阴道镜下宫颈管搔刮对HPV感染女性检出宫颈高级别病变的作用  

Effect of the endocervical curettage under colposcopy for diagnosing high-grade squamous intraepithelial lesions of patients with human papillomavirus infection

作　　者：陈菁 王朝行 刘勇[1] CHEN Jing;WANG Chaoxing;LIU Yong(Beijing Obstetrics and Gynecology Hospital,Capital Medical University.Beijing Maternal and Child Health Care Hospital,Beijing,100026;Xingyi People's Hospital,Guizhou Province)

机构地区：[1]首都医科大学附属北京妇产医院,北京妇幼保健院,100026 [2]贵州省兴义市人民医院

出　　处：《中国计划生育学杂志》2025年第3期585-590,共6页Chinese Journal of Family Planning

基　　金：首都医科大学附属北京妇产医院科技创新及转化专项(FCYYLC202408)。

摘　　要：目的:探讨阴道镜下子宫颈管搔刮术(ECC)对人乳头瘤病毒(HPV)阳性女性检出宫颈高级别病变(HSIL)的作用,并了解检出HSIL患者的临床特征。方法:回顾性分析2021年6月-2022年6月在首都医科大学附属北京妇产医院因HPV阳性行阴道镜检查并同时取宫颈活检的2127例的临床资料,以病理结果为诊断金标准,评价ECC对HSIL检出中的作用及其相关影响因素。结果:ECC对HSIL的检出率为5.2%(110/2127),仅通过ECC检出占1.3%(27/2127)。多因素回归分析发现,患者年龄、HPV16/18阳性、细胞学异常、转化区可见性,已绝经是ECC检出HSIL的影响因素。年龄≥60岁的女性检测到HSIL的概率显著高于年龄<30岁的女性(OR=7.586,95%CI 2.911~19.770),已绝经的女性检出HSIL的概率是未绝经女性的2.180倍(95%CI 1.326~3.586)。1型转化区的女性检测到HSIL的概率较2/3型转化区显著降低(OR=0.429,95%CI 0.215~0.858),细胞学异常增加了HSIL的检出率(OR=9.965,95%CI 5.940~16.720),HPV 16/18型感染的女性HSIL检出率是HPV HR感染的2.337倍(95%CI 1.345~4.061),混合HPV感染(Mix组)也增加了HSIL的检出率(OR=1.920,95%CI 1.195~3.085)。结论:对于HPV阳性者经阴道镜下可见病变及可疑病变进行多点活检;绝经期女性、尤其是≥60岁;细胞学HSIL;HPV16/18阳性;转化区不完全可见的患者应同时行ECC可以提高HSIL检出率。Objective:To explore the effect of the endocervical curettage(ECC)under colposcopy for diagnosing highgrade squamous intraepithelial lesions(HSIL)of patients with human papillomavirus(HPV)infection,and to study the clinical characteristics of the women with HSIL.Methods:A retrospective analysis was conducted on the clinical data of 2,127 patients who underwent colposcopic assessment and concurrent cervical biopsy due to HPV positivity in the gynecology outpatient department of Beijing obstetrics and gynecology hospital from June 2021 to June 2022.The pathological results of the patients were used as the gold standard to evaluate the role of ECC of the patients for detecting their HSIL and its associated influencing factors.Results:The detection rate of HSIL of the patients by ECC was 5.2%(110/2127),with 1.3%(27/2127)of the patients detected solely by ECC.Multivariate regression analysis found that the factors influencing the HSIL detection of the patient by ECC were their age(P=0.000),HPV16/18 positivity(P=0.003),cytological abnormalities(P=0.000),visibility of the cervical transformation zone(P=0.017)and postmenopausal status(P=0.002).The probability of detecting HSIL of the patients aged≥60 years old was significantly higher than that(OR=7.586,95%CI 2.911-19.770)of the patients aged<30 years old.The patients aged 40-49 years old(OR=2.134,95%CI 0.888-5.130)and the patients aged 50-59 years old(OR=2.235,95%CI 0.860-5.810)also showed a higher detection rate of HSIL,but which had no statistical significance as high as that of the patients aged≥60 years old.The probability of HSIL of the postmenopausal patients was 2.180 times higher than that of the premenopausal patients significantly(95%CI 1.326-3.586).The probability of HSIL detection in the cervical type 1 transformation zone of the patients was significantly lower than that in the cervical type 2/3 transformation zone of the patients(OR=0.429,95%CI 0.215-0.858).The cytologic HSIL of the patients significantly increased their detection rate of HSIL(OR=9.965

关 键 词：人乳头瘤病毒感染 宫颈高级别病变 阴道镜 宫颈管搔刮术 

分 类 号：R73[医药卫生—肿瘤]