HPV E6/E7 mRNA阳性而阴道镜检查阴性患者中漏诊HSIL及以上病变的危险因素分析  

Risk factors for missed HSIL and above lesions in patients with HPV E 6/E 7 mRNA positive but negative colposcopy

作　　者：罗燕艳[1] 罗小婉[1] 符丽华[1] 尚雪[1] 林钰叶[1] LUO Yanyan;LUO Xiaowan;FU Lihua;SHANG Xue;LIN Yuye(Department of Gynecology,Boai Hospital of Zhongshan City,Zhongshan,Guangdong 528403,China)

机构地区：[1]中山市博爱医院妇科,广东中山528403

出　　处：《中国医学工程》2021年第7期15-19,共5页China Medical Engineering

基　　金：中山市社会公益科技研究项目(2019B1011)。

摘　　要：目的探讨HPV E6/E7 mRNA阳性而阴道镜检查阴性患者中漏诊HSIL及以上病变的危险因素。方法对HPV E6/E7 mRNA初筛阳性患者,进一步进行液基薄层细胞学(TCT)检查、HPV分型检测、阴道镜检查及病理活检。对其中466例阴道镜检查阴性患者经病理确诊为HSIL及以上的病例进行分析,探讨这部分患者漏诊HSIL及以上病变的危险因素。结果以病理为金标准,466例HPV E6/E7 mRNA阳性而阴道镜检查阴性的患者中检出42例组织学HSIL,检出率为9.01%(42/466);腺癌1例,检出率为0.21%(1/466)。466例的TCT结果NILM、ASC-US、LSIL、ASC-H、HSIL分别为80.47%、13.95%、4.29%、0.43%、0.86%。随着TCT异常级别的升高(因ASC-H例数少,将ASC-H并入HSIL中进行统计分析),组织病理为HSIL病例的检出率呈上升趋势,差异有统计学意义(χ^(2)=14.440, P=0.002)。HSIL及以上病例检出率在HPV16中最高,但与HPV18/45、其他型别间比较,差异无统计学意义(P>0.05)。随着年龄的增加,组织学HSIL及以上病例的检出率呈上升趋势,且差异有统计学意义(χ^(2)=13.328, P=0.020)。Logistic回归分析也显示年龄是HPV E6/E7m RNA阳性而阴道镜检查阴性患者漏诊HSIL及以上病例的危险因素,其O^R值为1.070,95%CI:1.027-1.114 (P<0.05)。结论对于HPV E6/E7 m RNA阳性的女性,如果阴道镜检查阴性,需要参考TCT结果并结合年龄因素的影响,必要时行宫颈活检和/或ECC,以免遗漏HSIL及以上病例。【Objective】To explore the risk factors of missed HSIL and higher lesions in patients with HPV E 6/E 7 mRNA positive but negative colposcopy.【Methods】For HPV E 6/E 7 mRNA-positive patients,further liquid-based cytology(TCT)examination,HPV typing test,colposcopy and pathological biopsy were performed.A total of 466 cases of patients with negative colposcopy examination were diagnosed as HSIL and above by pathology,and the risk factors for missed diagnosis of HSIL and above were explored.【Results】Taking pathology as the gold standard,42 histological HSILs were detected in 466 HPV E 6/E 7 mRNA-positive patients with negative colposcopy impression,the detection rate was 9.01%(42/466);1 case of adenocarcinoma,the detection rate was 0.21%(1/466).TCT results of 466 cases:NILM,ASC-US,LSIL,ASC-H,HSIL were 80.47%,13.95%,4.29%,0.43%,0.86%,respectively.As the abnormal level of TCT increases(due to the small number of ASC-H cases,ASC-H is incorporated into HSIL for statistical analysis),the detection rate of HSIL cases with histopathology is on the rise,and the difference is statistically significant(χ^(2)=14.440,P=0.002).Although the detection rate of HSIL and above cases was the highest in HPV 16,there was no significant difference with HPV 18/45 and other types.With the increase of age,the detection rate of histological HSIL and above cases showed an upward trend,and the difference was statistically significant(χ^(2)=13.328,P=0.020).Logistic regression analysis also showed that age is a risk factor for missed HSIL and above cases in patients with HPV E 6/E 7 mRNA positive and colposcopy negative.The OR value is 1.070,95%CI:1.027~1.114(P<0.05).【Conclusion】For women with HPV E 6/E 7 mRNA positive,if colposcopy is negative,TCT results and age factors should be taken into consideration.If necessary,cervical biopsy and/or ECC should be performed to avoid omission of HSIL and above cases.

关 键 词：高危型人乳头瘤病毒E6/E7 mRNA 液基细胞学 年龄 高度鳞状上皮内病变 危险因素 

分 类 号：R711.74[医药卫生—妇产科学]