瑞琳他抗/HIFU治疗后未转阴预警因素：基于110例HPV16/18感染的回归性研究-东南大学学报医学版

瑞琳他抗/HIFU治疗后未转阴预警因素：基于110例HPV16/18感染的回归性研究

单位：石家庄市人民医院妇科, 河北石家庄 050011

分类号：R271.1

出版年·卷·期（页码）：2023·42·第五期（712-718）

摘要：

目的:探讨人乳头瘤状病毒(HPV)16/18感染患者瑞琳他抗/高强度聚焦超声(HIFU)治疗后未转阴的预警因素及其对临床治疗决策的指导价值。方法:选取2020年5月至2021年12月我院110例HPV16/18感染的低级别鳞状上皮内病变(LSIL)及以下患者进行回顾性研究,根据瑞琳他抗/HIFU治疗后HPV16/18感染转阴情况分为转阴组、非转阴组,对非转阴情况进行单因素及多因素Logistic回归分析。结果:年龄41~50岁患者非转阴的风险是<25岁的12.762倍,HPV16/18双重感染患者非转阴的风险是HPV 16(+)或18(+)患者的22.231倍,HPV-mRNA E6/E7(+)患者非转阴的风险是(-)患者的37.722倍,伴阴道炎患者非转阴风险是无阴道炎患者的9.463倍,采用HIFU治疗患者非转阴的风险是药物治疗患者的0.430倍,性伴数量 ≥ 2个患者非转阴的风险是性伴=1个患者的12.731倍,尿液1-羟基芘浓度亦与转阴情况相关(P<0.05)。多因素Logistic回归方程:Logit(P)=-11.054+2.546×年龄41~50岁+3.101×HPV16/18双重感染+3.630×HPV-mRNA E6/E7(+)+2.247×阴道炎-0.843×HIFU治疗+2.544×性伴数量 ≥ 2个+2.702×尿液1-羟基芘浓度;该模型预测瑞琳他抗/HIFU治疗后转阴的受试者工作特征(ROC)曲线下面积(AUC)为0.901(95%CI 0.830~0.949),敏感度为86.11%,特异度为82.93%。结论:年龄、HPV16/18双重感染、HPV-mRNA E6/E7(+)、阴道炎、性伴数量、尿液1-羟基芘浓度均是HPV16/18感染患者瑞琳他抗/HIFU治疗后未转阴的预警因素,通过对以上预警因素的评价可为临床选取非手术治疗或外科手术治疗决策提供参考,既避免持续感染贻误病情,又可避免过度治疗增加患者负担。

Objective: To investigate the early warning factors of non-negative conversion in patients with human papillomavirus(HPV) 16/18 infection after treatment with Raylene resists/high intensity focused ultrasound(HIFU) and its guiding value for clinical treatment decision. Methods: 110 patients with low-grade squamous intraepithelial lesions(LSIL) and below infected with HPV16/18 in our hospital from May 2020 to December 2021 were selected for regression study. According to the conversion of HPV16/18 infection after treatment with Raylene resists/HIFU, they were divided into negative conversion group and non-negative conversion group. Univariate and multivariate Logistic regression were used to analyze the non-negative conversion warning factors. Results: The risk of non-negative conversion in patients aged 41-50 years was 12.762 times that of <25 years, and the risk of non-negative conversion in patients with HPV16/18 double infection was 22.231 times that of patients with HPV16(+) or 18(+). The risk of non-negative conversion in HPV-mRNA E6/E7(+) patients was 37.722 times that of(-) patients, the risk of non-negative conversion in patients with vaginitis was 9.463 times that of patients without vaginitis, and the risk of non-negative conversion in patients treated with HIFU was 0.430 times that of patients treated with drugs. The risk of non-negative conversion was 12.731 times higher in patients with ≥ 2 sexual partners than in patients with 1 sexual partners. Urine 1-hydroxypyrene concentration was also correlated with negative conversion(P<0.05). Multi-factor Logistic regression equation: Logit(P)=-11.054+2.546×age 41-50 years +3.101×HPV16/18 double infection +3.630×HPV-mRNA E6/E7(+) +2.247×vaginitis -0.843×HIFU treatment +2.544×number of sex partners ≥ 2 +2.702×urine 1-hydroxypyrene concentration; the predicted area under receiver operating characteristic(ROC) curve(AUC) for patients who turned negative after Raylene resists/HIFU treatment was 0.901(95%CI 0.830-0.949), the sensitivity was 86.11%, and the specificity was 82.93%. Conclusion: Age, HPV16/18 double infection, HPV-mRNA E6/E7(+), vaginitis, number of sexual partners, urine 1-hydropyrene concentration are all early warning factors for patients with HPV16/18 infection who do not turn negative after treatment with Raylene resists/HIFU. The evaluation of the above warning factors can provide a reference for the clinical selection of non-surgical treatment and surgical treatment decision-making, which can avoid persistent infection and delay of the disease, and avoid excessive treatment to increase the burden of patients.

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