25岁以下女性宫颈上皮内瘤变2级消退状况研究  

Study on regression of cervical intraepithelial neoplasia grade 2 in women under 25 years old

作　　者：徐海波[1] 季进峰 姚涓[1] XU Hai-bo;JI Jin-feng;YAO Juan(Department of Gynecology,Nantong Cancer Hospital,Nantong 226006;Department of Integrated Traditional Chinese and Western Medicine,Nantong Cancer Hospital,Nantong 226006)

机构地区：[1]南通市肿瘤医院妇科,南通226006 [2]南通市肿瘤医院中西医结合科,南通226006

出　　处：《生殖医学杂志》2024年第3期322-329,共8页Journal of Reproductive Medicine

摘　　要：目的观察25岁以下宫颈上皮内瘤变2级(CIN2)患者在随访24个月后的病变消退情况。方法选择2015年1月至2020年12月在我院妇科门诊筛查确认的540例CIN2患者为研究对象。纳入患者至少每6个月进行1次阴道镜检查,并配合活检,持续24个月。根据24个月内患者CIN2病变消退情况将纳入患者分为消退组(273例)和未消退组(267例),对两组患者的基线资料进行单因素分析,并采用多因素Logistic分析探讨影响CIN2病变消退的影响因素,采用受试者工作特征曲线(ROC)及配对卡方检验评估各因素/指标的预测价值。结果24个月随访结束时,50.56%(273/540)的CIN2患者发生了病变消退。单因素及多因素分析结果显示阴道镜印象≥CIN2、人乳头瘤病毒(HPV)16感染、细胞学检查提示高度鳞状上皮内病变、吸烟是25岁以下CIN2患者病变未消退的危险因素(P<0.05);诊断年份较早是患者病变未消退的保护因素(P<0.05)。HPV16联合阴道镜检查、细胞学检查结果对CIN2患者病变未消退的预测价值较高,ROC曲线下面积(AUC)为0.822,95%CI为(0.677,0.962)。结论25岁以下CIN2患者中,超过一半的患者可能在24个月内自动消退,无需进行创伤性治疗。HPV16联合阴道镜检查、细胞学检查结果对CIN2病变未消退具有较好的预测价值,值得临床医生密切关注。Objective:To determine the regression of cervical intraepithelial neoplasia grade 2(CIN2)among women under 25 years old after 24 months of treatment.Methods:A total of 540 CIN2 patients who were screened and confirmed in the outpatient department of Nantong Cancer Hospital from January 2015 to December 2020 were selected as the research subjects.The included patients underwent the colposcopy examination at least once every 6 months and cooperated with biopsy,lasting for 24 months.According to the regression of CIN2 lesions in patients within 24 months,the included patients were divided into a regression group(273 cases)and a non-regression group(267 cases).Single-level factor analysis was conducted on the baseline data of the two groups,and a multivariate logistic analysis was used to explore the influencing factors of non-regression of CIN2 lesions.The predictive value of each factor/indicator was evaluated using receiver operating characteristic curve(ROC)and paired chi-square test.Results:At the end of 24 months of follow-up,50.56%of CIN2 patients experienced regression of the lesion.The results of univariate and multivariate analyses showed that CIN2 and CIN2+of the colposcopy impression,human papillomavirus(HPV)16 infection,highly squamous intraepithelial lesions by cytological examination,and smoking were risk factors for non-regression of lesions in CIN2 patients under 25 years old(P<0.05),while the early diagnosis was a protective factor(P<0.05).The predictive value of HPV16 combined with colposcopy and cytological examinations for non-regression of CIN2 patients’lesions was high,with an area under the ROC curve(AUC)of 0.822 and a 95%CI of(0.677,0.962).Conclusions:The CIN2 lesions in more than half of patients under the age of 25 may automatically subside within 24 months without traumatic treatment.The combination of HPV16,colposcopy,and cytological examination results has a good predictive value for the non-regression of CIN2 lesions,and is worthy of close attention by clinical doctors.

关 键 词：宫颈上皮内瘤变 消退 影响因素 

分 类 号：R711.74[医药卫生—妇产科学]