Clinical Analysis Of Persistent HR-HPV Infection After Cervical Conization For High-grade Squamous Intraepithelial Lesion

Objective: To investigate the Related influences,risk factors and outcomes of persistent infection of High risk Human Papilloma Virus in patients with High grade squamous intraepithelial lesion(HSIL)after cervical conization.Method: Collecting the preoperative and postoperative data of patients diagnosed with cervical high-grade squamous intraepithelial lesion(HSIL)accompanied by HR-HPV infection who underwent cervical conical resection in our hospital from January 2015 to December 2020.According to their postoperative follow-up,they were segmented into HR-HPV persistent infection group and control group.Statistical analysis and regression were performed on the clinical data of the two groups.The two groups were compared in age,menopause,number of births,number of abortions,HPV typing,multiple HPV infection,preoperative HPV viral load,cervical cytology,vulva/vaginal lesions,coning mode,coning height,glandular involvement,multi-quadrants involvement,positive incisional margin,postoperative vaccination,and postoperative drug therapy.Independent influencing factors of postoperative HR-HPV persistent infection in patients with HSIL were obtained by Logistic analysis,and the outcomes of patients with postoperative HR-HPV persistent infection were summarized.Result: A total of 748 patients with HSIL meeting the inclusion criteria were collected,including 431 patients who underwent cold-knife conical resection,317 patients who underwent LEEP surgery,74 patients with persistent HR-HPV infection and 674 patients with non-persistent HPV infection were reviewed after surgery.There were no significant differences between the persistent infection group and the control group in terms of duration of delivery,operation method,gland involvement and cone height(P > 0.05).There were statistical differences between the two groups in age,menopause,abortion,HPV typing,multiple HPV infection,cervical cytology,viral load,combined vulvar/vaginal lesions,positive incisal margin,multiple quadrants involving lesions,postoperative HPV vaccine,and postoperative drug therapy(P < 0.05).The results of multivariate Logistic regression analysis showed that,Menopause,number of abortion ≥ 2,HPV16/18 infection,multiple HPV infection,viral load ≥2000 r LU /CO,cytological examination > LSIL,combined vulva/vaginal lesions,positive incisional margin,and multiple quadrants of disease involvement were independent risk factors for persistent postoperative HR-HPV infection in HSIL patients.In addition,follow-up monitoring of persistent HR-HPV infection after surgery and HPV negative transformation of different intervention treatment programs: the vast majority of cervical biopsy pathology is chronic inflammation of cervical mucosa and low-grade lesions CIN I(or combined with low-grade lesions of vulva/vagina),can be followed up observation or physical therapy,while for some patients with cervical biopsy pathology of CINII or CINIII,attention should be paid and timely intervention should be given,including secondary cervical conectomy or total hysterectomy.74 patients with persistent HR-HPV infection were followed up,and 90%(45/50)of the follow-up observers had negative HPV within 24 months after surgery.100%(12/12)of physical therapy patients had negative HPV within 24 months after surgery;100%(7/7)of secondary coning patients had negative HPV within 18 months after surgery;100%(5/5)of patients with hysterectomy had HPV turn negative within 12 months after surgery.Discussion: Menopause,≥ 2 abortions,HPV16/18 typing infection,multiple HR-HPV typing infection,HPV viral load ≥ 2000 r LU /CO,cervical fluid base cytology > LSIL,complicated vulva and vaginal lesions,positive incisal margin,and multiple quadrants of disease involvement were independent risk factors for postoperative HR-HPV persistent infection in patients with HSIL.HSIL Patients with persistent HR-HPV infection after cervical coning are at risk for postoperative recurrence or further progression of cervical lesions.Close monitoring and re-examination should be conducted for women with persistent risk factors for HR-HPV infection after cervical conectomy,which may help to reduce the incidence of disease recurrence and progression.