阴道上皮内瘤变与宫颈上皮内瘤变的关联性及高危因素分析  

The correlation between vaginal intraepithelial neoplasia and cervical intraepithelial neoplasia, and their risk factors

作　　者：马莉[1] 洪颖[2] 

机构地区：[1]南京中医药大学中西结合鼓楼临床医学院,南京210008 [2]南京大学医学院附属鼓楼医院妇产科

出　　处：《中国医师杂志》2015年第1期41-44,共4页Journal of Chinese Physician

基　　金：江苏省科技厅科技支撑计划-社会发展课题（BE2012606）

摘　　要：目的探讨阴道上皮内瘤变（VAIN）与宫颈上皮内瘤变（CIN）的关联性及高危因素分析。方法回顾性分析121例VAIN患者的临床表现、液基细胞学（TCT）、人乳头瘤病毒感染、病毒感染型别等检查结果以及治疗和随访的临床资料。结果VAIN Ⅰ、VAIN Ⅱ、VAIN Ⅲ分别占33．9％（41／121）、38．0％（46／121）、24．4％（34／121）；年龄≤40岁患者中VAIN Ⅲ占10．7％（3／28），年龄〉40岁患者中VAINⅢ占33．3（31／93）；121例VAIN患者中77．7％（94／121）有CIN病史，其中15．7％（19／121）有宫颈癌病史；27．3％（33／121）有全子宫切除病史，其中75．8％（25／33）是由于子宫颈上皮内瘤样病变或宫颈癌切除子宫。VAIN Ⅰ患者人乳头瘤病毒负荷量检测（HPV-HC2）阳性率为87．8％（36／41），而在VAIN Ⅱ、VAIN Ⅲ患者中阳性率为100％，感染高危型HPV的比例为95．9％（116／121），其中混合感染的占56．9％（66／116）；VAIN的患者中有94．6％（114／121）液基细胞学检测结果提示异常，88．4％（107／121）VAIN患者病变部位发生在阴道上1／3。宫颈疾病后确诊发病时间（3．45±2．02）年，未行全子宫切除（3．24±1．97）年，全子宫切除术后至病理确诊VAIN的时间（5．01±3．95）年：因宫颈疾病原因切除后确诊VAIN时间（3．96±2．99）年，非宫颈疾病原因切除时间（9．94±5．37）年。121例VAIN患者在治疗过程中，有6例患者进展为浸润癌。结论VAIN临床表现与CIN相似，CIN诊治原则也能适用于VAIN的诊断和治疗，年龄、感染高危型HPV、多重高危HPV感染及CIN是VAIN发病的高危因素。Objective To investigate the correlation and risk factors between vaginal intraepithelial neoplasia （VAIN） and cervical intraepithelial neoplasia （CIN）. Methods A total of 121 cases of VAIN patients was retrospectively analyzed with examination results such as clinical manifestations, liquid based cytology （TCT）, human papilloma virus infection, virus infection type, and clinical data of treatment and follow up. Results VAIN I , VAIN I1 , and VAIN m were accounted for 33.9% （41/121）, 38. 0% （46/121）, and 24.4% （34/121） ; for 40 or less years old patients, VAIN HI was accounted for 10.7% （3/28） ; for more than 40 years old patients, VAIN II1 was accounted for 33.3 % （31 /93 ） . Among 121 VAIN patients, 77. 7% （94/121） patients had CIN history, 15.7% of which （19/121） had a history of cervical cancer; 27. 3% （33/121） with hysterectomy history, of which 75.8% （25/33） was due to cervi- cal intraepithelial neoplasia and cervical cancer resection of the uterus. Papilloma viral load in patients with VAIN Ⅰ was detected with a （HPV-HC2） positive rate of 87.8% （36/41）, while in VAIN Ⅱ and VAIN Ⅲ patients, the positive rate was 100%, the infection of high risk type of HPV ratio was 95.9% （ 116/ 121 ）. of which the mixed infection was accounted for 56. 9% （66/116）. There was 94. 6% in oatients with VAIN （ 114/121 ）, and liquid-based cytology test results suggest abnormality; 88.4% （ 107/121 ） in pa- tients with VAIN lesions occurred in upper 1/3 of vaginal. After diagnosed cervical disease, the onset time of VAIN was （3.45 ＋ 2.02） years, non-total-hysterectomy was （3.24 ＋ 1.97） years, after hysterectomy to pathological diagnosis time for VAIN was （5.01±3.95） years： for the diagnosis of VAIN disease after resection of cervical original time was （3.96±2. 99） years, and rather than non cervical disease resection was an average of （9. 94±5. 37） years. In the course of treatment of the 121 cases of CIN patients, 6 cases of

关 键 词：阴道肿瘤 宫颈上皮内瘤样病变 危险因素 回顾性研究 

分 类 号：R737.33[医药卫生—肿瘤]