宫颈癌前病变和早期宫颈浸润癌的监测

Observation on cervical intraepithelial neoplasia and early cervical carcinoma

目的探讨宫颈癌及癌前病变筛查的可行性。方法行程控超薄细胞检测系统（TCT）检查5545例，对其中307例阳性和219例阴性但临床可疑宫颈病变共计526例进一步行阴道镜及镜下取活检病理检查，以病理组织学为金标准，对结果进行分析。结果单因素Logistic回归分析与宫颈上皮内瘤变（CIN）相关的危险因素为宫颈HPV感染、性活动开始年龄、性伴数、性生活防护、STD病史、年龄及流产次数（P〈0．05）。TCT和阴道镜与病理诊断的符合率分别为49．4％和83．8％；TCT对低度鳞状上皮内病变（LSIL）、高度鳞状上皮内病变（HSIL）及鳞癌（CC）的漏诊率分别为63．63％、74．44％、100％，阴道镜对LSIL、HSIL及CC的漏诊率分别为33．37％、12．22％、0。TCT、阴道镜、TCT联合阴道镜诊断CIN以上的灵敏度分别为61．2％、84．6％、94．5％，特异性分别为85．4％、88．2％、90．8％。结论（1）女性CIN和宫颈癌的发生与宫颈人乳头腺病毒（HPV）感染、性行为以及各种下生殖道感染等因素相关。（2）液基细胞学可用于宫颈病变的初筛，TCT检查联合阴道镜下活组织检查，可提高宫颈病变的检出率及准确率，两者联合能满足早期子宫颈癌及癌前病变筛查的需要。

Objective To discuss the correlation between cervical intraepithelial neoplasia（CIN） and uterine cervix cancer and the combination of TCT and colposcope for the investigation of cervical lesion. Methods 5545 patients were preliminarily screened by cervical fluid basement cell folium smear,in which 307 patients are masculine and 219 are negative,the 526 patients are suspected cervical lesions in clinical symptoms and they further underwent colposcopy and biopsy,the results were analyzed by pathohistology which is golden standard. Results CIN coherent dangerous factors analyzed by single factor Logistic regression analysis are ： cervical HPV pollution, age of sexual activity, sexual partners numbers, protection of sexual life, STD history, age and frequency of miscarriage （ P 〈 0. 05 ）. The coincidence between TCT, colposcopy and pathologic diagnosis are 49. 4% ,83.8% ;the omission diagnostic rate of LSIL,HSIL and CC from TCT are 63.63% ,74.44% ,100% ;the omission diagnostic rate of LSIL,HSIL and CC from colposcopy are 33. 37%, 12. 22% ,0; the sensitivity of TCT, colposcopy and TCT combine colposcopy for CIN are 61.2% ,84. 6% ,94. 5% and specificity are 85.4% ,88.2% ,90. 8%. Conclusions （ 1 ） The generation of CIN and cervical cancer are correlated with cervical HPV pollution, sexual behavior and various kinds of lower genital tract infection. （2）Fluid basement cell folium smear can promote the property of diagnosis, meet the demands of early stage uterus neck cancer and precancer lesion investigation, are suitable to be routine check methods in primary hospital.