子宫颈细胞学意义未明的不典型鳞状细胞组织学诊断及人乳头瘤病毒检测结果分析  

Histological diagnosis and HPV results in patients with cervical cytology ASC-US

作　　者：曹智 贾鑫华 张询[3] 吴婷[2] 乔友林[4] CAO Zhi;JIA Xin-hua;ZHANG Xun;WU Ting;QIAO You-lin(不详;Bejing Chaoyang District Maternal and Child Health Care Hospital,Bejing 100021,China)

机构地区：[1]北京市朝阳区妇幼保健院,北京100021 [2]厦门大学公共卫生学院国家传染病诊断试剂与疫苗工程技术研究中心,福建厦门361102 [3]中国医学科学院肿瘤医院流行病学室,北京100021 [4]中国医学科学院/北京协和医学院群医学及公共卫生学院,北京100144

出　　处：《中国实用妇科与产科杂志》2023年第6期639-642,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家高技术研究发展计划(863计划)(2012AA02A408);中国医学科学院医学与健康科技创新工程服务“一带一路”倡议先导科研专项(2017-I2M-B&R-03);中国医学科学院医学与健康科技创新工程(2021-12M-1-004)

摘　　要：目的探讨子宫颈细胞学判读为意义未明的不典型鳞状细胞(ASC-US)的受试者其组织病理学和人乳头瘤病毒(HPV)感染情况及两者之间的关系。方法自2012年11月至2013年4月在中国5个地区招募入组7372名18~45岁健康女性,共进行11次随访。其中子宫颈细胞学判读为ASC-US的受试者共387例,将其纳入分析,每一例受试者均进行第2代杂交捕获法(HC2)和HPV分型检测。对细胞学诊断为ASC-US的受试者的组织学结果与HPV结果进行对比分析。结果在招募入组的7372名妇女中,细胞学不满意54例,召回其中49例,另5名受试者未进行重新检测,余7367例细胞学结果如下:未见上皮内病变(NILM)6695例(90.88%),ASC-US 387例(5.25%),不能排除高级别鳞状上皮内病变不典型鳞状细胞(ASC-H)14例(0.19%),不典型腺上皮细胞(AGC)9例(0.12%),低级别鳞状上皮内病变(LSIL)204例(2.77%),高级别鳞状上皮内病变(HSIL)57例(0.77%),癌1例(0.01%)。387例诊断为ASC-US的受试者其组织学结果如下:阴性/慢性炎症338例(87.34%),子宫颈上皮内瘤变(CIN)1和阴道上皮内瘤变(VaIN)1分别为24例(6.20%)和2例(0.52%),CIN212例(3.10%),CIN33例(0.78%),癌1例(0.26%),其他7例(1.81%)。ASC-US患者中CIN2+者占4.13%(16/387)。在后续11次随访中ASC-US患者CIN2+累计发病39例(10.08%,39/387)。与非高级别病变相比,HPV、HPV 16和HPV多重感染在高级别病变中阳性率更高,差异有统计学意义。结论在ASC-US患者的分流管理中,应高度重视HPV高危型阳性人群,尤其HPV 16感染和HPV多重感染者,建议转诊阴道镜检查。Objective To investigate the histopathology and HPV infection in subjects with cervical cytology reading of atypical squamous cells of undetermined significance(ASC-US)and the relationship between them.Methods A total of 7372 healthy women aged 18-45 years were recruited from November 2012 to April 2013 in 5 regions of China,with 11 follow-up visits.Among them 387 subjects with ASC-US cervical cytology were included in this analysis,and each subject was tested for hybridization capture 2(HC2)and human papillomavirus(HPV)typing.The histological results of sub-jects with a cytological diagnosis of ASC-US were analyzed in comparison with HPV results.ResultsOf the 7372 women recruited into the cohort,cytology was unsatisfactory in 54 cases,of which 49 were recalled and another 5 subjects were not retested,leaving 7367 cytology results as follows:no intraepithelial lesions(NILM)in 6695 cases(90.88%),ASC-US in 387 cases(5.25%),high-grade squamous intraepithelial lesions atypical squamous cells not excluded(ASC-H)in 14 cases(0.19%),atypical glandular cells(AGC)in 9 cases(0.12%),low-grade squamous intraepithelial lesions(LSIL)in 204 cases(2.77%),high-grade squamous intraepithelial lesions(HSIL)in 57 cases(0.77%),and carcinoma in 1 case(0.01%).In 387 subjects diagnosed with ASC-US,the histological findings were as follows:negative/chronic inflammation in 338 cases(87.34%),cervical intraepithelial neoplasia(CIN)1 and vaginal intraepithelial neoplasia grade(VaIN)1 in 24 cases(6.20%)and 2 cases(0.52%),respectively,CIN2 in 12 cases(3.10%),CIN3 in 3 cases(0.78%),1 case of carcinoma(0.26%),and 7 other cases(1.81%),with a cumulative incidence of 39 cases(10.08%,39/387)in follow-up visits.About 4.13%(16/387)of ASC-US patients were CIN2+.HPV,HPV 16 and HPV multiple infections had higher positive rates in high-grade lesions compared to non-high-grade lesions,and the diference was statistically significant.Conclusion In the triage management of ASC-US patients,top priority should be given to the HPV high-risk positive population,esp

关 键 词：子宫颈癌 意义未明的不典型鳞状细胞 组织病理学 人乳头瘤病毒感染 

分 类 号：R711.74[医药卫生—妇产科学]