宫颈不典型鳞状细胞232例临床分流方法探讨  

Clinical Sorting Method of 232 Cases with Atypical Squamous Cells

作　　者：杨冬[1] 诸雪峻[2] 

机构地区：[1]首都医科大学附属北京安贞医院,北京100029 [2]北京市第六医院,北京100007

出　　处：《实用妇产科杂志》2011年第9期671-673,共3页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨宫颈不典型鳞状细胞(ASC)正确诊断、合理临床分流方法。方法:232例ASC患者接受阴道镜下宫颈活检,并采用第二代杂交捕获法检测高危型人乳头瘤病毒(HPV)。结果:①232例ASC中未明确诊断意义的不典型鳞状上皮细胞(ASCUS)214例(92.2%),不排除高度病变的不典型鳞状上皮细胞(ASCH)18例(7.8%)。②ASCUS组和ASCH组宫颈活检阳性患者、CINⅡ～Ⅲ及宫颈浸润癌患者分别为98例(45.8%)、18例(8.4%)和15例(83.3%)、6例(33.3%),两组间比较差异有高度统计学意义(P=0.003;P=0.005)。ASCUS组中97例HPV阳性,其中77.3%宫颈活检阳性,16.5%系CINⅡ～Ⅲ及宫颈癌患者;而117例HPV阴性病例中,19.7%宫颈活检阳性,1.7%系CINⅡ患者,无CINⅢ和宫颈癌患者。③HPV检测ASCUS中CIN及宫颈癌的敏感性76.5%,特异性81.0%;阴道镜检查ASCUS中CIN及宫颈癌的敏感性83.7%,特异性77.6%,两者间比较差异无统计学意义(P=0.283;P=0.627)。结论:ASCH中高度病变及宫颈癌检出率高,应及时进行阴道镜下宫颈活检;HPV-DNA检测和阴道镜检查是分流ASCUS的有效方法。HPV阴性患者在6个月后随诊细胞学,HPV阳性患者接受阴道镜下活检是处理ASCUS的最佳方法。Objective：To explore the correct diagnosis and proper sorting method in women with ASC.Methods：232 Women diagnosed as ASC were included in this study,and underwent colposcopy and hr-HPV test（Hybrid Capture 2）.Results：①In the 232 cases of ASC,214 cases of ASCUS（92.2%）and 18 cases of ASCH（7.8%） were found.②The positive result of cervical biopsy and CINⅡ or higher grade lesion in ASCUS or ASCH groups were 98 cases（45.8%）,18 caes（8.4%）,and 15 cases（83.3%）,6 cases（33.3%）,the differences between the two groups were significant（P=0.003;P=0.005）.In cases with ASCUS,97 cases of hr-HPV Test were positive,in which 77.3% cases were with positive biopsy,16.5% cases were CINⅡ or higher grade disease.While,117 cases of HPV test were negative,in which 19.7% cases were positive biopsy,1.7% cases were CINⅡ,no higher grade disease.③The sensitivity and specificity of hr-HPV test for CIN and cervical cancer were 76.5% and 81.0%,while those of colposcopy were 83.7% and 77.6% respectively,no differences were found between the two groups（P=0.283;P=0.627）.Conclusions：ASCH strongly predicts the presence of HSIL and cervical cancer,colposcopic examination is the proper choice.HPV test and colposcopic examination are effective sorting methods for patients with ASCUS.For HPV negative patients,repeat pap smear in 6 month is proper,while for HPV positive patients,colposcopic examination is recommended.

关 键 词：宫颈不典型鳞状细胞 未明确诊断意义的不典型鳞状上皮细胞 人乳头瘤病毒 

分 类 号：R711.74[医药卫生—妇产科学]