1357例宫颈上皮内瘤变临床特征及阴道镜图像的诊断意义  

Clinical features of 1357 cases of cervical intraepithelial neoplasia and diagnostic significance of colposcopic images

作　　者：陈苗 高丽[1] 张婷[1] 王俊侠[1] 陈芳珍[1] 张忠明[1] 朱克修[1] 安瑞芳[1] CHEN Miao;GAO Li;ZHANG Ting;WANG Junxia;CHEN Fangzhen;ZHANG Zhongming;ZHU Kexiu;AN Ruifang(Department of Gynecology and Obstetrics,The First Affiliated Hospital of Xi’an Jiaotong University,Shaanxi Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院妇产科,陕西西安710061

出　　处：《中国妇幼健康研究》2023年第2期59-63,共5页Chinese Journal of Woman and Child Health Research

基　　金：陕西省重点研发计划项目-社会发展领域(2018ZDXM-SF-044)。

摘　　要：目的分析并总结宫颈上皮内瘤变的临床及阴道镜图像特征,以提高诊断高级别宫颈上皮内瘤变(HSIL)的准确性。方法选取2016年9月至2019年11月于西安交通大学第一附属医院诊断为宫颈上皮内瘤变的1357例患者为研究对象,诊断分为低级别宫颈上皮内瘤变(LSIL)组(n=786)和高级别宫颈上皮内瘤变(HSIL)组(n=571),探讨两组临床及阴道镜特征。结果年龄≥46岁时,HSIL发病率高于LSIL,差异有统计学意义(χ^(2)=10.87,P<0.05);HSIL组孕次、产次、TCT异常、接触性出血、宫颈增生比例均高于LSIL组(χ^(2)/t值介于2.50~15.96之间,P<0.05);HSIL组最常见的HPV感染型别为HPV16型(51.4%),HSIL组HPV16型阳性比例高于LSIL组,HPV18型阳性及其他高危阳性比例均低于LSIL组(χ^(2)值分别为60.65、6.67、27.73,P<0.05);HSIL组出现厚醋白者及异常血管比例均高于LSIL组,差异有统计学意义(χ^(2)值分别为329.67、32.31,P<0.05);两组碘试验比较差异无统计学意义(P>0.05)。结论高级别宫颈上皮内瘤变以HPV16型最常见,年龄≥46岁者高级别宫颈上皮内瘤变发生率较高。阴道镜下醋白上皮及异常血管对宫颈上皮内瘤变具有较高的诊断价值,碘试验具有非特异性改变。Objective To analyze and summarize clinical features and colposcopy image characteristics of cervical intraepithelial neoplasia(CIN),so as to improve accuracy of diagnosis of high grade cervical intraepithelial neoplasia(HSIL).Methods 1357 women who were diagnosed as CIN in The First Affiliated Hospital of Xi′an Jiaotong University from September 2016 to November 2019 were selected as research subjects.The patients were divided into low grade cervical intraepithelial neoplasia(LSIL)group(n=786)and HSIL group(n=571).The clinical features and colposcopic characteristics of the patients were analyzed and compared between the two groups.Results At the age of≥46 years,the incidence of HSIL was significantly higher than the incidence of LSIL in the patients with CIN,and the difference was statistically significant(χ^(2)=10.87,P<0.05).The gravidity,parity,incidences of abnormalities in thinprep cytologic test(TCT),contact bleeding and cervical hyperplasia of the patients in the HSIL group were all higher than those in the LSIL group(t/χ^(2)=2.50-15.96,all P<0.05).In the HSIL group,the most common type of HPV infection was HPV16,accounting for 51.4%.The positive rate of HPV16 in the HSIL group was higher than that in the LSIL group,while the positive rates of HPV18 and other high-risk HPVs in the HSIL group were lower than those in the LSIL group(χ^(2)=60.65,6.67 and 27.73 respectively,all P<0.05).The proportions of patients with thick vinegar white and abnormal blood vessels in the HSIL group were higher than those in the LSIL group,and the differences were statistically significant(χ^(2)=329.67 and 32.31 respectively,both P<0.05).There was no significant difference in result of Lugol′s iodine test between the two groups(P>0.05).Conclusion HPV16 is the most common type of HPV that causes HSIL,and the incidence of HSIL is higher in those patients aged≥46 years.The appearances of vinegar white epithelium and abnormal blood vessels under colposcope have higher diagnostic values for CIN,while non-specific change

关 键 词：宫颈上皮内瘤变 人乳头瘤病毒 阴道镜 液基细胞学检查 

分 类 号：R173[医药卫生—妇幼卫生保健]