HPV疫苗接种对阴道镜下组织学子宫颈高级别上皮内病变检出的影响  

The impact of HPV vaccination on colposcopy the detection of high-grade squamous intraepithelial lesion

作　　者：郭靖 庞佩 高迪 张岱[1] 李家悦 毕蕙[1] GUO Jing;PANG Pei;GAO Di;ZHANG Dai;LI Jiayue;BI Hui(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing,100034,China;Department of Gynecology,Exhibition Road Hospital Xicheng District,Beijing,100037,China;University college Dublin School of Medicine,Ireland)

机构地区：[1]北京大学第一医院妇产科,北京100034 [2]北京市西城区展览路医院妇科,北京100037 [3]都柏林大学医学院,爱尔兰

出　　处：《中国妇产科临床杂志》2024年第6期504-507,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的比较人乳头瘤病毒(human papilloma virus,HPV)疫苗接种状态对阴道镜下组织学子宫颈高级别上皮内病变(high-grade squamous intraepithelial lesion,HSIL)及以上病变(HSIL+)检出的影响。方法回顾性分析2020年6月至2022年12月在北京大学第一医院妇产科进行阴道镜检查并同时进行多点定位活检±子宫颈管搔刮术(endocervical curettage,ECC)的2289例患者的临床资料,分为疫苗接种组(629例)和未接种组(1660例),以组织病理学结果为诊断的金标准,评估HPV疫苗接种状态下以阴道镜印象HSIL+为阈值对组织学HSIL+检出的敏感性、特异性、阳性预测值及阴性预测值的影响。结果①疫苗接种组细胞学高级别异常(4.9%,31/629)与未接种组(8.4%,139/1660)比较,差异有统计学意义(χ^(2)=7.874,P=0.005);疫苗接种组HPV16/18阳性(28.5%,179/629)与未接种组(39.0%,647/1660)比较,差异有统计学意义(P<0.001);②组织学证实HSIL+536例(23.4%),其中疫苗接种组(17.0%,107/629)与未接种组(25.8%,429/1660)比较,差异有统计学意义(P<0.001)。③疫苗接种组阴道镜印象HSIL+的阳性预测值(PPV)(55.0%)与未接种组(66.0%)比较,差异无统计学意义(P>0.05),在疫苗接种组的HPV16/18阳性者中,阴道镜印象HSIL+的PPV较未接种组降低(P<0.05)。结论HPV疫苗接种对阴道镜下组织学HSIL+检出无明显影响,阴道镜仍为评估子宫颈癌筛查异常者的有用工具,目前尚无需因为HPV疫苗接种改变现有的管理流程。Objective To examine the impact of human papillomavirus(HPV)vaccination status on the histological detection of high-grade squamous intraepithelial lesion and above(HSIL+)guided by colposcopy.Methods This is a retrospective study including 2289 patients who underwent endocervical curettage(ECC)from June 2020 to December 2022 in the Department of Obstetrics and Gynecology of Peking University First Hospital.Patients are divided into two groups based on their vaccination status:those who have received the HPV vaccine(629 cases)and those who have not received the HPV vaccine(1660 cases).Using histopathology as the diagnostic gold standard and colposcopy impression of HSIL+as the threshold,clinical data of patients were analyzed to evaluate the effects of HPV vaccination on the sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of HSIL+on histology.Results①The proportion of high-grade abnormalities on cytology in the vaccinated group(4.9%,31/629)was significantly lower than in the unvaccinated group(8.4%,139/1660)(χ^(2)=7.874,P=0.005).the prevalence of HPV 16/18 positive was also lower in the vaccinated group(28.5%,179/629),compared with the unvaccinated group(39.0%,647/1660)(P<0.001).②A total of 536(23.4%)HSIL+cases confirmed by histology.The difference between the rates of HSIL+among those who are vaccinated(17.0%,107/629)and those who are not vaccinated(25.8%,429/1660)was statistically significant(P<0.001).③The PPVs of colposcopy for HSIL+were 55.0%in the vaccinated group and 66.0%in the unvaccinated group,showing no statistical difference(P>0.05).However,among the HPV16/18 positive patients in the vaccinated group,the PPV of colposcopy for HSIL+is significantly lower than that in the unvaccinated group.Conclusions HPV vaccination has no significant effect on the histological detection of HSIL+on colposcopy-guided biopsy.As colposcopy is still a useful tool for the management of abnormal cervical cancer screening results,no change to the current management process needs

关 键 词：子宫颈癌筛查 人乳头瘤病毒疫苗 阴道镜 子宫颈高级别鳞状上皮内病变 

分 类 号：R186[医药卫生—流行病学] R446.8[医药卫生—公共卫生与预防医学]