外阴尖锐湿疣与子宫颈病变相关性分析

The Analysis of Correlativity between Vulvar Condyloma Acuminatum and Cervical Lesions

目的:对外阴尖锐湿疣患者,同时感染高危型HPV和伴有子宫颈上皮病变的相关性进行分析。方法:2002年5月至2004年4月,对外阴尖锐湿疣患者,进行外阴活检、阴道镜检查、高危型人乳头瘤病毒(HPV)检测,并同时在阴道镜下取材进行子宫颈组织病理学诊断。结果:418例病理诊断外阴尖锐湿疣病例中,子宫颈高危型HPV-DNA阳性287例,占68.66%;子宫颈上皮内瘤变(CIN)发生率20.56%;高危型HPV-DNA阴性131例,占31.34%,子宫颈上皮内瘤变(CIN)发生率7.63%。组织病理检查:未出现子宫颈HPV感染167例,占39.95%;子宫颈HPV感染182例,占43.54%;CIN-Ⅰ51例,占12.20%;CIN-Ⅱ16例,占3.83%;CIN-Ⅲ2例,占0.48%;未检出宫颈癌,1例外阴尖锐湿疣合并VINII～III。结论:外阴尖锐湿疣患者,存在混合感染和出现多个部位病损的情况;外阴尖锐湿疣可以认为是一个有特征的临床症状,提示子宫颈高危型HPV感染并伴发CIN的可能性;妊娠期妇女具有更高风险感染HPV病毒。对有外阴尖锐湿疣病史的患者,应特别注意宫颈病变的情况。

Objective： To analyze the correlativity between the high-risk human papillomavirus （HPV） infections and concomitant epithelial lesions of the cervix in the patients with vulvar condyloma acuminatum. Methods： The vulvar biospy, colposcopy and high-risk HPV-DNA test were conducted in the patients with vulvar condyloma acuminatum and sampling with cervical bioscopy for cervical histopathological diagnosis was performed concurrently, from May 2002 to April 2004. Results： In 418 cases with vulvar condyloma acuminatum diagnosed by infections of cervix, accounting for 68.66%of the totals pathology, 287 were positive high-risk HPV （＋） （287/418）, among which the incidence of cervical intraepithelial neoplasm （CIN） was 20.56% （59/287）; the high-risk HPV（-） occurred in 131 of total cases, accounting for 31.34%, among which the incidence of CIN was 7.63% （10/131）. The results of histopathological examination were as follows： no cervical infection was found in 167 cases （39.95%）, cervical HPV infection occurred in 182 （43.54%）, CIN- Ⅰ was found in 51 cases （12.20%）, CIN- Ⅱin 16 （3.83%）, CIN-Ⅲ in 2 （0.48%）. None of them was cervical cancer. The vulvar condyloma acuminatum with concomitant VINⅡ-Ⅲ was found in only one case. Conclusions： The mixed HPV infection and lesion of multiple positions may occur in the patients with vulvar condyloma acuminatum. The vulvar condyloma acuminatum can be regarded as a characteristic clinical symptom, suggesting the possibility of cervical high-risk HPV infection with concomitant CIN, and more high-risk of HPV infection will exist in the women at pregnancy. Special care of cervical lesion should be paid for those with a history of vulvar condyloma acuminatum.