Study On The Correlation Between Drug Intervention At Different Time After HSIL Conization And The Outcome Of HR-HPV Infection

Objective:To study the correlation between combined drug intervention after HSIL conization and the outcome of HR-HPV infection,in order to find the best time for drug intervention after surgery to reduce the recurrence rate after surgery;at the same time to analyze the correlation of persistent HR-HPV infection after surgery Risk factors,intervention measures and personalized follow-up measures are taken for patients with risk factors,in order to provide theoretical support for clinical practice.Methods:According to the inclusion and exclusion criteria,a total of 178 HSIL patients who were admitted to the Department of Gynecology of the Affiliated Hospital of Hebei University and received cold knife conization of the cervix from June 2019 to December 2019were selected.The patients were divided into groups according to whether they received drug intervention or not.The treatment There were 40 cases in group A and 138 cases in observation group.Patients in treatment group A were given drugs(recombinant human interferonα-2b vaginal effervescent tablets)1 month after surgery,and patients in the observation group were followed up routinely.Collect clinical data such as age,pregnancy and parity,menopausal status,preoperative TCT and HPV infection,vaginal lavage,postoperative pathology and other clinical data,compare the general clinical data of the two groups of patients,and compare the two groups at 6 months after surgery The outcome of HR-HPV infection and the local immune function of the vagina.Patients in the observation group were rechecked for HR-HPV at 6 months after surgery and did not turn negative.According to whether they received drug intervention,they were divided into treatment group B and control group.The two groups of patients were compared with HR-HPV infection at 12months after surgery.The outcome and the local immune function of the vagina.The related risk factors of postoperative HR-HPV persistent infection were analyzed,and the factors such as age,pregnancy and parity,menopausal status,preoperative TCT and HPV infection,postoperative pathology,etc.Results:1.Among all patients,there are 118 cases(66.3%)with a single type of HPV infection,and a total of 60 cases(33.7%)with multiple types of HPV infection.The most common type of HPV infection is HPV16,with 65 cases(55.1%),followed by 13 cases(11.0%)with HPV52 infection,11 cases(9.3%)with HPV18 infection,and 10 cases with HPV58 infection.(8.5%),9 cases of HPV31 infection(7.6%),3 cases of HPV33 infection(2.5%),3 cases of HPV35 infection(2.5%),the least being HPV51 and 56 infections,2 cases each.Among patients with multiple types of HPV infection,there were 44 cases(73.3%)with HPV16 subtype,and 16 cases(26.7%)with multiple infections of other subtypes.2.Treatment group A and observation group patients in age,pregnancy and parity,menopausal status,preoperative TCT classification,HR-HPV infection,preoperative vaginal lavage fluid IL-2,IL-10 concentration and the ratio of IL-2/IL-10,postoperative pathological resection margin and whether the glands were involved were compared,and there was no statistical difference.At 6 months after the operation,the HPV infection rate of treatment group A(72.5%)was higher than that of the observation group(52.2%),and there was a statistical difference(χ~2=5.220,P=0.022<0.05).The concentration of immune factor IL-2 in vaginal lavage fluid of treatment group A(143.28±16.77)was higher than that in the observation group(135.86±19.11),and there was a statistical difference(t=2.217,P=0.028<0.05);two groups of patients There was no statistically significant difference in IL-10 concentration and the ratio of IL-2/IL-10.3.According to the preoperative HR-HPV infection situation,it will be divided into single type HPV infection and multiple types of HPV infection.The treatment group A and the observation group are compared with the negative conversion rate at 6months after surgery.The results show that there are multiple types of HPV infection.Among the groups,the negative rate of treatment A group(70.6%)was significantly higher than that of the observation group(34.9%),with statistical difference(χ~2=6.275,P=0.012<0.05).According to the pathological involvement of the glands after the operation,it was divided into the involved glands and the unaffected glands.The negative conversion rate at 6 months after the operation was compared between the two groups.The difference in the monthly HPV conversion rate was not statistically significant.4.At 12 months after the operation,the HPV infection rate of the treatment group B(62.9%)was higher than that of the control group(45.2%),but there was no statistical difference.The level of immune factor IL-2(148.91±21.68)in the vaginal lavage fluid of the treatment group B patients was higher than that of the control group(137.10±22.51),which was statistically different(t=2.170,P=0.034<0.05).There was no statistical difference in the concentration of IL-10 and the ratio of IL-2/IL-10.5.Through univariate analysis,it was found that multiple types of HPV infection before operation(χ~2=4.307,P=0.038<0.05),postoperative pathology showed positive margins(χ~2=8.977,P=0.003<0.05),glands involved(χ~2=6.510,P=0.011<0.05)is a related risk factor for persistent HR-HPV infection at 12 months after surgery,there was no statistically significant difference from the patient’s age,pregnancy and parity,menopausal status,preoperative TCT,HPV16 infection and postoperative drug intervention.The level of IL-2(t=-6.602,P=0.000<0.05)and the ratio of IL-2/IL-10(t=-3.533,P=0.001<0.05)in vaginal lavage fluid of patients with persistent HR-HPV infection after operation were higher than those in non-persistent infection group,with statistical difference.Logistic multivariate regression analysis was performed,and the results showed that multiple types of HPV infection before operation,positive resection margins after postoperative pathology,and glandular glands were independent risk factors for persistent HR-HPV infection after HSIL conization(P<0.05),Which increased the risk of persistent infection after surgery by 2.31(1/0.432)times,5.34(1/0.187)times and 3.92(1/0.255)times,respectively.The increase in the concentration of IL-2,an immune index,indicates that the risk of persistent HPV infection after surgery has decreased.Conclusions:1.In this study,the HR-HPV infection of HSIL patients was mainly single type infection,the most common HPV infection subtype was type 16,followed by type 52,18,and 58.2.Early drug intervention after conization can help improve the local immunity of the vagina and increase the postoperative HR-HPV infection rate.Recombinant human interferonα-2b vaginal effervescent tablets may be in the treatment of patients with multiple types of HPV infection Has a certain effect.3.Multiple types of HR-HPV infection before surgery,positive pathological margins after surgery,and gland involvement are independent risk factors for persistent HR-HPV infection at 12 months after surgery.