基于Markov模型的低度宫颈上皮内瘤变转移概率及影响因素研究  

Transition probabilities and influencing factors of cervical intraepithelial neoplasia 1:an analysis using a multistate Markov model

作　　者：闫佳欣 武彩红 裴蕊欣 贾海霞 宋丽 王捷 丁玲 王金桃 YAN Jia-xin;WU Cai-hong;PEI Rui-xin;JIA Hai-xia;SONG Li;WANG Jie;DING Ling;WANG Jin-tao(Department of Epidemiology,School of Public Health,Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学公共卫生学院流行病学教研室,太原030001

出　　处：《现代预防医学》2022年第1期167-170,177,共5页Modern Preventive Medicine

基　　金：国家自然科学基金(81872705,81473060,81703313);国家卫生和计划生育委员会公益性行业科研专项(201402010)。

摘　　要：目的应用多状态Markov模型分析低度宫颈上皮内瘤变(CIN1)的转归,估计其转移概率并探讨影响CIN1转归的因素。方法选取课题组在山西省建立的社区已婚妇女队列中经病理学确诊为CIN1的564例妇女为研究对象,对其实施6个月、12个月和24个月的随访观察。依据各个随访时点研究对象的病理学检查结果,将CIN1的转归分为逆转为NC(正常宫颈)、CIN1持续和进展为CIN2+(包括CIN2、CIN3及宫颈癌)三个状态,应用Markov模型对CIN1的转归情况及其相关因素进行分析,并预测其转归概率。结果564例CIN1患者中共453人完成了24个月的随访,CIN1妇女发生逆转、持续和进展的概率分别为75.50%、12.80%和11.70%,利用Markov模型预测的24个月时CIN1逆转率、持续率和进展率分别为80.12%、8.62%和11.26%,拟合效果良好。本次特别发现由CIN1逆转为正常宫颈的妇女仍有再进展为CIN1(5.56%)及CIN2+(1.31%)的风险。应用Markov模型对CIN1的转归影响因素分析显示,高危型人乳头瘤病毒(HR-HPV)感染可促进CIN1进展为CIN2+以及由CIN1逆转为NC后再进展为CIN1的风险,绝经和高洗阴频率(≥4次/周)均有利于CIN1逆转为NC。结论CIN1逆转为正常宫颈的概率较高,随着时间的延长,CIN1进展为高级别病变的概率逐渐增加,病变持续的概率呈下降趋势,由CIN1逆转为正常宫颈的妇女再进展为宫颈病变的现象不容忽视,HR-HPV感染可增加CIN1进展和由CIN1逆转为NC后再进展为CIN1的风险。Objective To investigate the prognosis of cervical intraepithelial neoplasia 1(CIN1)based on a multistate Markov model,so as to estimate the probabilities of transition between states,and to explore the influencing factors for the prognosis of CIN1.Methods A total of 564 women diagnosed with CIN1 were selected from a community based cohort in Shanxi Province in 2014 and were followed up at 6 months,12 months and 24 months.According to the pathological results at each follow-up time point,the prognosis of CIN1 was classified into three states:progression to CIN2+(including CIN2,CIN3,and cervical cancer),persistence and regression to normal cervix(NC).A three-state Markov model was constructed to analyze the influencing factors and predict the transition probabilities of CIN1.Results 453 women had finished the 24-month follow-up,and the probabilities of the regression,persistence and progression in women with CIN1 were 75.50%,12.80%and 11.70%,respectively.And the estimated 24-month probabilities of the regression,persistence and progression of CIN1 by the multistate Markov model were 80.12%,8.62%and 11.26%,respectively,with a good model fit.Particularly,it was found that women with normal cervix who had regressed from CIN1 in fact still had a risk of progressing to CIN1(5.56%)or CIN2+(1.31%).HR-HPV infection would promote the progression of CIN1 and NC(regressed from CIN1).Menopause and higher frequency of washing vagina(≥4 times/week)were the contributing factors to the regression of CIN1.Conclusion Women with CIN1 have a higher probability of regression than persistence and progression.With the passage of time,the probability of the progression of CIN1 has increased,whereas the probability of the persistence of CIN1 has decreased.Women with normal cervix who are regressed from CIN1 are not allowed to be ignored.HR-HPV infection could increase the risk of the progression of CIN1 and NC(regressed from CIN1).

关 键 词：多状态MARKOV模型 低度宫颈上皮内瘤变 疾病转归 

分 类 号：R737.33[医药卫生—肿瘤]