子宫颈细胞学未见异常的PCB患者的临床管理——附149例临床资料分析  

Clinical management of PCB patients with no abnormal cervical cytology—Clinical data analysis of 149 cases

作　　者：裴志飞 林秀峰[1] 石云[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：《中国妇幼健康研究》2017年第1期81-83,102,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的通过对细胞学未见异常的性交后出血(PCB)患者临床资料分析,探讨PCB的临床管理路径。方法回顾性总结2013年11月至2016年5月就诊于北京大学第一医院妇产科门诊149例细胞学未见异常因PCB转诊阴道镜患者的人乳头瘤病毒(HPV)检测、阴道镜以及病理结果,分析PCB患者中子宫颈高级别病变以及浸润癌的风险,探讨PCB患者的管理。结果149例细胞学未见异常因PCB转诊阴道镜的患者,年龄21~82岁,平均年龄42.91±10.83岁。阴道镜下活检病理共检出子宫颈上皮内瘤变2(CIN2)4例,子宫颈浸润癌2例,CIN2+检出率为4.0%(6/149)。其中128例(85.9%,128/149)同时进行了HPV-DNA检测,123例检测阴性,占96.1%(123/128);5例检测阳性,占3.9%(5/128);在123例HPV阴性者中,共检出CIN21例(1/123,0.8%),子宫颈癌1例(1/123,0.8%),CIN2+检出率为1.6%(2/128),在5例HPV阳性者中无CIN2+检出,在21例未行HPV检测者中共检出CIN2 3例(3/21,14.3%),子宫颈癌1例(1/21,4.8%),CIN2+检出率为19.0%(4/21);未行HPV检测与行HPV检测的病例相比较,CIN2+的检出有统计学差异(χ2=14.271,P=0.004),OR=14.824(95%CI:2.522~87.141)。结论在细胞学未见异常的PCB中存在有较低的CIN2+风险,应重视排查,细胞学联合HPV检测均阴性可能减低PCB患者的CIN2+风险。Objective To explore clinical management path of postcoital bleeding（ PCB） through analysis on clinical data of PCB patients with no abnormal cytology. Methods Human papilloma virus（ HPV） test,colposcope and pathological results of 149 patients with no abnormal cytology and with PCB referrral colposcope were reviewed retrospectively. Risk of cervical high grade intraepithelial lesions and invasive cancer in PCB patients were analyzed,and clinical management of PCB patients was explored. Results There were 149 cases with no abnormal cytology and with PCB referral colposcope,aged 21- 82 years with a mean age of 42. 91 ± 10. 83 years. Totally 4 cases of cervical intraepithelial neoplasia 2（ CIN2） and 2 cases of invasive cervical carcinoma were detected by biopsy under colposcope,and detection rate of CIN2 ＋ was 4. 0%（ 6 /149）. Among them,128 cases（ 85. 9%,128 /149） were detected with HPV-DNA test simultaneously,and 123 cases were negative,accounting for 96. 1%（ 123 /128）. Five cases were positive,accounting for 3. 9%（ 5 /128）. Among 123 HPV negative cases,1 case（ 1 /123,0. 8%） of CIN2 and 1 case of invasive cervical carcinoma（ 1 /123,0. 8%）were detected,and detection rate of CIN2 ＋ was 1. 6%（ 2 /128）. No CIN2 ＋ was detected in 5 HPV positive cases. Three cases of CIN2（ 3 /21,14. 3%） and 1 case of invasive cervical carcinoma（ 1 /21,4. 8%） were detected in 21 cases without HPV detection,and detection rate of CIN2 ＋ was 19. 0%（ 4 /21）. Comparison of cases without HPV test and cases with HPV test revealed that difference in detection of CIN2 ＋ had statistical significance（ χ2= 14. 271,P = 0. 004,OR = 14. 824,95% CI： 2. 522- 87. 141）. Conclusion There is a low risk of CIN2 ＋ in PCB patients with no abnormal cytology,and attention should be paid to clinical investigation. If cytology combined with HPV detection is negative,risk of CIN2 ＋ for PCB patients may be reduced.

关 键 词：性交后出血 阴道镜 病理 子宫颈上皮内瘤变 免疫组织化学染色 

分 类 号：R711[医药卫生—妇产科学]