子宫颈低级别鳞状上皮内病变合并高危型HPV持续感染的治疗研究现状与展望

Current Status and Prospects of Treatment Research on Cervical Low-Grade Squamous Intraepithelial Lesion with Persistent High-Risk HPV Infection

摘要: 子宫颈低级别鳞状上皮内病变(LSIL)合并高危型人乳头瘤病毒(HPV)持续性感染是宫颈癌筛查后常见的临床问题，其高逆转率与潜在进展风险并存，过度治疗可能带来产科并发症。近年来，关于HPV持续感染机制及局部免疫应答的研究不断深入，为分层管理提供了新依据。本文回顾目前的前沿进展，探讨免疫清除缺陷与病毒免疫逃逸如何协同促进LSIL的持续与进展，综述现有的治疗方式，包括定期随访、局部药物应用及物理消融治疗等，旨在促进对这类患者的规范化与个体化治疗，减少不必要的侵入性干预，并展望了光动力疗法、治疗性疫苗及低能量聚焦超声等新策略的应用前景。近年来，随着阴道镜技术普及和女性生育年龄推迟，如何平衡病变进展风险与过度治疗带来的产科并发症成为焦点。研究提示，局部免疫微环境的功能缺陷，如T细胞耗竭及细胞因子异常，在病变持续中起关键作用。本文回顾该领域的前沿进展，探讨HPV免疫逃逸及宫颈局部免疫抑制如何促进LSIL的持续与潜在进展，为精准治疗提供新思路；综述现有治疗策略，包括以定期细胞学及HPV联合随访为基础的期待管理、局部药物如免疫调节剂、物理消融如激光、聚焦超声，分析其适应证与利弊；旨在促进基于风险分层的精准化治疗，最大限度地避免宫颈机能受损及产科并发症，并展望了治疗性HPV疫苗、低能量聚焦治疗及新型免疫调节剂等新兴方向，以期为患者提供更优化、低损伤的治疗选择。

Abstract: Cervical low-grade squamous intraepithelial lesion (LSIL) with persistent high-risk human papillomavirus (HPV) infection is a common clinical issue following cervical cancer screening, characterized by a high spontaneous regression rate coexisting with a potential risk of progression; overtreatment may lead to obstetric complications. Recent advances in the mechanisms of persistent HPV infection and local immune responses have provided a new basis for stratified management. This review summarizes current progress, exploring how defective immune clearance and viral immune evasion synergistically promote the persistence and progression of LSIL, and reviews existing treatment modalities—including regular follow-up, topical pharmacotherapy, and physical ablation—with the aim of promoting standardized and individualized management while reducing unnecessary invasive interventions. It also looks ahead to the prospects of novel strategies such as photodynamic therapy, therapeutic vaccines, and low-energy focused ultrasound. With the widespread adoption of colposcopy and the trend of delayed childbearing, balancing the risk of lesion progression against the obstetric complications of overtreatment has become a major concern. Studies indicate that functional defects in the local immune microenvironment, such as T-cell exhaustion and aberrant cytokine profiles, play a key role in lesion persistence. This review discusses how HPV immune evasion and cervical local immunosuppression facilitate LSIL persistence and potential progression, offering new insights for precision therapy; it summarizes current treatment strategies, including expectant management based on combined cytology and HPV co-testing, topical immunomodulators, and physical ablation such as laser and focused ultrasound, analyzing their indications, advantages, and disadvantages. The goal is to promote risk-stratified precision treatment that maximally preserves cervical competence and avoids obstetric complications. The review also envisions emerging directions, including therapeutic HPV vaccines, low-energy focused therapy, and novel immunomodulators, aiming to provide patients with more optimized, minimally invasive treatment options.