妇产科门诊宫颈病变筛查的意义及管理策略  

Significance and Management Strategies of Cervical Lesion Screening in Obstetrics and Gynecology Outpatients

作　　者：王敬民[1] 邹辉[1] 时畅[2] 郑军[1] 于虹[1] 石红[1] 

机构地区：[1]大连医科大学附属第一医院妇产科,116011 [2]大连医科大学附属第一医院病理科,116011

出　　处：《中华妇幼临床医学杂志（电子版）》2014年第6期80-85,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

摘　　要：目的探讨妇产科门诊宫颈病变筛查的意义及管理策略。方法选择2010年1月至2012年12月于大连医科大学附属第一医院妇产科门诊行宫颈薄层液基细胞学(TCT)检查的31 372受检者中TCT结果示意义不明的非典型鳞状细胞(ASC-US)及以上级别的1 865例患者为研究对象。本研究遵循的程序符合大连医科大学附属第一医院人体试验委员会所制定的伦理学标准,得到该委员会批准,并征得受试对象本人的知情同意,与之签署临床研究知情同意书。对TCT结果为ASC-US及以上级别者经高危型人乳头状瘤病毒(HR-HPV)检测分流,对有宫颈癌高危因素者进行阴道镜或宫颈锥切术行活组织病理学检查。结果 12010-2012年接受TCT检查的患者数和异常宫颈涂片患者数均呈逐年增加趋势。2低度鳞状上皮内病变(LSIL)和高度鳞状上皮内病变(HSIL)患者的HR-HPV(+)检出率较ASC-US患者明显升高,前二者分别与后者比较,差异有统计学意义(P<0.01),而LSIL与HSIL患者的HR-HPV(+)检出率比较,差异无统计学意义(χ2=0.716,P>0.05)。3HR-HPV(+)患者的CINⅡ及以上级别病变检出率随着TCT细胞学级别上升而增高,而ASC-US,LSIL,HSIL患者的该检出率分别为28.2%,38.2%,68.3%,三者间两两比较,差异均有统计学意义(P<0.01)。4HR-HPV(+)患者的CINⅡ及以上级别病变检出率显著高于HR-HPV(-)患者,二者比较,差异有统计学意义(P<0.01),而HR-HPV(-)患者与未检测HPV患者比较,差异也有统计学意义(P<0.01)。结论宫颈TCT检查结合HR-HPV基因检测是筛查早期宫颈病变的有效方法。建立、健全妇产科门诊宫颈病变筛查规范化流程,重视对ASC-US及以上级别患者的干预,以及HR-HPV检测在ASC-US中的分流作用,是门诊宫颈病变筛查的工作重点,可降低宫颈癌发生率。Objective To study the significance and management strategies of cervical lesion screening in obstetrics and gynecology outpatients. Methods From January 2010 to December 2012,the clinical data of 1 865 patients with atypical squamous cell of undetermined significance （ASC-US） and above lesions were included in the study. High risk human papillomavirus （HR-HPV） were detected in those patients. And electronic colposcope biopsy of the cervix or cervical conization were taken in patients with high risk factors. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of the First Affiliated Hospital of Dalian Medical University. Informed consent was obtained from each participants. Results （1）The number of patients with TCT examination were increased from 2010 to 2012. Meanwhile the number of patients with abnormal cervical smears were also increased. （2）The incidence rate of HR-HPV（ ＋ ） in patients with low-grade squamous intraepithelial lesion（LSIL） and high-grade squamous intraepithelial lesion（HSIL） were significantly higher than that of ASC-US patients respectively（P〈0.01）. But there was no significant difference in the incidence rate of HR-HPV（＋） between LSII. and HSIL patients（P〉0.05）. （4） The detection rates of CIN 11 and above lesions in ASC-US, LSIL and H SIL patients were 28.2 %, 38.2 %, 68.3%, respectively, and significant differences were found among them （P〈 0. 01）. （4） There was significant differences in detection rates of CIN Ⅱ and above lesions between HR-HPV（＋ ） and HR-HPV （-） patients. The detection rates of CIN Ⅱ and above lesions in patients with HR-HPV（-）was obviously higher than those of nondetected HPV patients（P〈0.01）. Conclusions Combination of TCT inspection of the cervix and HR-HPV detection are effective methods for cervical lesions screening. So establish and improve the standardization of outpatient cervical lesion screening process, pay more attention to HR-HPV de

关 键 词：宫颈上皮内瘤样病变 乳头状瘤病毒科 宫颈薄层液基细胞学 

分 类 号：R737.33[医药卫生—肿瘤]