妊娠期妇女子宫颈细胞学检查结果异常的相关因素分析

Factors associated with abnormal cervical cytology in pregnant women

目的探讨妊娠期妇女宫颈细胞学检查结果异常的相关因素。方法选择2007年9月至2008年9月在首都医科大学附属北京妇产医院产科定期产前检查的妊娠12—36周的妇女，除外先兆流产、胎膜早破、前置胎盘等并发症共12112例，于初次产前检查时常规行宫颈液基细胞学检查（TCT），同时记录妊娠期妇女的职业、受教育程度、户口地址、家庭收入、民族、初次性生活年龄、性伴侣个数、避孕方法、孕产史、妇科伴随症状、相关肿瘤家族史、既往妇科病史、吸烟史，并记录当天妇科检查情况，分析TCT结果异常的相关危险因素。结果资料完整的妊娠期妇女共11906例，资料满意率为98．30％（11906／12112）。其中，TCT结果正常10354例，占86．96％（10354／11906）、未明确诊断意义的不典型鳞状上皮细胞（ASCUS）1134例，占9．52％（1134／11906）、未明确诊断意义的不典型腺上皮细胞（AGUS）112例，占0．94％（112／11906）、低度鳞状上皮内病变（LSIL）229例，占1．92％（229／11906）、高度鳞状上皮内病变（HSIL）74例，占0．62％（74／11906），宫颈鳞癌3例，占0．02％（3／11906）。多因素非条件logistic回归分析结果显示，与ASCUS及AGUS相关的危险因素包括初次性生活年龄（ORACUS=2．90、ORAGU。：7．32）、性伴侣个数（ORASCUS=1．49、ORACUS=2．02）、流产次数（ORACUS=1．68、ORAGUS=3．50）；与LSIL、HSIL相关的危险因素包括初次性生活年龄（ORLSIL=6．34、ORHSIL=9．26）、性伴侣个数（ORLSIL=1．69、ORHSIL=1．65）、流产次数（ORLSIL=1．53、ORHAIL=5．33）、吸烟（ORLSIL=1．84、ORHSIL=1．77）；与TCT结果异常（包括ASCUS、AGUS、LSIL、HSIL）相关的感染因素包括滴虫性阴道炎（P〈0．01）、人乳头状瘤病毒（HPV）感染（P〈0．01）；柱状上皮异位与TCT结果异常密切相关（χ^2=43．269，P=0．009），但与柱状上皮异位的程度无关。结论妊娠期妇女宫颈细胞学检查结果异常发生的相关因素与非妊娠期相同。

Objective To investigate the risk factors associated with abnormal cervical cytology findings in pregnant women. Methods From Sep. 2007 to Sep. 2008, 12 112 pregnant women who underwent their antenatal examinations at 12 - 36 gestational weeks in Beijing Obstetics and Gynecology Hospital were enrolled in this study. They were all excluded from the following pathologic obstetrics factors including threatened abortion, premature rupture of membranes or placental previa. Thinprep cytology test （TCT） were given at their first examination, meanwhile, a personal clinic file was established to record her occupation, education, address, family income, nationality, age of first intercourse, number of sex partners, contraception, marriage and pregnancy, current gynecologic diseases, family history of gynecologic tumors, history of gynecologic diseases and smoking and result of pelvic examination. Those risk factors leading to abnormal cervical cytology were analyzed. Results The complete clinical data were collected from 11 906 cases（98.30% , 11 906/12 112）. It was found that 10 354 women were shown with normal TCT result, however, 1134 women （9. 52%, 1134/11 906） with atypical squamaous cells of undetermined significance（ASCUS）, 112 women （0. 94%, 112/11 906） with atypical glandular cells of undetermined significance（ AGUS）, 229 women （1.92%, 229/11 906） with low grade squamaous intraepithelial（ LSIL）, 74 women （0. 62%, 74/11906） with high grade squamaous intraepithelial（HSIL）. Multiple factorial non-conditioned logistic regression analysis showed that age of first sexual intercourse （ ORASCUS = 2. 90, ORAGuS = 7.32） , number of sex partners （ ORASCUS = 1.49, ORAGUS = 2.02 ）, number of abortion （ ORASCUS = 1.68, ORAGUS= 3.50） were correlated with ASCUS and AGUS. In LSIL group and HSIL group, age of first sexual intercourse （ ORLSIL = 6. 34, ORHSIL = 9. 26 ）, number of sex partners （ ORLSIL= 1.69, ORHSIL = 1. 65 ） , number of abortion （ ORLSIL = 1. 53, ORHSIL = 5. 33 ） , smoking （ ORLSIL = 1.84, ORHSIL = 1. 77 ） were remarkable variables. The infection of human papilloma virus （HPV） and trichomonas vaginitis were correlated with abnormal cervical cytology （including ASCUS, AGUS, LSIL and HSIL） significantly （P 〈 0.01 ）. Columnar epithelium dystopia were also significantly correlated with abnormal cervical cytology （χ^2 = 43. 269, P = 0. 000）. However, abnormal cervical cytology was uncorrelated with degrees of Columnar epithelium dystopia. Conclusions The risk factors associated with abnormal cervical cytology in pregnant women were the same with those of non-pregnant women.