高危型人乳头瘤病毒阴性/不典型鳞状细胞和低度鳞状上皮内病变患者的随访观察

doi:10.3969/j.issn.1006-7795.2015.02.009

首都医科大学学报 ›› 2015, Vol. 36 ›› Issue (2): 205-211.doi: 10.3969/j.issn.1006-7795.2015.02.009

• HR-HPV感染与宫颈病变的相关问题研究 • 上一篇下一篇

高危型人乳头瘤病毒阴性/不典型鳞状细胞和低度鳞状上皮内病变患者的随访观察

何鑫¹, 陶绘丞², 王淑珍¹, 朱志清¹, 王跃³, 刁小莉³, 曲久鑫⁴

1. 首都医科大学附属北京朝阳医院妇产科, 北京 100020;
2. 北京市通州区妇幼保健院妇产科, 北京 101100;
3. 首都医科大学附属北京朝阳医院病理科, 北京 100020;
4. 首都医科大学附属北京朝阳医院检验科, 北京 100020

收稿日期:2014-12-28 出版日期:2015-04-21 发布日期:2015-04-16
通讯作者: 王淑珍 E-mail:darrywang2003@163.com
基金资助:
北京市自然科学基金(7122069),北京市科学技术委员会科技计划(Z131100004013018),北京市金桥工程种子资金项目(2014-2016)。

An analysis of high-risk human papillomavirus DNA-negative cervical intraepithelial neoplasia in atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion smears: a retrospective study

He Xin¹, Tao Huicheng², Wang Shuzhen¹, Zhu Zhiqing¹, Wang Yue³, Diao Xiaoli³, Qu Jiuxin⁴

1. Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
2. Department of Obsterics and Gynecology, Maternity and Child Hospital of Tongzhou, Beijing 101100, China;
3. Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
4. Department of Laboratory, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Received:2014-12-28 Online:2015-04-21 Published:2015-04-16
Supported by:
This study was supported by Natural Science Foundation of Beijing(7122069), Scientific Project of Beijing Municipal Science and Technology Commission(Z131100004013018), Seed Funding of Beijing Jinqiao Project(2014-2016).

摘要/Abstract

摘要： 目的分析高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)阴性的不典型鳞状细胞(atypical squamous cells undetermined significance,ASCUS)和低度鳞状上皮内病变(low squamous intraepithelial lesion,LSIL)患者的随访结果,探讨HR-HPV阴性的ASCUS和LSIL患者的合理处理方法。方法回顾性分析2010年1月1日至2012年12月31日期间,就诊于首都医科大学附属北京朝阳医院妇科门诊,HR-HPV阴性、宫颈液基细胞学为ASCUS和LSIL的356例患者的病理资料,对HR-HPV阴性的ASCUS和LSIL经阴道镜及宫颈活检排除高级别病变的306例患者定期进行HR-HPV随访。HR-HPV检测采用杂交检测法2代(hybird capture-Ⅱ,HC-Ⅱ)。结果 HR-HPV阴性/ASCUS和LSIL患者宫颈上皮内瘤变(cervical intraepithelial lesions,CIN)-Ⅲ及以上病变发病率分别为7.9%和9.1%。HR-HPV阳性/ASCUS和LSIL患者CIN-Ⅲ及以上病变发病率分别是22.9%和17.9%。HR-HPV阳性的ASCUS和LSIL患者CIN-Ⅲ及以上病变发病率明显高于HR-HPV阴性患者,差异具有统计学意义(P=0.000)。HR-HPV阳性对ASCUS及LSIL患者宫颈高级别病变的阴性预测值分别为87.13%和84.42%。HR-HPV阴性/ASCUS和LSIL患者CIN-Ⅱ及以上病变检出率是14.3%。不同年龄段的HR-HPV阴性/ASCUS和LSIL的患者,宫颈高级别病变患者的发生率不同,差异具有统计学意义(P<0.05)。30~39岁妇女宫颈高级别病变的发生率最高(18.2%)。结论 HR-HPV阴性的ASCUS和LSIL患者发生CIN-Ⅲ及以上病变分别是7.9%和9.1%,CIN-Ⅱ及以上病变达14.3%,30~39岁的HR-HPV阴性/ASCUS和LSIL患者宫颈高级别病变发生率达18%,建议对于HR-HPV阴性的ASCUS和LSIL患者应行阴道镜检查可疑病变部位活检。

关键词: 高危型人乳头瘤病毒, 不典型鳞状细胞, 低度鳞状上皮内病变, 宫颈上皮内瘤变

Abstract: Objective To evaluate the cervical pathology among high-risk human papillomavirus(HR-HPV)-negative women with atypical squamous cells of undetermined significance(ASCUS) cells and low-grade squamous intraepithelial lesion(LSIL), and to investigate the reasonable management strategies for HR-HPV-negative patients with ASCUS and LSIL. Methods In this retrospective study, 356 cases who visited the Department of Gynecology, Beijing Chaoyang Hospital Affiliated to Capital Medical University during January 1, 2010 to 31 December 2012, and were HR-HPV-negative/ASCUS and LSIL on Pap smear were included; 306 patients were followed up. All the patients were examined by colposcopy and cervical biopsy if necessary. HR-HPV was detected by hybridization assay II, hybird capture Ⅱ(HC-Ⅱ). SPSS18.0 statistical software was used. Results Of the 202 cases, 16(7.9%) and 14 of 154(9.1%) HR-HPV negative ASCUS and LSIL women developed CIN-Ⅲ or worse compared with 32 of 140(22.9%) and 40 of 223(17.9%) HPV-positive ASCUS and LSIL women(P=0.000). The negative predictive value of HR-HPV testing for CIN-Ⅲ or worse in ASCUS and LSIL women were 87.13% and 84.42%, respectively. When cervical pathological data were further evaluated by age groups in HR-HPV-negative women with ASCUS and LSIL, the risk of ≥ CIN-Ⅱ were significantly different in various age groups(P<0.05), the highest group was 30-39 years old patients(18.2%). Conclusion HR-HPV-negative patients with an ASCUS or LSIL Pap test result have a chance of being cervical high grade lesions, 7.9% and 9.1% of HR-HPV-negative patients with ASCUS or LSIL had CIN-Ⅲ or worse, and 14.3% of these patients had CIN-Ⅱ or worse lesions, the negative predictive value of HR-HPV testing for CIN-Ⅲ or worse were lower. Colposcopy should be done for HR-HPV-negative patients with ASCUS or LSIL.

Key words: high-risk human papillomavirus(HR-HPV), atypical squamous cells of undetermined significance(ASCUS), low-grade squamous intraepithelial lesion(LSIL), cervical intraepithelial neoplasia(CIN)

中图分类号:

R711.74

何鑫, 陶绘丞, 王淑珍, 朱志清, 王跃, 刁小莉, 曲久鑫. 高危型人乳头瘤病毒阴性/不典型鳞状细胞和低度鳞状上皮内病变患者的随访观察[J]. 首都医科大学学报, 2015, 36(2): 205-211.

He Xin, Tao Huicheng, Wang Shuzhen, Zhu Zhiqing, Wang Yue, Diao Xiaoli, Qu Jiuxin. An analysis of high-risk human papillomavirus DNA-negative cervical intraepithelial neoplasia in atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion smears: a retrospective study[J]. Journal of Capital Medical University, 2015, 36(2): 205-211.

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高危型人乳头瘤病毒阴性/不典型鳞状细胞和低度鳞状上皮内病变患者的随访观察

An analysis of high-risk human papillomavirus DNA-negative cervical intraepithelial neoplasia in atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion smears: a retrospective study

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