外阴鳞状上皮内病变的检出率及临床特征分析  

Detection rate and clinical characteristics of vulvar squamous intraepithelial lesion

作　　者：张璐[1] 肖银平 陶祥 曹远奎 隋龙[1] 丛青[1] Zhang Lu;Xiao Yinpin:;Tao Xiang;Cao Yuankui;Sui Long;Cong Qing(Cervical Disease Center,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Department of Pathology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院宫颈与阴道早期疾病诊疗中心,上海200011 [2]复旦大学附属妇产科医院病理科,上海200011

出　　处：《中华妇产科杂志》2023年第8期603-610,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：上海市卫生健康委员会科研项目(202240079)。

摘　　要：目的探讨外阴鳞状上皮内病变(SIL)的检出率及临床特征。方法收集2018年1月1日至2022年8月31日在复旦大学附属妇产科医院经阴道镜活检诊断为外阴高级别鳞状上皮内病变(HSIL)的患者(外阴HSIL组),按1∶1纳入同期病理诊断为外阴低级别鳞状上皮内病变(LSIL)的患者(外阴LSIL组)。回顾性分析外阴SIL的检出率,并比较两组患者人乳头状瘤病毒(HPV)的阳性率及亚型分布、细胞学检查结果、阴道镜诊断、病变部位等临床特征。结果(1)2018—2022年阴道镜引导下活检外阴SIL的检出率逐年升高,分别为1.64%(740/45057)、2.34%(1110/47402)、2.68%(1108/41335)、3.26%(1536/47078)、3.31%(667/20155),平均检出率为2.57%(5161/201027)。(2)本研究纳入外阴HSIL组患者1096例,外阴LSIL组按1∶1纳入同期患者1096例。2192例外阴SIL患者中,2150例有HPV检测结果,总HPV阳性率为92.7%(1993/2150),其中外阴HSIL组患者HPV阳性率显著高于外阴LSIL组[分别为96.0%(1012/1054)、89.5%(981/1096);χ^(2)=33.62,P<0.001];外阴HSIL组患者中最常见的HPV感染亚型自高到低依次为HPV 16型(66.7%)、HPV 52型(14.3%)和HPV 58型(10.0%),外阴LSIL组患者依次为HPV 16型(24.9%)、HPV 6型(20.1%)、HPV 52型(17.1%)。2171例外阴SIL患者有子宫颈或阴道细胞学检查结果,细胞学检查的总体敏感度为53.6%,外阴LSIL组与外阴HSIL组分别为54.3%和52.9%,两组比较,差异无统计学意义(χ^(2)=0.40,P=0.526)。870例外阴SIL患者有阴道镜诊断结果,外阴HSIL组阴道镜诊断的准确率显著低于外阴LSIL组[分别为40.2%(163/405)、81.7%(380/465);χ^(2)=158.72,P<0.001]。2192例外阴SIL患者中,合并子宫颈阴道病变者占57.3%(1257/2192);其中,外阴HSIL组患者合并子宫颈阴道病变的发生率显著高于外阴LSIL组[分别为62.6%(686/1096)和52.1%(571/1096);χ^(2)=24.67,P<0.001]。936例有病灶数统计资料的外阴SIL患者中,外阴HSIL组中82.5%(386/468)的患者为单个病灶,外阴LSIL组为81.4%(381Objective To explore the detection rate,clinical characteristics of vulvar squamous intraepithelial lesion(SIL).Methods Women diagnosed with vulvar high-grade squamous intraepithelial lesions(HSIL)through colposcopy-guided biopsy from January 1,2018 to August 31,2022 in Obstetrics and Gynecology Hospital of Fudan University were included in a 1∶1 ratio with patients diagnosed with vulvar low-grade squamous intraepithelial lesions(LSIL)during the same period.Clinical characteristics including human papillomavirus(HPV)infection rate,genotype,cytology result,colposcopy impression,and lesion location were retrospectively analyzed.Results(1)The proportion of vulvar SIL detected by colposcopy-guided biopsy increased annually from 2018 to 2022,with rates of 1.64%(740/45057),2.34%(1110/47402),2.68%(1108/41335),3.26%(1536/47078),3.31%(667/20155),with an average rate of 2.57%(5161/201027).(2)A total of 1096 cases of vulvar HSIL and 1096 cases of vulvar LSIL were included.The overall infection rate of HPV was 92.7%(1993/2150),with higher infection rate in vulvar HSIL patients than that in vulvar LSIL patients[96.0%(1012/1054)vs 89.5%(981/1096);χ^(2)=33.62,P<0.001].Among vulvar HSIL patients,the common HPV genotype from high to low were HPV 16(66.7%),HPV 52(14.3%),and HPV 58(10.0%).For vulvar LSIL patients,the most common HPV genotype were respectively HPV 16(24.9%),HPV 6(20.1%)and HPV 52(17.1%).The overall sensitivity rate of cytology was 53.6%,with no significance difference between vulvar LSIL and HSIL groups(54.3%vs 52.9%;χ^(2)=0.40,P=0.526).The accuracy of colposcopy impression for vulvar HSIL was lower than that for vulvar LSIL[40.2%(163/405)vs 81.7%(380/465);χ^(2)=158.72,P<0.001].About 57.3%(1257/2192)of the patients had concomitant cervical and vaginal lesions,with a higher rate in vulvar HSIL group than that in vulvar LSIL group[62.6%(686/1096)vs 52.1%(571/1096);χ^(2)=24.67,P<0.001].Unifocal lesion was the main type,with no significance difference between vulvar LSIL and HSIL groups[81.4%(381/468)vs 82.5%(386/

关 键 词：乳头状瘤病毒感染 外阴疾病 鳞状上皮内病变 癌前状态 阴道镜检查 

分 类 号：R711.72[医药卫生—妇产科学]