和28.09%,中高载量患者所占比例为21.35%,高载量患者比例为5.62%。不同年龄段患者之间的差别未见统计学意义(P>0.05)。与非叶酸缺乏组比较,叶酸缺乏的患者可见消退以及病情持续预后的患者比例显著低于非叶酸缺乏患者,同时恶变的比例在叶酸缺乏患者中高于非叶酸缺乏患者,差别均有统计学意义(P<0.05);叶酸缺乏组患者中恶变转归患者比例最高,非叶酸缺乏组患者病情持续预后的患者所占比例最高,差别均有统计学意义(P<0.05);不同HPV病毒载量组比较差别有统计学意义(χ2=25.89,P<0.05);分别比较HPV病毒载量阴性、低载量、中低和中高载量以及高载量患者中的肿瘤消退、持续、进展以及恶变转归之间的差别,可见阴性载量患者中病情持续稳定患者所占比例最高,各种转归构成之间的差别有统计学意义(P<0.05);中高和高载量组患者均表现为病情进展的患者所占比例最高,且各种转归构成之间的差别有统计学意义(P<0.05);而HPV病毒低载量和中低载量患者的预后比例差别未见统计学意义。结论:HPV载量及血清叶酸水平会对宫颈上皮内瘤变Ⅲ级患者转归存在潜在影响,叶酸缺乏以及HPV载量高与潜在预后不佳存在关联。

Objective:To analyze and discuss the clinical value of HPV and serum folate detection in the evaluation of the outcome of grade Ⅲ cervical intraepithelial neoplasia. Methods:A total of 89 patients with grade Ⅲ cervical intraepithelial neoplasia diagnosed in our hospital from January 2015 to January 2017 were included in the study. Analysis and discussion of HPV and serum folic acid levels were performed to evaluate patients with grade Ⅲ cervical intraepithelial neoplasia. The clinical value of the outcome were analyzed by SPSS 17.0 statistical software package to evaluated the prognosis.Results:The folic acid and HPV viral load distributions of the subjects in the study were as follows; the average folate level in the patients was (25.86±5.96) nmol/L; the folic acid deficiency level was less than 7 nmol/L in serum, and the total folic acid was seen in the patients. The deficiency rate was 41.57%; among them, the proportion of patients with folic acid deficiency in the <35-year-old group was 64.00% and 32.81% in the 35-year-old group. There was a statistically significant difference between the two age groups, P<0.05. The proportion of patients with HPV negative viral load was 17.98%. The proportion of patients with low and medium-low load was 26.97% and 28.09%. The proportion of patients with medium-high load was 21.35%, and the proportion of patients with high load was 5.62%. The difference was not statistically significant among patients of different age groups, P<0.05. Compared with the non-folate-deficient group, patients with folic acid deficiency showed a significantly lower percentage of patients who had subsided and sustained disease prognosis than non-folate-deficient patients. The proportion of malignant transformation was higher in folic acid deficiency patients than in patients without folic acid deficiency, and the difference was statistically significant. P<0.05; the proportion of patients with malignant transformation in the folic acid deficiency group was the highest, and the proportion of patients with non-folate deficiency was the highest, and the difference was statistically significant (P<0.05). Differences in different HPV viral load groupswere statistically significant(χ2=25.89, P<0.05); tumor regression, persistence, progression, and malignant outcomes were compared among HPV-negative, low-, middle-, and mid-and high-load and high-load patients, respectively. The difference between the two groups showed that the proportion of patients with negative load in patients with stable disease was the highest, and the difference between the outcomes was statistically significant (P<0.05). The patients in the middle-high and high-load groups showed progression of the disease. The proportion of patients was the highest, and the difference between the outcome components was statistically significant (P<0.05). The proportion of patients with HPV low-load and low-to-medium load was significant. Conclusion:HPV load and serum folate level have a potential impact on the outcome of patients with grade Ⅲ cervical intraepithelial neoplasia. Folic acid deficiency and high HPV load are associated with poor prognosis.

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