宫颈上皮内瘤变合并阴道上皮内瘤变临床特征分析  

Clinical analysis of cervical intraepithelial neoplasia complicated with vaginal intraepithelial neoplasia

作　　者：庄新荣[1] 马杏莲 高秀娟[1] 张雅丽[1] 张桂香[1] Zhuang Xinrong;Ma Xinglian;Gao Xiujuan(Department of Obstetrics and Gynecology,the Affiliated Hospital of Chengde Medical University,Chengde 067000)

机构地区：[1]承德医学院附属医院妇产科,承德067000

出　　处：《现代妇产科进展》2023年第4期268-272,共5页Progress in Obstetrics and Gynecology

基　　金：承德市科学技术研究与发展项目(No:202006A074)。

摘　　要：目的:探讨宫颈上皮内瘤变(CIN)合并阴道上皮内瘤变(VAIN)的临床特点及危险因素。方法:收集承德医学院附属医院妇产科634例CIN患者的临床资料,其中49例CIN合并VAIN,585例CIN。对比分析两组患者的临床特征,logistic回归多因素分析CIN合并VAIN的独立危险因素。结果:CIN合并VAIN组患者的中位年龄56岁,绝经后患者占85.7%,CIN组患者的中位年龄38岁,绝经后患者占16.6%,两组比较差异有统计学意义(P<0.05)。CIN合并VAIN组中,95.9%的患者具有HPV感染,其中多重HPV感染占57.1%,多重HPV感染率明显高于CIN组(35.4%)(P<0.05)。两组患者均以HPV16型感染最常见,CIN合并VAIN组中感染最多的依次为HPV16、52、66、58、53型,CIN组依次为HPV16、58、52、33、18型。多因素分析显示,年龄是CIN合并VAIN的独立危险因素(OR=1.245,P<0.05)。VAIN3患者的TCT较多为HSIL和ASC-H,VAIN1较多为ASCUS和LSIL。CIN分级与VAIN分级具有一致性(Kappa=0.294,P<0.05),随着宫颈病变分级升高,阴道病变的分级相应升高。结论:CIN合并VAIN与患者年龄密切相关,对于年龄较大尤其是绝经后、多重高危HPV感染、细胞学异常的患者,阴道镜检查宫颈时应重视对阴道的检查,以便于及时发现阴道病变,早期干预,避免漏诊漏治。Objective:To explore the clinical characteristics and high risk factors of cervical intraepithelial neoplasia(CIN)coexisted with vaginal intraepithelial neoplasia(VAIN).Methods:Clinical data of patients pathologically diagnosed with CIN were collected.A total of 634 cases were analyzed,including 49 cases complicated with VAIN("VAIN concurrent"group)as the study object,585 cases of single lesions("CIN single"group)as the control group.The clinical characteristics of the two groups were analyzed,and the independent risk factors of CIN complicated with VAIN were analyzed by logistic regression.Results:The median age of"VAIN concurrent"group was 56 years,of which 85.7%were postmenopausal patients,significantly higher than"CIN single"group(P<0.05).In"VAIN concurrent"group,95.9%of the patients had HPV infection,of which 57.1%had multiple HPV infection,and the multiple HPV infection rate was significantly higher than that of"CIN single"group(P<0.05).HPV16 was the most common type of infection in both groups.The most common HPV types were in"VAIN concurrent"group HPV16,52,66,58,53",and in CIN single"group HPV16,58,52,33 and 18.Multivariate analysis showed that age was an independent risk factor for CIN complicated with VAIN(OR=1.245,P<0.05).The TCT results of most VAIN3 patients were HSIL and ASC-H,while the TCT results of most VAIN1 patients were ASCUS and LSIL.The level of CIN was consistent with that of VAIN(Kappa 0.294,P<0.05).With the increase of the level of cervical lesions,the level of vaginal lesions increased accordingly.Conclusion:CIN complicated with VAIN is closely related to age.For older(especially postmenopausal)patients with multiple high-risk HPV infections and cytological abnormalities,vaginal examination should be examined carefully by colposcopy,so as to timely find vaginal lesions,intervene early and prevent misdiagnosis.

关 键 词：阴道上皮内瘤变 宫颈上皮内瘤变 人乳头瘤病毒 

分 类 号：R737.3[医药卫生—肿瘤]