Analysis Of The Related Factors Of High-risk Human Papillomavirus Clearance After Cervical Conization

Objective:To investigate the factors related to persistent HPV infection and clearance after high-frequency electrosurgical excision procedure(LEEP)in patients diagnosed with cervical intraepithelial neoplasia(CIN),as well as the distribution of HPV subtypes in the outpatients of Nanjing Drum Tower Hospital.METHODS:We analysed retrospectively 400 patients who visited the outpatient department of gynecology in Nanjing Drum Tower Hospital during the period from January 2015 to January 2017.All patients who underwent loop electrosurgical^ excision procedures(LEEP)owing to HR-HPV-associated CIN and had complete medical records were included.All of them had negative resection margins on LEEP specimens and underwent HPV testing with the hybrid capture 2 system at 3-,6-,12-and24-month follow-up visits after LEEP.We studied the persistent HPV infection rate and the clearance time in the postoperative situation in order to investigate the factors that may affect HR-HPV clearance after surgery.Results:The top 4 infection subtypes in our outpatients were HPV16,HPV58,HPV33 and HPV53,accounting for 28.06%,16.77%,13.87%and 11.61%of the single high risk type infection respectively.The HR-HPV persistent infection rates were 44.25%,34.50%,18.25%and 9.25%respectively at 3,6,12 and 24 months after LEEP.The postoperative persistent HR-HPV infection rates of patients whose preoperative HR-HPV load was>500RLU/CO was significantly higher than those of patients whose preoperative HR-HPV load was<500RLU/CO(p<0.05),and the clearance of the former was significantly slower than the latter(p<0.05).The persistent infection rates of different HR-HPV types were various,among which the HPV 16 persistent infection rate was significantly higher than the others(P<0.05).Multiple HR-HPV infections lasted longer than single infections(P<0.05).It took more time to eliminate HPV after LEEP in the patients diagnosed with high grade lesions(CINII-III)than low grade lesions(CINI)(P<0.05).Clearance rates did not differ among patients of different ages or parity histories.Patients with endocervical glandular involvement did not differ from those with no glandular involvement on the HPV clearance rates either(p>0.05).Conclusion:HPV16,HPV58,HPV33 and HPV53 formed the majority of HPV infection in our outpatients.LEEP is an effective method to clear the HR-HPV infection in 6-12 months for most of the patients.The rate of persistent HPV infection after conization was related to the preoperative HR-HPV load,HPV genotype,single or multiple infection and lesion grade.The patients who match any of the following conditions-preoperative HR-HPV load ?500 RLU/CO,HPV multiple infection,HPV 16 subtype and high-grade lesions(CINII-?),should be followed up closely after treatment.