宫颈上皮内低度病变患者的自然转归及其研究  

Study of Natural History of Cervical Intraepithelial Neoplasia Grade Ⅰ

作　　者：乌兰娜[1] 荣晅[1,2] 李瑞珍[1] 刘志红[1] 李鹃[1] 王纯[1] 刘淼[1] 唐国亮[1] 

机构地区：[1]北京大学深圳医院宫颈癌早诊早治中心,518036 [2]陕西省人民医院妇产科

出　　处：《国际妇产科学杂志》2012年第4期337-340,共4页Journal of International Obstetrics and Gynecology

摘　　要：目的:了解宫颈上皮内瘤变Ⅰ级(CINⅠ)的自然转归情况。方法 :对经病理诊断为CINⅠ的548例患者进行为期24～48个月的定期随访。以液基细胞学检查(LCT)联合高危型人乳头瘤病毒(HPV)检测(HC-Ⅱ)作为监测手段。当LCT诊断为意义不明的不典型鳞状细胞(ASCUS)及以上病变且高危型HPV阳性或LCT诊断为低度鳞状上皮内病变(LSIL)以上病变,进行阴道镜下多点活检,以病理结果为最终诊断,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个月时的累积失访率为10.22%。②随访36个月,CINⅠ向高级别进展的为16例,持续不变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0.57%,67.05%和37.36%;12个月时分别为1.15%,48.08%和55.56%;24个月时分别为2.30%,20.88%和77.20%;36个月时分别为3.07%,5.56%和85.63%。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:①CINⅠ患者病变累计进展率和累计逆转率在36个月内均随时间增加而增高。②在高危型HPV阳性的CINⅠ患者中,HPV的自然清除率随着时间的增加逐渐增高。③CINⅠ可能由高危型HPV的一过性感染所致,高危型HPV感染的CINⅠ患者,CINⅠ病变逆转趋势与高危型HPV清除趋势一致。Objective：To investigate the natural history of CINⅠ 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： ①The 36 months dropout rate was 10.22%.②At 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 477 patients had regressed.Within 6 months,the CINⅠ progression rate,resistance rate and regression rate was separately 0.57%,67.05%,and 37.36%.Within 12 months,the CINⅠ progression rate,resistance rate and regression rate was separately 1.15%,48.08%,and 55.56%.Within 24 months,the CINⅠ progression rate,resistance rate and regression rate was separately 2.30%,20.88%,and 77.20%.Within 36 months,the CINⅠ progression rate,resistance rate and regression rate was separately 3.07%,5.56%,and 85.63%.③The 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%.Conclusions： ① 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.The cultivate progression rate and regression rate became higher and higher along with the time during the 36 months follow-up.②The cultivate rate of HR-HPV clearance became higher and higher with the time during the 36 months follow-up.③CINⅠ were caused by transient HR-HPV infection,HR-HPV positive CINⅠ lesions had the same regression trend with HR-

关 键 词：宫颈上皮内瘤样病变 癌前状态 乳头状瘤病毒科 细胞诊断学 宫颈肿瘤 

分 类 号：R737.33[医药卫生—肿瘤]