微创医学

目的探讨宫颈上皮内瘤变（CIN）合并高危型人乳头瘤病毒（HR-HPV）感染患者的临床特征。方法选取150例CIN合并HR‑HPV感染患者作为研究组，选取同期HPV基因分型检测结果为阴性、宫颈光滑无炎症、无其他病症及病史的130例患者作为对照组。所有患者均进行外周血T淋巴细胞亚群（包括CD3+、CD4+、CD8+、CD4+/ CD8+）、炎症因子［白细胞介素‑4（IL‑4）、γ‑干扰素（IFN‑γ）］水平检测和HPV DNA载量检测。比较两组患者外周血T 淋巴细胞亚群水平、不同CIN 级别患者的HPV DNA载量及分布情况，分析CIN级别、HPV DNA载量、T淋巴细胞亚群和炎症因子水平之间的相关性。结果共检出CINⅠ级43例、CINⅡ级57例、CIN Ⅲ级50例，HPV DNA低载量32例、中载量41例、高载量77例。（1）研究组患者的CD3+、CD4+、CD4+/CD8+水平低于对照组，CD8+水平高于对照组，差异均具有统计学意义（均P<0.05）。（2）随着患者CIN级别的升高，其HPV DNA 载量逐渐升高，同时其HPV DNA 载量水平也发生改变（P<0.05）。（3）患者CD3+、CD4+、CD4+/CD8+、IFN‑γ、IL‑2水平随着CIN级别的升高而降低，CD8+、IL‑4水平则随CIN级别的升高而升高（P<0.05）。（4）随着HPV DNA载量的升高，CD3+、CD4+、CD4+/CD8+、IL‑2、IFN‑γ水平降低，CD8+、IL‑4水平则升高（P<0.05）。（5）CIN级别、HPV DNA载量与CD3+、CD4+、CD4+/CD8+、IL‑2、IFN‑γ水平呈负相关，而与CD8+、IL‑4水平呈正相关（P<0.05）。结论 HR‑HPV感染是引起CIN、宫颈癌等宫颈病变的主要危险因素，在HR‑HPV感染过程中，外周血T淋巴细胞亚群和炎症因子扮演重要角色。

Objective To investigate the clinical features of cervical intraepithelial neoplasia (CIN) combined with high risk human papilloma virus infection (HR-HPV). Methods A total of 150 patients with CIN combined with HR-HPV infection were selected as a study group, and 130 patients with negative HPV genotyping test results, smooth cervix without inflammation, and no other diseases or medical history were selected as a control group. All patients were tested for peripheral blood T lymphocyte subsets (including CD3+, CD4+, CD8+, CD4+/CD8+), inflammatory factors [interleukin-4 (IL-4), interferon-γ (IFN-γ)] levels and HPV DNA load. The levels of peripheral blood T lymphocyte subsets, HPV DNA load and distribution of patients with different CIN grades were compared between the two groups, and the correlation among CIN grade, HPV DNA load, T lymphocyte subsets and inflammatory factor level was analyzed. Results A total of 43 cases of CIN grade I, 57 cases of CIN grade Ⅱ, and 50 cases of CIN grade Ⅲ were detected, as well as 32 cases of HPV DNA low load, 41 cases of HPV DNA medium load, and 77 cases of HPV DNA high load. (1) The levels of CD3+, CD4+, CD4+/CD8+ were lower and the level of CD8+ was higher in the study group than those in the control group, with statistically significant differences (all P<0.05). (2) With the increase of CIN grade, the HPV DNA load gradually increased, and the HPV DNA load level also changed (P<0.05). (3) Patients' levels of CD3+, CD4+, CD4+/CD8+, IFN‑γ and IL‑2 decreased with the increase of CIN grade, while the levels of CD8+ and IL‑4 increased with the increase of CIN grade (P<0.05). (4) With the increase of HPV DNA load, the levels of CD3+, CD4+, CD4+/CD8+, IL-2 and IFN-γ decreased, while the levels of CD8+ and IL-4 increased (P<0.05). (5) CIN grade and HPV DNA load were negatively correlated with the levels of CD3+, CD4+, CD4+/CD8+, IL-2 and IFN‑γ, but positively correlated with CD8+ and IL-4 levels (P<0.05). Conclusion HR-HPV infection is the main risk factor for CIN, cervical cancer and other cervical lesions, in the process of HR-HPV infection, peripheral blood T lymphocyte subsets and inflammatory factors play an important role.

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