孕期HPV感染液基薄层细胞制片术检查及其不良妊娠结局的危险因素分析  

Liquid-based thin-cytologicy test in pregnant women with HPV infection and risk factors analysis of adverse pregnancy outcomes

作　　者：赵云霞[1] 保妮娜[1] 李渊渊[1] 李辉[1] 魏向群 陈美毅 ZHAO Yunxia;BAO Nina;LI Yuanyuan;LI Hui;WEI Xiangqun;CHEN Meiyi(Department of Gynecology,Second People's Hospital of Yunnan Province,Kunming 650021,Yunnan,China;Health Management Center,First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan,China)

机构地区：[1]云南省第二人民医院妇科,昆明650021 [2]昆明医科大学第一附属医院健康管理中心,昆明650032

出　　处：《中国性科学》2019年第12期45-49,共5页Chinese Journal of Human Sexuality

摘　　要：目的探讨孕期人乳头状瘤病毒(HPV)感染液基薄层细胞制片术(TCT)检查及其不良妊娠结局的相关危险因素。方法选取2015年3月至2018年8月在云南省第二人民医院进行产检的且经HC-II检测及HPV分型检测为HPV感染的175例孕妇作为研究对象。将这175例患者设为观察组,另根据配对原则随机抽取175例无HPV感染孕妇作为对照组。均进行TCT检测,并统计检测结果,另随访至分娩,观察妊娠结局及不同孕期发生不良妊娠结局的差异,并采用多因素Logistic回归分析法分析影响不良妊娠结局的危险因素。结果随访至分娩,观察组母体及围产儿不良结局发生率分别为12.00%(21/175)、6.47%(11/170),对照组母体及围产儿不良结局发生率分别为2.86%(5/175)、1.14%(2/176),差异均具有统计学意义(P<0.05);观察组与对照组发生不良妊娠结局孕妇在HPV检测孕早、中、晚期的构成比差异对比无统计学意义(P>0.05);观察组中TCT检测为NILM/正常范围阳性率明显低于对照组(P<0.05),观察组中TCT检测为ASC/AGC、LSIL、HSIL及SCC/ACA的阳性率均明显高于对照组(P<0.05),观察组与对照组中TCT检测均未发现AECFN与ACIS;经Logistic回归分析,孕妇年龄>35岁、流产史、TCT检测为HSIL或HCC/ACA、HPV感染高危型、妊娠期高血压及妊娠期糖尿病均是母体及围产儿不良妊娠结局的独立危险因素(OR=3.077、3.043、3.010、3.111、2.721、3.034、2.951、2.721、2.499、2.641、2.754、2.724、2.965、2.930,均P<0.05)。结论对孕期HPV感染者行TCT检测可有效筛查宫颈病变,且TCT检测为宫颈高度病变及癌变、HPV感染高危型、高龄产妇、流产史、妊娠合并症均可诱导不良妊娠结局的发生,临床工作者可据此对孕妇及早给予预防处理,以减少不良妊娠结局的发生。Objective To explore the detection of human papillomavirus(HPV) infection during pregnancy by liquid-based thin-cytologicy test(TCT) and the risk factors of adverse pregnancy outcomes. Methods 175 pregnant women with HPV infection who underwent maternity examination in the Second People′s Hospital of Yunnan Province from March 2015 to August 2018 detected by HC-II test and HPV infection typing were selected as A group, and 175 pregnant women without HPV infection were selected as B group according to the principle of pairing. All of them were examined by TCT and the results were statistically analyzed, then following up to delivery, and the pregnancy outcomes and differences in adverse pregnancy outcomes of different pregnancy stages were observed, and the risk factors of adverse pregnancy outcomes were analyzed by multivariate Logistic regression analysis method. Results Following up until delivery, the incidence rates of adverse outcomes of maternal and perinatal infant respectively were 12.00%(21/175) and 6.18%(11/178) of the A group, of which the B group respectively were 2.86%(5/175) and 1.14%(2/176), and the differences were statistically significant(all P<0.05). There was no significant difference in the proportion of adverse pregnancy outcomes in early, middle and late pregnancy of HPV detection between A group and B group(P>0.05). The positive rate of NILM/normal range by TCT test in A group was significantly lower than that in B group(P<0.05), and the positive rates of ASC/AGC, LSIL, HSIL and SCC/ACA by TCT test in A group were significantly higher than those in B group(P<0.05), and the AECFN and ACIS were not detected by TCT test in A group and B group. Logistic regression analysis showed that the age of pregnant women > 35 years old, history of abortion, the HSIL or HCC/ACA detected by TCT, high-risk HPV infection, gestational hypertension and gestational diabetes mellitus were independent risk factors for adverse pregnancy outcomes(OR=3.077,3.043,3.010,3.111,2.721,3.034,2.951,2.721,2.499,2.641,2.75

关 键 词：液基薄层细胞制片术 HPV感染分型 HPV感染孕妇 妊娠结局 预测价值 

分 类 号：R714[医药卫生—妇产科学]