未见上皮内病变或恶性病变妇女高危型HPV的自然变化 ——前瞻性随访一年  

Screening and Management of Cervical LesionNatural changes of high-risk HPV in women with negative for intraepithelial lesion or malignancy： a prospective 1 year study

作　　者：何明[1] 吴玉梅[1] 阴桢宏[1] 耿宇宁[1] 杨淑丽[1] 康林棣 

机构地区：[1]首都医科大学附属北京妇产医院妇瘤科,100006

出　　处：《中华妇产科杂志》2017年第11期740-744,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：北京市优秀人才培养项目（2014000021469G246）;北京市医院管理局“青苗”人才培养计划（QML20151302）;北京市医院管理局重点医学专业发展计划（ZYLX201705）;北京市科学技术委员会重点项目（D131100005313009）;首都医科大学附属北京妇产医院中青年学科骨干培养专项（fcyy201601）

摘　　要：目的探讨未见上皮内病变或恶性病变（NILM）妇女高危型HPV（HR-HPV）的自然变化规律，为规范HR-HPV筛查时间提供依据。方法前瞻性收集2015年1月1日—12月31日在首都医科大学附属北京妇产医院初诊的433例NILM妇女，其年龄为22~74岁，平均年龄（45±21）岁。其中，〈50岁263例，≥50岁170例；HR-HPV阳性156例，HR-HPV阴性277例。对433例NILM妇女进行为期1年的随访（分别于3、6、9、12个月随访），行常规的子宫颈液基细胞学检查（TCT）联合HR-HPV检测的双筛查，如果TCT检查结果异常且HR-HPV阳性则行阴道镜下多点活检评估病情，观察HR-HPV的自然变化及子宫颈病变的发生情况。结果（1）HR-HPV的自然变化：156例HR-HPV阳性的NILM妇女中，42例（26.9%，42/156）3个月内HR-HPV转阴，88例（56.4%，88/156）6个月内转阴，99例（63.5%，99/156）9个月内转阴，100例（64.1%，100/156）12个月内转阴；〈50岁妇女3、6、9、12个月时的HR-HPV转阴率均明显高于≥50岁者（P〈0.05）。277例HR-HPV阴性的NILM妇女中，35例（12.6%，35/277）3个月内HR-HPV新发阳性，70例（25.3%，70/277）6个月内新发阳性，80例（28.9%，80/277）9个月内新发阳性，83例（30.0%，83/277）12个月内新发阳性；〈50岁妇女3、6、9、12个月时的HR-HPV HR-HPV新发阳性率均高于≥50岁者，但分别比较，差异均无统计学意义（P〉0.05）。（2）子宫颈病变的发生情况：156例HR-HPV阳性的NILM妇女中，无一例发生子宫颈病变；277例HR-HPV阴性的NILM妇女中，4例分别在6个月内和12个月内HR-HPV新发阳性且TCT检查异常，遂行阴道镜下子宫颈活检后病理诊断2例为CINⅠ、1例为CINⅡ、1例为CINⅢ，病变进展率为1.4%（4/277），占HR-HPV新发阳性患者的4.8%（4/83）。结论对HR-HPV阳性的NILM妇女，建议每隔6个月进行细胞学和HR-HPV联合筛查，必要时行阴道镜下子宫颈活检评估子宫颈病变�ObjectiveTo investigate the natural changes of high-risk HPV （HR-HPV） in women with negative for intraepithelial lesion or malignancy （NILM） for regulating HR-HPV screening.MethodsFour hundred and thirty-three newly-diagnosed women were enrolled from January 1st, 2015 to December 31, 2015 in Beijing Obstetrics and Gynecology Hospital. The ages of these patients were between 22 and 74 years, the average age was （45±21） years old. Two hundred and sixty-three cases were less than 50 years old, 170 cases were more and equal to 50 years old. One hundred and fifty-six cases were HR-HPV positive, 277 cases were HR-HPV negative. Follow up tests were conducted for all 433 patients, who were screened by ThinPrep cytologic test （TCT） combined with HR-HPV and were diagnosed with NILM, for a period of 1 year （at the 3, 6, 9 and 12 months intervals respectively）, if the TCT results are abnormal and the HR-HPV test results are positive, will follow up colposcopy directed cervical biopsy.Results（1） HR-HPV natural changes： of 156 NILM cases with HR-HPV infection, 42 cases （26.9%, 42/156） turned negative within 3 months, 88 cases （56.4%, 88/156） turned negative within 6 months, 99 cases （63.5%, 99/156） turned negative within 9 months, and 100 cases （64.1%, 100/156） turned negative within 12 months. The negative conversion ratio at 3, 6, 9 and 12 months for women at childbearing age （〈50 years） were significantly higher than those at non-childbearing age （≥50 years old; all P〈0.05）. Of 277 NILM cases without HR-HPV infection, 35 cases （12.6%, 35/277） had new HR-HPV positive infections within 3 months, 70 cases （25.3%, 70/277） had new infections within 6 months, 80 cases （28.9%, 80/277） had new infections within 9 months, and 83 cases （30.0%, 83/277） had new infections within 12 months. The new infections rate at 3, 6, 9 and 12 months for women at childbearing age （〈50 years old） were slightly higher than those at non-childbearing age （≥50 years old;

关 键 词：乳头状瘤病毒科 宫颈肿瘤 普查 前瞻性研究 

分 类 号：R737.33[医药卫生—肿瘤]