宫颈细胞学检查未见异常的人乳头瘤病毒16、18、31、33型感染妇女的管理  

Management of women with negative cervical cytology test but HPV 16,18,31,33 subtype positive

作　　者：陈锐[1] 赵健[1] 毕蕙[1] 

机构地区：[1]北京大学第一医院妇产科,北京100034

出　　处：《中国实用妇科与产科杂志》2014年第2期123-126,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨30岁及以上妇女宫颈细胞学检查未见异常但人乳头瘤病毒（HPV）16、18、31、33型感染者的管理模式。方法收集2008年1月至2009年12月在北京大学第一医院妇产科门诊同时行宫颈细胞学检查及HPVDNA分型检测的30岁及以上妇女的资料，分析细胞学未见异常但HPV16、18、31、33型感染者中检出CINⅡ及以上病变的可能性，探讨其立即行阴道镜检查的必要性。结果165例细胞学检查未见异常但HPV16、18、31、33型阳性者中，共检出CINⅠ 13例（7．9％），CINⅡ／lI24例（14．5％）；其中HPV16型感染99例（60．0％），检出CIN Ⅱ／Ⅲ19例（19．2％）；HPV31、33型感染者分别为19例和30例，各检出CINⅡ／Ⅲ3例。按是否检出CINⅡ／Ⅲ进行Logistic回归分析，发现HPV16型感染与无HPV16型感染者相比其发生CINⅡ／Ⅲ的风险提高，OR值3．073（95％CI1．077～8．768），P=0．036。结论对30岁及以上女性中宫颈细胞学未见异常但HPV16、18、31、33型感染者应予以重视，建议及时行阴道镜检查，尤其是HPV16型感染者。Objective To discuss the management of women （≥ 30 years） whose cervical cytology test is negative but HPV16,18,31,33 subtype positive. Methods Collect the data of patients who choose the combination test of TCT and HPV-DNA genotyping for cervical screening between Jan. 2008 and Dec. 2009 in our Gyn. Out-patient department, analyze their possibility of CIN Ⅱ plus lesion detection rate, then discuss the necessity of immediate colposcopy for this group of women. Results There are 165 patients in total who suffers HPV16,18,31,33 infection but cytology test negative, among those 165 ones, 13 cases（7.9% ）are confirmed to be CIN Ⅰ ,24 cases（14. 5% ） are confirmed to be CIN Ⅱ/Ⅲ by histopathology. There are 99 cases of HPV 16 infection, accounts for 60. 0%, 19 （19.2%） cases are diagnosed of CIN Ⅱ / Ⅲ ; 19 cases of HPV31 and 30 cases of HPV33 infection,3cases of CIN Ⅱ / Ⅲ are detected separately. Using Logistic regression analysis according to whether there are CIN Ⅱ / Ⅲ detected, the result is HPV16 increased the risk of CIN Ⅱ / Ⅲ compared to those HPV16 negative ones, the Odd ratio is 3. 073 （ 95 % CI 1. 077 - 8. 768 ） , P = 0. 036. Conclusion Clinicians have to pay more attention to women （≥30 years）whose cervical cytology test is negative but HPV16,18,31,33 subtype positive,and immediate colposcopy is necessary,especially with those HPV16 infection ones.

关 键 词：人乳头状瘤病毒 基因亚型 宫颈上皮内瘤样病变 宫颈癌筛查 管理 

分 类 号：R711.74[医药卫生—妇产科学]