LSIL-H独立诊断宫颈病变的临床意义  

The clinical significance of LSIL-H as an independent diagnostic criterion in cervical lesions

作　　者：葛娟[1] 周东华[1] 欧阳晨捷 田杰[1] 平静[1] 秦艳[1] 范菊花[1] GE Juan ZHOU Donghua OUYANG Chenjie TIAN Jie PING Jing QIN Yan FAN Juhua(Department of Pathology, Foshan Maternal and Child Health Hospital of Southern Medical University, Foshan, Guangdong 528000, Chin)

机构地区：[1]南方医科大学附属佛山市妇幼保健院病理科,广东佛山528000

出　　处：《中国热带医学》2017年第9期921-924,共4页China Tropical Medicine

摘　　要：目的探讨宫颈低级别鳞状上皮内病变不除外高级别鳞状上皮内病变(low-grade squamous intraepitheliallesion,cannot exclude high-grade squamous intraepithelial lesion,LSIL-H)作为宫颈液基细胞学独立诊断标准对临床宫颈病变诊疗及风险估计的指导意义。方法收集近6年来130 000例液基细胞学标本,采用双盲法进行回顾性诊断分析,并追踪高危型人乳头瘤病毒(high risk-HPV,HR-HPV)的感染情况和组织病理学结果。结果选择LSIL 1 250例(0.96%),LSIL-H 382例(0.29%),非典型鳞状上皮细胞,不除外高度鳞状上皮内病变(atypical squamous cells,cannot ruleout a high grade lesion,ASC-H)296例(0.23%),高度鳞状上皮内病变(high squamous intraepithelial lesion,HSIL)497例(0.38%)列入本次研究的对象,结合组织病理学结果及高危型人乳头瘤病毒感染的结果分析显示,在宫颈高级别鳞状上皮内病变CIN2/3的患病率中,LSIL-H(45%)高于LSIL(10%),而低于HSIL(66%),差异具有统计学意义(P<0.01),而与ASC-H(43%)相比较差异无统计学意义(P>0.05);其中宫颈低级别鳞状上皮内病变CIN1的患病率中,LSIL-H(36%)高于ASC-H(12%),差异具有统计学意义(P<0.01);LSIL-H的HR-HPV阳性率(79%)高于LSIL(47%)和ASC-H(60%),并低于HSIL(91%),差异均具有统计学意义(P<0.01)。结论 LSIL-H具有较高的患高级别鳞状上皮内病变(CIN2/3)的风险率和HR-HPV感染率,LSIL-H的独立诊断对加强宫颈上皮内瘤样病变的筛查、管理,以及对临床宫颈病变的分流指导及风险的估计具有较高的价值。Objective To study the significance of the guidance and the risk estimation for clinical cervical lesions, by low-grade squamous intraepithelial lesion,cannot exclude high-grade squamous intraepithelial lesion（LSIL-H） as an independent diagnostic criterion for liquid-based cervical cytology. Methods The methodology collected 130 000 liquid based cytology cases for nearly five years and make retrospective diagnostic analysis by using double blind method,then tracking the infection of the high-risk human papilloma virus（HPV） and the histopathological findings. Results The diagnosis of LSIL 1 250 cases（0.96%）, LSIL-H 382 cases（0.29%）, ASC-H 296 cases（0.23%）, HSIL 497 cases（0.38%） were included in this study.Combining with the results of the infection of the high-risk human papilloma virus（HPV） and the histopathological findings,LSIL-H（45%） was significantly higher than the LSIL（10%）, and lower than that of HSIL（66%） in the prevalence of CIN2/3, and there were obviously statistical significance（P〈0.01）, but there was no significant difference compared with ASC-H（43%）（P〈0.05）; The prevalence of CIN1,LSIL-H（36%） was significantly higher than the ASC-H（12%）,which has statistical significance（P〈0.01）; The positive rate of HR-HPV, LSIL-H（79%） was significantly higher than LSIL（47%） and ASC-H（60%）,and lower than HSIL（91%）,which were statistical significance（P〈0.01）. Conclusion LSIL-H has a higher risk of high-grade squamous intraepithelial lesion（CIN2/3） and the infection of HR-HPV,the independent diagnostic of LSIL-H has high value to enhance the screening and management,or the guidance and risk estimation for clinical cervical lesions.

关 键 词：液基细胞学 宫颈低度鳞状上皮内病变不除外高度鳞状上皮内病变 高级别鳞状上皮内病变 高危型人乳头瘤病毒 

分 类 号：R711.74[医药卫生—妇产科学]