Influential Factors Of Persistent Infection Of High-risk HPV After Surgical Treatment Of HSIL

Research objectiveCervix high grade squamous intraepithelial lesions(HSIL)require surgery and regular follow-up,however there is still a risk of residual lesions and recurrence.Generally,persistent infection with high-risk HPV(HR-HPV)after operation was highly related to the residual lesions and recurrence.Here,we performed a study to identified the risk factors of postoperative HR-HPV persistent infection by analyzing the clinical data of postoperative patients with cervical HSIL.The diagnosis and treatment are summarized in the hope of identifying high-risk patients with residual or recurrent lesions as early as possible,making an individualized treatment plan for such patients,and achieving the ultimate goal of preventing lesions from further development and clearing HPV infection.Methods:This was a retrospective study of risk factors of persistent postoperative HR-HPV.Patients with HSIL who underwent cervical loop electrosurgical excision procedure,cervical cold knife conization or total hysterectomy in the first hospital of Jilin University from 2015.1 to 2019.12 were included in the analysis.A total of 1017 patients were identified,of these 340 patients met the inclusion criteria.Subjects were divided into persistent infection and negative groups The correlation between clinical factors and HR-HPV persistent infection after operation was analyzed.Results:Among the patients who were admitted to Jilin University First Hospital from January 2015 to December 2019,1017 patients were treated by cervical HSIL,including circular electrosurgy,cold knife conization or total hysterectomy.340 patients were followed up and qualified for the analysis.The age distribution was 20-72 years,with an average age of 42 years.114 patients(33.52%)were infected continuously after operation,226 were transferred to Yin(66.47%).The number of patients with HPV infection was compared in all age groups.Logistic regression analysis showed that age,menopause,positive margin and high virus load were independent risk factors for the persistent infection of high-risk HPV.In this group,286 patients were negative in margin cutting,86 were infected continuously,accounting for 30.07%,and 200 were transferred Yin,accounting for69.93%.54 were positive for the margin,28 were infected continuously,accounting for51.85%,26 were transferred to Yin,accounting for 48.15%.The difference was statistically significant(P < 0.05).This indicates that positive margin is a risk factor for HPV infection in patients with high-level squamous epithelial lesions.In this study,some patients with positive margin chose secondary operation,all of which were total hysterectomy.28 patients who had not selected secondary operation were positive for margin resection,including 14 patients with persistent infection,accounting for 50%,14 with Yin transfer,accounting for 50%.The positive margin was selected for secondary operation(total hysterectomy)in 26,continuous infection 12,accounting for46.15%,Yin transfer 14,accounting for 53.85%.The difference was not statistically significant when p > 0.05.In this group,140 patients were positive for HPV e6/e7 m RNA before operation,80 were infected continuously,accounting for 57.14%,60 were transferred Yin,accounting for 42.86%.There were 200 patients with negative HPV e6/e7 m RNA before operation,34 patients with persistent infection,17.00% and 166 patients with Yin transfer,accounting for 83.00%.According to the statistical results,P < 0.05,the difference was statistically significant.This indicates that the positive expression of HPV e6/e7 m RNA is a risk factor for the continuous infection of HPV in patients with high-level squamous epithelial lesions.In this group,98 patients with HPV virus load ≤ 100rlu/co before operation,20 people were continuously infected,accounting for 20.41%,78 were transferred Yin,accounting for 79.59%.242 patients with HPV virus load > 100rlu/co before operation,94 people were infected continuously,accounting for 38.84%,148 were transferred Yin,accounting for 61.16%.According to the statistical results,P < 0.05,the difference was statistically significant.This indicates that the high viral load is a risk factor for the continuous infection of HPV in patients with high-level squamous epithelial lesions.In this group,254 patients were hpv16/18 type virus before operation,92 were infected continuously,accounting for 36.22%,162 were transferred Yin,accounting for63.78%.86 were divided into other types,22 were persistent infection,accounting for25.58%;64 were transferred Yin,accounting for 74.42%.According to the statistical results,P > 0.05,the difference was not statistically significant.In this group,250 patients were infected with single infection before operation,82 were infected continuously,accounting for 32.80%,168 were transferred Yin,accounting for 67.20%.There were 90 multiple infections,32 of them were persistent infection,35.56%,58 were transferred Yin,accounting for 64.44%.According to the statistical results,P > 0.05,the difference was not statistically significant.Among the data of this group,256 patients with normal SCCA were normal before operation,78 were infected continuously,accounting for 30.47%,178 were transferred Yin,accounting for 69.53%.84 patients with SCCA abnormality,36 were persistent infection,42.86%,48 were transferred Yin,accounting for 57.14%.According to the statistical results,P < 0.05,the difference was statistically significant.This indicates that the abnormal SCCA is a risk factor for the continuous infection of HPV in patients with high-level squamous epithelial lesions.In this group of data,152 patients with vaginal anti HPV infection(such as interferon,bioprotein gel,Bao Kang Kang,etc.)after operation were infected,52 of them were persistent infection,accounting for 34.21%,and 100 of them were negative,accounting for 65.79%.188 patients were not treated after operation,62 were infected continuously,accounting for 32.98%;126 were transferred Yin,accounting for 67.02%.According to the statistical results,P > 0.05,the difference was not statistically significant.In this group,after statistical analysis,the statistical results of the patient’s birth mode and whether they are combined with infectious diseases(hepatitis B,hepatitis C,syphilis,AIDS)were p > 0.05,and the difference was not statistically significant.This shows that in this study,patients with infectious diseases and different reproductive patterns have no correlation with the continuous infection of high-risk HPV after highlevel squamous epithelial lesions.Conclusion:1.Age,menopausal,resection margins,preoperative HPV E6 / E7 m RNA level,preoperative high viral load and preoperative high SCCA value were the risk factors for persistent HR-HPV infection after surgical treatment of cervical HSIL.2.Compared with women of childbearing age,postmenopausal women with highrisk HPV after cervical surgery are more difficult to turn negative,therefore,postoperative follow-up of such patients should be strengthened.3.For patients with positive resection margins,the risk of residual lesions or recurrence is higher.Compared with patients with negative margin,postoperative follow-up should be strengthened.However,whether the patients with positive margin accept the second operation or not has no effect on the negative rate of HR-HPV,so it is not recommended that such patients must accept the second operation.4.There was no correlation between HR-HPV persistent infection and preoperative HPV infection subtype,the single subtype or multiple subtype infection and reproductive mode.