宫颈高危型人乳头瘤病毒阳性女性转诊阴道镜的价值分析  

The value of colposcopy in referral of cervical high-risk HPV positive women

作　　者：贾小平 姜敏[2] 李韵霞 阿依江 马彩玲[1] Jia Xiaoping;Jiang Min;Li Yunxia;A Yijiang;Ma Cailing(Department of Gynaecology,The First Affiliated Hospital of Xinjiang Medical University,Xinjiang 830054,China;Department of Gynaecology,Karamay Central Hospital,Karamay 834000 China)

机构地区：[1]新疆医科大学第一附属医院妇科,乌鲁木齐830054 [2]克拉玛依市中心医院妇科,克拉玛依834000

出　　处：《中国医师杂志》2022年第11期1620-1624,共5页Journal of Chinese Physician

基　　金：新疆维吾尔自治区自然科学基金(2020D01A17, 2021D01A21)。

摘　　要：目的探讨宫颈高危型人乳头瘤病毒(HR-HPV)阳性女性转诊阴道镜检查在宫颈癌筛查中的临床意义。方法收集克拉玛依市中心医院2018年1月至2021年11月宫颈HR-HPV阳性转诊阴道镜行宫颈活检的病例2 445例, 分析不同情况的宫颈HR-HPV阳性转诊阴道镜检查识别高级别鳞状上皮内病变(HSIL)及以上病变(HISL+)的情况, 了解不同情况宫颈HR-HPV阳性女性转诊阴道镜的价值。结果 2 445例HR-HPV阳性女性转诊阴道镜下宫颈活检确诊为未见上皮内病变或恶性病变(NILM)1 447例, 低级别鳞状上皮内病变(LSIL)362例, HSIL 510例, 鳞状细胞癌126例;阴道镜诊断与病理诊断完全符合率为67.08%(1 640/2 445), 一致性检验Kappa值为0.489。阴道镜诊断LSIL+的灵敏度是91.28%, 特异度是69.38%;诊断HSIL+的灵敏度是74.52%, 特异度是93.15%。合并宫颈液基细胞学(TCT)异常的HPV16/18阳性和HR-HPV其他12种阳性的HISL+检出率分别为64.78%(103/159)和78.79%(364/462);TCT未见异常的HPV16/18阳性和HR-HPV其他12种阳性的HISL+检出率分别为16.46%(82/498)和6.56%(87/1 326)。阴道镜下异常区HSIL+的检出率为44.69%(534/1 195), 常规活检HSIL+的检出率为8.16%(102/1 250)。结论宫颈HR-HPV阳性合并TCT异常的病例转诊阴道镜的HSIL+检出率较高, 阴道镜对识别宫颈病变有较高价值, 宫颈病变的明确诊断依据阴道镜下宫颈活检。Objective To investigate the clinical value of referral colposcopy in cervical high-risk human papillomavirus(HR-HPV)positive women in cervical cancer screening.Methods Totally 2445 cases,which were referred for colposcopic cervical biopsy for cervical HR-HPV positive in Karamay Central Hospital from January 2018 to November 2021 were collected.The status of cervical HR-HPV positive transferred colposcopy in different situations to identify high-grade squamous intraepithelial lesions(HSIL)and above(HISL+)was analyzed.The value of referral colposcopy in cervical HR-HPV positive women under different conditions was evaluated.Results 2445 HR-HPV positive women were referred for colposcopic cervical biopsy,which confirmed 1447 cases of negative for intraepithelial lesion or malignancy(NILM),362 cases of low grade squamous intraepithelia lesion(LSIL),510 cases of HSIL and 126 cases of squamous cell carcinoma(SCC);The complete coincidence rate between colposcopy diagnosis and pathological diagnosis was 67.08%(1640/2445),and the Kappa value of consistency test was 0.489.The sensitivity and specificity of colposcopy in the diagnosis of LSIL+were 91.28%and 69.38%,and HSIL+were 74.52%and 93.15%.The detection rates of HSIL+in HPV16/18 positive and other 12 HPV positive patients with abnormal cervical liquid based cytology(TCT)were 64.78%(103/159)and 78.79%(364/462),respectively.The positive rates of HPV16/18 and 12 other HPV positive HSIL+with normal TCT were 16.46%(82/498)and 6.56%(87/1326),respectively.The rate of detecting HSIL+in abnormal areas under colposcopy was 44.69%(534/1195),and that in routine biopsy was 8.16%(102/1250).Conclusions Among the referred for colposcopic cases,the detection rate of HSIL+was higher in cases with cervical HR-HPV positive and TCT abnormalities.Colposcopy has obvious value in identifying cervical lesions.The accurate diagnosis of cervical lesions is based on cervical biopsy under colposcopy.

关 键 词：阴道镜检查 人乳头瘤病毒 宫颈肿瘤 宫颈上皮内瘤样病变 阴道涂片 

分 类 号：R711[医药卫生—妇产科学]