1337例绝经女性宫颈病变筛查诊断的临床分析  

Clinical analysis of cervical lesions in 1 337 postmenopausal women diagnosed during screening

作　　者：齐伟宏[1] 李琴 杨晓科[1] 马琳琳[1] 李咏 黄发婷 曲冰 蒲建新 Qi Weihong;Li Qin;Yang Xiaoke;Ma Linlin;Li Yong;Huang Fating;Qu Bing;Pu Jianxin(Department of Obstetrics and Gynecology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Obstetrics and Gynecology,Karamay Hospital of Integrated Chinese and Western Medicine(Municipal People's Hospital),Kelamayi 834000,China)

机构地区：[1]北京医院妇产科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]克拉玛依市中西医结合医院(市人民医院)妇产科,克拉玛依834000

出　　处：《中华老年医学杂志》2023年第7期804-809,共6页Chinese Journal of Geriatrics

摘　　要：目的对绝经后中老年女性宫颈病变进行筛查诊断,分析中老年女性宫颈病变特点。方法回顾性分析2015年1月1日至2019年12月31日在北京医院妇科门诊就诊的绝经后女性1337例宫颈病变筛查资料,年龄50~86岁。根据年龄分为50~59岁组787例,60~69岁组483例,70~79岁组60例,80~89岁组7例。分别采集宫颈脱落细胞,进行高危型人乳头瘤病毒(HPV)检测和宫颈液基细胞学(TCT)检查,以宫颈活检病理学结果确定诊断,并分析宫颈病变情况。结果1337例入选者因症状就诊占53.0%(708例)。其中宫颈病变666例(49.8%),包括宫颈低级别病变(LSIL)357例,高级别病变(HSIL)252例,宫颈癌57例(4.3%)。70~79组患者HSIL发病率最高为30.0%(18/60);50~59组患者LSIL发病率最高为30.6%(241/787),不同宫颈病变类型在各年龄组比较差异有统计学意义(χ^(2)=28.919,P<0.01)。宫颈液基细胞学检查LSIL阳性率为51.6%(166/322),HSIL阳性率为70.8%(143/202),宫颈癌为71.4%(25/35),LSIL与HSIL及以上病变阳性率比较差异有统计学意义(P<0.05)。在宫颈恶性肿瘤组中,细胞学高度鳞状上皮病变为51.4%(18/35);HSIL组中上皮内病变或癌变为29.2%(59/202),LSIL组为48.4%(156/322),差异有统计学意义(χ^(2)=118.806,P<0.01)。206例未能明确意义的不典型鳞状细胞合并HPV阳性患者,52.9%(109例)为慢性宫颈炎,21例无HPV感染者76.2%(16例)为慢性宫颈炎。1301例患者完成HPV检查,以HPV单一型感染为主占69.4%(903例),混合型感染占比为30.6%(398例)。活检病理LSIL、HSIL、癌患者HPV感染分别为84.6%(302/357)、95.9(185/193)、100%(54/54),不同病理结果比较差异有统计学意义(P<0.01)。HPV单一型感染中,HPV16型是最常见感染亚型。宫颈HSIL及以上病变最常见HPV感染亚型为HPV16型和HPV18型。宫颈活检病理诊断与阴道镜诊断符合率LSIL为52.4%(187/357),HSIL为60.7%(153/252),宫颈癌为64.9%(37/57)。不同类型宫颈病变患者阴道镜诊断与病理诊断差异有Objective To screen and diagnose cervical lesions in middle-aged and elderly postmenopausal women and analyze the characteristics of cervical lesions in middle-aged and elderly women.MethodsA retrospective analysis was conducted on the screening data of 1337 postmenopausal women aged between 50 and 86 years who visited the outpatient clinics of the gynecology department of Beijing Hospital between January,2015 and December,2019.Participants were divided into groups based on age,with 787 in the 50-59 years old group,483 in the 60-69 years old group,60 in the 70-79 years old group,and 7 in the 80-89 years old group.Exfoliated cervical cells were collected,and high-risk human papillomavirus(HPV)detection and liquid-based cervical cytology examination were performed to confirm the diagnosis based on the pathological results of cervical biopsy.Cervical lesions were analyzed.Results53.0%(708)of the 1337 enrolled patients made their hospital visits because of symptoms.There were 666 patients(49.8%)with cervical lesions,including 357 with low-grade squamous intraepithelial lesions(LSIL),252 with high-grade squamous intraepithelial lesions(HSIL)and 57(4.3%)with cervical cancer.The 70-79 group showed the highest incidence of HSIL at 30.0%(18/60),while the 50~59 group had the highest incidence of LSIL at 30.6%(241/787),and there were significant differences in different types of cervical lesions between different age groups(χ^(2)=28.919,P<0.01).Liquid-based cervical cytology examination revealed a positive rate of 51.6%(166/322)for LSIL,a positive rate of 70.8%(143/202)for HSIL,and a rate of 71.4%(25/35)for cervical cancer.There were significant differences in LSIL,HSIL and other above-mentioned positive rates of lesions(P<0.05).In the cervical malignancy group,cytological high-grade squamous epithelial lesions made up 51.4%(18/35).Intraepithelial lesions or cancerous lesions represented 29.2%(59/202)in the HSIL group.The rate of intraepithelial lesions or cancerous lesions in the LSIL group was 48.4%(156/322),with statist

关 键 词：宫颈肿瘤 人乳头瘤病毒16 

分 类 号：R737.33[医药卫生—肿瘤]