10272例宫颈液基细胞学检查结果分析

The value of thin liquid-based cytology test in cervical lesions screeing:a study of 10 272 cases

目的探讨宫颈病变的临床特点及液基薄层细胞学检测术(TCT)在宫颈病变筛查中的作用。方法对10272例门诊及住院患者行TCT检测。细胞学检查阳性者继行阴道镜检查及多点活检,并送组织病理学检查和免疫组化高危型人乳头状瘤病毒(HPV)16或/和18的检测。结果在10272例TCT检测中,1172例属于非典型鳞状细胞(ASC)及其以上病变,其中ASC534例,非典型腺细胞(AGC)12例,低度鳞状上皮内病变(LSIL)242例,高度鳞状上皮内病变(HSIL)338例,宫颈癌46例。组织学诊断宫颈上皮内瘤变(CIN)1为309例,CIN2为151例,CIN3为277例,宫颈癌为112例。组织学与TCT的符合率在LSIL为30.99%(75/242),HSIL为65.38%(221/338),宫颈癌为82.61%(38/46)。CIN的高发阶段为31～40岁,其次为41～50岁年龄段;宫颈癌的高发阶段为41～50岁,其次为31～40岁年龄段。在10272例中,宫颈糜烂4491例,伴CIN426例;滴虫感染503例,伴CIN57例;霉菌感染693例,伴CIN72例;HPV阳性944例,伴CIN760例。结论宫颈病变具有十分明显的年轻化趋势,HPV感染者的CIN发生率显著高于宫颈糜烂、滴虫感染、霉菌感染者,宫颈病变与HPV感染有明显关联性。降低HPV感染,治疗并阻止CIN病变升级,是降低宫颈癌发病率的重要环节。

Objective To study the clinical characteristics of cervical lesions and value of thin liquid-based cytology test （TCT） in screening of cervical lesions.Methods Eligible 10 272 subjects underwent TCT were from in-and out-patient department from April 2007 to April 2009.The cases of atypical squamous cell （ASC） and above were detected by colposcopy,and biopsy sampling taken.High risk type human papillomavirus （HPV） 16/18 was detected on tissue section by immunohistochemical method.Results Of 10 272 cases,1 172 were ASC and above,including 534 ASC,12 atypical glandular cell （AGC）,242 low grade squamous intraepithelial lesions （LSIL）,338 high grade squamous intraepithelial lesions （HSIL） and 46 cervical carcinoma.By pathological examination,309 cases were diagnosed as cervical intraepithelial neoplasia （CIN）1,151 CIN2,277 CIN3 and 112 cervical cancer.The coincidence rates of TCT and pathologic histology were 30.99%（75/242）in LSIL,65.38%（221/338） in HSIL and 82.61%（38/46） in cervical carcinoma,respectively. The ages of high prevalence of CIN were 31-40 years and 41-50 years next;the ages of high prevalence of cervical carcinoma were 41-50 years and 31-40 years next. Of 10 272 cases,4 491 were cervical erosions and 426 with CIN;503 were trichomonas infection and 57 with CIN; 693 were fungal infection and 72 with CIN;944 cases presented positive HPV16/18 and 670 with CIN.Conclusions Cervical lesions have a younger tend.The incidence of CIN in patients with HPV infection is significantly higher than those of cervical erosions,trichomonas infection and fungal infection.HPV infection is obviously correlated with cervical lesions.To decrease infection of HPV,cure and stop progression of CIN are the key links for decreasing incidence of cervical carcinoma.