应用高危型人乳头瘤病毒(human papilloma virus, HPV)检测联合液基薄层细胞学试验(thinprep cytologic test, TCT)评价宫颈电圈环切术(loop electrosurgical excision procedure, LEEP)治疗重度宫颈上皮内瘤样病变(cervical intraepithelial neoplasia, CIN)Ⅱ及Ⅲ的效果及预后。

选择2005年11月至2006年12月在本院行宫颈电圈环切术的重度宫颈上皮内瘤样病变患者病变组织标本为研究对象。根据诊断结果分为CINⅡ组(n＝68，59.13%)，CINⅢ组[包括原位癌(carcinoma in situ，CIS) ](n＝47，40.87%)(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准)。本组115例患者均于宫颈电圈环切术后4～6个月行液基薄层细胞学检测，6～8个月行高危型人乳头瘤病毒第二代杂交捕获法(hybrid capture Ⅱ，HC2)检查，并随访至2008年1月。采用回顾性分析法对其进行宫颈电圈环切术后疗效及预后分析研究。

CIN Ⅱ组行宫颈电圈环切术前，人乳头瘤病毒阳性率为73.53%(50/68)，CIN Ⅲ组为95.74%(45/47)，CINⅢ组较CINⅡ组显著升高，两组比较，差异有显著意义(P<0.05)。宫颈电圈环切术后，6例患者(5.22%，6/115)病灶残留或复发。宫颈电圈环切术前，人乳头瘤病毒呈阳性患者中，宫颈电圈环切术后，5例病灶残留或复发，占术前人乳头瘤病毒呈阳性总例数的5.26%，与术前人乳头瘤病毒呈阴性患者预后比较，差异无显著意义(P>0.05)。术后随访中，第二代杂交捕获法人乳头瘤病毒检测灵敏度为66.67%，特异度为98.12%，阳性预测值为57.14%，阴性预测值为98.15%；液基薄层细胞学试验的人乳头瘤病毒检测灵敏度为83.33%，特异度为76.15%，阳性预测值为16.13%，阴性预测值为98.81%。宫颈电圈环切术后，人乳头瘤病毒及液基薄层细胞学试验检测均呈阳性的4例患者，全部病灶残留或复发，因此联合两种检测方法具更高的阳性预测值和特异度。

宫颈电圈环切术是目前治疗重度宫颈上皮内瘤样病变的有效方法。高危型人乳头瘤病毒感染与重度宫颈上皮内瘤样病变的发生高度相关。术前对重度宫颈上皮内瘤样病变患者进行人乳头瘤病毒检测，对评估术后预后临床意义不大。人乳头瘤病毒检测联合液基薄层细胞学试验对评价宫颈电圈环切术效果及患者转归，具有重要临床价值。

To explore the therapeutic effects of human papilloma virus (HPV) test combined with thinprep cytologic test (TCT) on evaluating loop electrosurgical excision procedure (LEEP) and the follow-up of high-grade cervical intraepithelial neoplasia(CIN).

From March 2005 to December 2006, 115 patients who subjected to loop electrosurgical excision procedure(LEEP) due to histologically confirmed cervical intraepithelial neoplasia(CIN) Ⅱ/Ⅲ were selected. They were classified into two groups according to the diagnosis, one of which was consisted of patients with cervical intraepithelial neoplasia Ⅱ(CINⅡ group, n=68, 59.13%), the other with cervical intraepithelial neoplasiaⅢ(including carcinoma in situ, CIN Ⅲ group, n=47, 40.87%). The study was according to the ethical standards enacted by the ethics committee and confirmed by the committee. Informed consent was obtained from all participates. All 115 cases who underwent loop excision procedure were followed-up until January 2008. Follow–up visits were consisted of cervical thinprep cytologic test during the following 4~6 months after the operation and hybrid capture Ⅱ (HC2) during the following 6~8 months. A retrospective analysis was performed to study effects and prognosis after loop electrosurgical excision procedure.

The positive human papilloma virus rate was 95.74% in CIN Ⅲ group which was significantly higher than that in CIN Ⅱ group (73.53%) before loop electrosurgical excision(P<0.05). Six cases (5.22%, 6/115) showed residual or recurrent disease after the procedure during the follow–up, while 5 (5.26%, 5/115) who were positive in hybrid captureⅡ before the loop electrosurgical excision procedure showed residual or recurrent disease. No statistically significant difference in residuals or recurrence between two groups (P>0.05). The sensitivity, specificity, positive predictive value(PPV), negative predictive value of hybrid capture Ⅱ were 66.67%, 98.12%, 57.14%, 98.15%. While the sensitivity, specificity, positive predictive value, negative predictive value of the thinprep cytologic test were 83.33%, 76.15%, 16.13%, 98.81%. Four cases whose hybrid capture Ⅱ and thinprep cytologic test both were positive showed residual or recurrent. Specificity and positive predictive value were significantly higher when two tests were combined.

Loop electrosurgical excision procedure is an effective way for treating high–grade cervical intraepithelial neoplasia. High risk human papilloma virus may play an important role in the occurrence of high grade cervical intraepithelial neoplasia. Pre–treatment of high risk human papilloma virus testing seems to have no predictive value for the prognosis of patients who undergo loop electrosurgical excision procedure for high–grade cervical intraepithelial neoplasia. High risk human papilloma virus combined with thinprep cytologic test during the post–treatment may be of great importance after loop electrosurgical excision procedure.