阴道镜下隐匿子宫颈上皮内瘤变Ⅲ级病变的HPV亚型感染特征及鳞状上皮厚度分析  

Characteristics of invisible cervical intraepithelial neoplasia Ⅲ under colposcopy

作　　者：陈晴[1] 杜辉[1] 王纯[1] 唐金龙[1] 吴瑞芳[1] Chen Qing, Du Hui, Wang Chun, Tang Jinlong, Wu Ruifang.(Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, Chin)

机构地区：[1]北京大学深圳医院妇产科暨深圳市女性重大疾病早期诊断技术重点实验室,518036

出　　处：《中华妇产科杂志》2018年第3期172-177,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：深圳市科技计划（GCZX2015043016200372）;深圳市卫生和计划生育委员会临床研究项目（SZLY2017005）

摘　　要：目的探讨阴道镜下隐匿子宫颈上皮内瘤变Ⅲ级（CINⅢ）病变的HPV亚型感染特征及鳞状上皮厚度。方法对2009--2010年期间进行的深圳子宫颈癌筛查项目Ⅱ（SHENCCAST1I）研究中有完整资料、病理诊断为CINⅢ的93例患者的169个象限的CINⅢ组织的石蜡标本采用“三明治”法重新制作6张连续切片，其中第l张和最后1张行HE染色以明确病理诊断并确保其间的切片中含有同样级别的病变，第3～5张（第2张用于其他研究）共3张白片用于行基质辅助激光解吸电离飞行时间质谱（MALDI—TOF—MS）法HPV分型检测，并在显微镜下（×10）对CIN Ⅲ病变部位的鳞状上皮厚度进行测量。其中，由阴道镜指示对可见病灶进行活检发现的CINm定为“可见CINⅢ”，通过子宫颈随机多点活检发现的CINⅢ定为“隐匿CIN Ⅲ”。结果（1）169个象限中，43个象限为隐匿CINⅢ、126个象限为可见CIN Ⅲ，其HPV16型阳性率分别为37．2％（16／43）和55．6％（70／126），两者比较，差异有统计学意义（x2=4．318，P=0．038）。93例CINⅢ患者中，HPV16型阳性和非HPV16型阳性患者分别为49和44例，其中年龄≥45岁患者所占比例分别为20．4％（10／49）和40．9％（18／44），两者比较，差异有统计学意义（x2=4．630，P=0．031）；CINⅢ病灶〉1个象限患者所占比例分别为79．6％（39／49）和52．3％（23／44），两者比较，差异也有统计学意义（x2=7．786，P=0．005）。（2）阴道镜下可见CINⅢ病变的鳞状上皮厚度为（161±9）μm，较隐匿CINⅢ病变者[（140±12）μm]厚，两者比较，差异有统计学意义（t=4．383，P=0．038）。HPV16型阳性与非HPV16型阳性患者的CINⅢ病变的鳞状上皮厚度分别为（172±11）和（130±10）μm，两者比较，差异有统计学意义（t=4．784，P=0．031）。结论阴道镜下隐匿CINⅢ不易识别，可能与非HPV16型阳性、病灶范围小、�Objective To explore the human papilomavirus （HPV） genotypes and epithelial thickness of invisible cervical intraepithelial neoplasia Ⅲ （CIN Ⅲ ） under colposeopy. Methods One hundred and sixty-nine biopsies from 93 patients with a final diagnosis of CIN Ⅲ were extracted from the Shenzhen cervical cancer screening trial Ⅱ （SHENCCAST Ⅱ ）. The SHENCCAST Ⅱ was conducted from 2009 to 2010. All the cervical blocks from these patients were re-cut and placed on 6 slides, i.e. sandwich model, with the top and bottom sections being stained with HE, the top second be processed for other studies, 3 sections for HPV genotypes by matrix-assisted laser desorption ionization-time of flight-mass spectrometry （MALDI-TOF-MS） assay. The thickness of squamous epithelium of CIN Ⅲ was measured by a microscope （×10） after re-cut. Colposcope directed CIN Ⅲ biopsies positively was defined as visible CIN Ⅲ, while random CIN Ⅲ biopsies positively was defined as invisible CIN Ⅲ. Results HPV16 positivity was 37.2% （16/43） and 55.6% （70/126） between invisible and visible CIN Ⅲ biopsies, respectively （X2=4.318, P=0.038）. Forty-nine cases of the 93 CIN Ⅲ patients were HPV16 positive, while 44 of them non-HPV16 positive. The proportion of patients with ≥45 years of age for other non-HPV16 positive 40.9% （18/44） was significantly higher than that HPV16 positive 20.4% （10/49; X2=4.630, P= 0.031 ）. Patients with HPV16 positive were more likely to have lesions ≥1 quadrant （X2=7.786, P=0.005） than other non-HPV16 positive. Compared the average epithelium thickness of invisible CIN m tissue （140±12） μm, the average epithelium thickness of visible CIN m tissue （161±9） μm was thicker. There was statistical difference between two groups （t=4.383, P=0.038）. The mean average epithelial thickness of CIN m with HPV16 positive （172±11） μm was thicker than that the mean average epithelial thickness of CIN Ⅲ with non-HPV16 positive （130±10）μm （t=4.784, P=0.

关 键 词：宫颈上皮内瘤样病变 宫颈鳞状上皮内病变 阴道镜检查 乳头状瘤病毒科 

分 类 号：R737.33[医药卫生—肿瘤]