育龄期子宫颈HSIL患者的病变消退及其影响因素分析  

Analysis of natural regression and influencing factors of HSIL in the cervix of childbearing age patients

作　　者：吴敏霞 何晓明 尤志学[1] Wu Minxia;He Xiaoming;You Zhixue(Department of Gynecology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Gynecology,Jiangnan University Affiliated Obstetrics and Gynecology Hospital,Wuxi Maternal and Child Health Hospital,Wuxi 214002,China)

机构地区：[1]南京医科大学第一附属医院妇科,南京210029 [2]江南大学附属妇产医院无锡市妇幼保健院妇科,无锡214002

出　　处：《中华妇产科杂志》2023年第7期516-525,共10页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨育龄期子宫颈高级别鳞状上皮内病变(HSIL)患者的病变消退及其影响因素,评估保守管理在有生育需求HSIL患者中的适用性。方法采用真实世界数据的前瞻性研究,选择2015年4月30日至2022年4月30日在南京医科大学第一附属医院就诊,经阴道镜指引下子宫颈活检病理诊断为HSIL的275例育龄期患者,包括子宫颈上皮内瘤变(CIN)Ⅱ229例(83.3%)、CINⅡ~Ⅲ(即未明确分级的HSIL)46例(16.7%)。采用随访而非立即手术治疗的保守管理,中位随访时间为12个月(范围:3~66个月),分析随访期内HSIL患者的病变消退、持续和进展情况,并分析与病变消退及消退时间相关的影响因素。结果(1)275例HSIL患者中,213例(77.5%,213/275)随访期内病变消退。其中,229例CINⅡ患者中,180例(78.6%,180/229)病变消退、21例(9.2%,21/229)病变持续、28例(12.2%,28/229)病变进展;46例CINⅡ~Ⅲ患者中,33例(71.7%,33/46)病变消退、12例(26.1%,12/46)病变持续、1例(2.2%,1/46)病变进展为鳞癌Ⅰa1期。CINⅡ患者的病变消退率与CINⅡ~Ⅲ患者比较,差异无统计学意义(χ2=1.03,P=0.309)。(2)单因素分析显示,诊断时年龄、诊断时年龄<25岁与HSIL患者病变消退率均明显有关(P均<0.05);而HSIL分级(分为CINⅡ、CINⅡ~Ⅲ)、细胞学检查、高危型人乳头状瘤病毒(HPV)检测、阴道镜评估、随访期活检次数、随访期妊娠情况均与HSIL患者病变消退率无关(P均>0.05)。(3)Kaplan-Meier法病变消退曲线分析显示,诊断时年龄≥25岁患者的中位病变消退时间与<25岁者比较显著延长(分别为15、12个月;χ2=6.02,P=0.014)。结论对于育龄期HSIL患者,特别是经阴道镜检查充分评估的CINⅡ者,优先推荐非立即手术干预的保守管理。诊断时年龄≥25岁是影响HSIL患者预后的危险因素。Objective To investigate the natural regression and related factors of high-grade squamous intraepithelial lesion(HSIL)in the cervix of childbearing age women,and to evaluate the applicability of conservative management for future fertility needs.Methods This study included 275 patients of reproductive age with fertility needs,who were diagnosed as HSIL by biopsy from April 30,2015 to April 30,2022,including 229 cases(83.3%)cervical intraepithelial neoplasia(CIN)Ⅱand 46 cases(16.7%)CINⅡ-Ⅲ.They were followed-up without immediate surgery in the First Affiliated Hospital of Nanjing Medical University.The median follow-up time was 12 months(range:3-66 months).The regression,persistence and progression of lesions in patients with HSIL were analyzed during the follow-up period,the influencing factors related to regression and the time of regression were analyzed.Results(1)Of the 275 HSIL patients,213 cases(77.5%,213/275)experienced regression of the lesion during the follow-up period.In 229 CINⅡpatients,180 cases(78.6%)regressed,21 cases(9.2%)persisted,and 28 cases(12.2%)progressed.In 46 CINⅡ-Ⅲpatients,33 cases(71.7%)regressed,12 cases(26.1%)persisted,and 1 case(2.2%)progressed to invasive squamous cell carcinoma stageⅠa1.There was no significant difference in the regression rate between the two groups(χ2=1.03,P=0.309).(2)The average age at diagnosis,age<25 years old at diagnosis were independent influencing factor of HSIL regression in univariate analysis(all P<0.05).There was no significant difference between HSIL regression and pathological grading,the severity of screening results,human papillomavirus(HPV)genotype,colposcopy image characteristics,number of biopsies during follow-up and pregnancy experience(all P>0.05).(3)The median regression times for patients aged≥25 years and<25 years at diagnosis were 15 and 12 months,respectively.Kaplan-Meier analysis showed that age≥25 years at diagnosis significantly increased the median regression time compared to<25 years(χ2=6.02,P=0.014).Conclusions Fo

关 键 词：宫颈鳞状上皮内病变 保守管理 肿瘤消退 自行性 阴道镜检查 

分 类 号：R737.33[医药卫生—肿瘤]