宫颈上皮内瘤变Ⅰ级的自然转归研究  

Study of natural history of cervical intraepithelial neoplasia grade Ⅰ

作　　者：荣晅[1] 乌兰娜[2] 高积勇[3] 周艳秋[2] 王纯[2] 吴瑞芳[2] 

机构地区：[1]陕西省人民医院妇科,西安710068 [2]北京大学深圳医院妇产科,深圳518036 [3]西安交通大学医学院第一附属医院妇产科,西安710061

出　　处：《现代妇产科进展》2012年第5期365-368,372,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:了解我国宫颈上皮内瘤变Ⅰ级(CINⅠ)的自然转归情况。方法:对经病理诊断为CINⅠ的548例患者进行24～48个月的定期随访。以液基细胞学检查(LCT)联合高危型HPV检测(HC-Ⅱ)作为监测手段。对LCT≥ASCUS,高危型HPV阳性或LCT≥LSIL者,行阴道镜下多点活检,以病理为最终诊断评价CINⅠ在6、12、24和36个月的自然转归情况。以寿命表法计算病变转归率。结果:(1)随访36个月时,累积失访率为10.22%。(2)随访36个月,CINⅠ向高级别进展者16例,病情稳定者29例,病变逆转447例。CINⅠ随访6个月时病变进展、持续存在和逆转为正常的百分率分别为0.58%、67.11%、37.39%;12个月时分别为1.15%、48.13%、55.61%;24个月时分别为2.30%,20.90%,77.28%;36个月时分别为3.07%,5.56%,85.71%。(3)高危型HPV阳性的CINⅠ患者6、12、24和36个月HPV累计自然清除率分别为52.76%、61.84%、82.64%和94.52%。结论:绝大多数CINⅠ可在36个月内自然逆转,其携带高危型HPV病毒亦可被自然清除。CINⅠ可能由高危型HPV一过性感染所致。Objective：To investigate the natural history of cervical intraepithelial neoplasia grade I lesions.Methods：548 patients were enrolled into the cohort.They were followed up for 24~48 months without any treatment.Every 6 to 12 months,the patients were called back to have the liquid-based cytological test and high-risk human papillomavirus test（HC-Ⅱ）.If the LCT was ASCUS and HR-HPV was positive or LCT was higher than ASCUS,then colposcopy was used to assess the disease situation and multi-point biopsies were made at the same time.The biopsy results were the gold standard to assess the outcome if it was progression,resistance or regression.Results：（1）The 36 months defaulting rate was 10.22%.（2）At the end of the follow-up,16 patients had progressed to higher grade lesions,including 11 CINⅡ and 5 CINⅢ.No one had progressed to invasive cervical cancer.29 patients whose CINⅠ lesions had resistant and 447 patients had regressed.Within 6 months,the CINⅠ progression rate,resistance rate and regression rate was separately 0.58%,67.11%,and 37.39%.Within 12 months,the CINⅠ progression rate,resistance rate and regression rate was separately 1.15%,48.13%,and 55.61%.Within 24 months,the CINⅠ progression rate,resistance rate and regression rate was separately 2.30%,20.90%,and 77.28%.Within 36 months,the CINⅠ progression rate,resistance rate and regression rate was separately 3.07%,5.56%,and 85.71%.（3）The 6,12,24,36 months HR-HPV cultivate clearance rate of HR-HPV positive CINⅠ was separately 52.76%,61.84%,82.64%,and 94.52%.Conclusion：Most of the CINⅠ lesions（85.71%） can regress themselves during 36 months,only few part（3.07%） of them will progress to high grade lesions.For HR-HPV positive CINⅠ patients,most（82.64%） of the HPV will be cleared naturally in 2 years.CINⅠ lesions were caused by transient HR-HPV infection.

关 键 词：宫颈上皮内瘤变Ⅰ级 自然转归 人乳头瘤病毒 

分 类 号：R713.4[医药卫生—妇产科学]