不典型鳞状细胞的临床意义及HPV检测的分流作用  

Clinical significance of atypical squamous cells in cervical smear and human papillomavirus test

作　　者：屈秦红[1] 郝敏[1] 任景芳[1] 赖炜玲[1] 刘慧强[1] 徐永群[2] 

机构地区：[1]山西医科大学第二医院妇产科,030001 [2]山西医科大学第二医院中心实验室,030001

出　　处：《中国妇产科临床杂志》2005年第3期185-188,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的　探讨不典型鳞状细胞(ASC)的临床意义、进一步处理措施以及HPV检测的分流作用。方法　对宫颈细胞学诊断为ASC的12 6例患者,分别进行阴道镜检查、宫颈组织学检查及HPV检测。结果　细胞学检查中不能明确意义者7 94 % ,倾向于良性反应性改变者74 6 0 % ,倾向于上皮内瘤变者17 4 6 % ;②阴道镜下,倾向于良性反应性者多表现为正常转化区(44 6 8% ,P <0 0 0 5 ) ,倾向于上皮内瘤变者,以醋酸白色上皮最多见(36 36 % ) ,但与其余各种阴道镜表现比较,差异无统计学意义;③宫颈组织学检查发现宫颈癌4例(3 17% ) ,高度病变8例(6 35 % ) ,高度病变及宫颈癌均出现于倾向于上皮内瘤变一组。④HPV的检出率随病变程度的加重而上升(P <0 0 0 5 )。结论　对于ASC患者必须要有足够的重视,对其中不明意义的、倾向于上皮内瘤变者或HPV检测阳性患者建议行阴道镜检查,其余可用宫颈细胞学随访。Objective To investigate the clinical significance of atypical squamous cells(ASC) in cervical smear,its management strategies and the value of human papillomavirus (HPV) test.Methods Colposcopy,convertional Pap smear and HPV test were performed in 126 women with a referral diagnosis of ASC.Results ① 126 out of 3880 cases were found with ASC.including 7.94% with undetermined significance,74.60% with benign reaction and 17.46% with neoplastic changes.The high incidences of ASC were found among women at 30 to 50 years old (P<0.01).② Most cases with benign reaction were found with normal colposcopic findings(44.68%,P<0.005);most cases with neoplastic changes were found with white epithelium(36.36%),but no significant difference was observed.③ By convertional Pap smear,4(3.17%) was cervical squamous cancer,8 (6.35%)high grade squamous intraepithelial lesion,114(90.48%)low grade squamous intraepithelial lesion and chronic cervicitis.④ HPV infection rate increased with the severe of cervical lesions(P<0.005).Conclusions Women with ASC should be paid attention to.Cervical biopsies under the guidance of colposcopy is recommended for women with ASC of undetermined significance and neoplastic changes or with HPV infection.

关 键 词：HPV检测 临床意义 鳞状细胞 不典型 分流 上皮内瘤变 宫颈细胞学诊断 阴道镜检查 组织学检查 细胞学检查 处理措施 病变程度 患者建议 ASC 反应性 宫颈癌 统计学 检出率 良性 高度 

分 类 号：R711.74[医药卫生—妇产科学]