昆明市官渡区社会人群宫颈癌筛查结果分析

Analysis of Cervical Cancer Screening Results in Community Women in Guandu District of Kunming

目的 探讨昆明市官渡区社会人群中妇女宫颈癌流行病学情况,为本地区宫颈癌防治提供科学依据.方法 选择2009年2月至9月,昆明市官渡区常住人口中,25～55岁自愿参加全免费宫颈癌筛查的2506例有性行为妇女为研究对象,平均年龄为38.7岁.将其按文化程度、年龄和年经济收入进行分组（本研究遵循的程序符合本院人体试验委员会所制定的标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书）.对宫颈癌的筛查采用传统巴氏涂片细胞学检查法、醋酸肉眼检查（visual inspection assay,VIA）法,对结果呈阳性患者,进行13种高危型人乳头状瘤病毒感染（human papilloma virus,HPV）检测,同时行阴道镜检查,并取病变组织活检,经组织病理学确诊宫颈癌前病变宫颈上皮瘤（cervical intra-epithelial neoplasia,CIN）及宫颈癌.对本地区不同经济收入、年龄和文化程度妇女的宫颈癌检出率进行统计学分析.结果 2506例受检妇女中,巴氏涂片细胞学检查的阳性率为3.91%（98/2506）,人乳头状瘤病毒感染阳性率为0.52%（13/2506）,宫颈癌检出率为0（0/2506）,宫颈癌前病变检出率（病理学诊断为≥CIN Ⅰ者）为0.199%（5/2506）.文化程度越高妇女的巴氏涂片细胞学检查阳性检出率越低,差异有显著意义（P＜0.05）;经济条件越差妇女的巴氏涂片细胞学检查阳性检出率越高,差异有显著意义（P＜0.05）;39～55岁妇女巴氏涂片细胞学检查阳性率高于年龄小于39岁妇女,且差异有显著意义（P＜0.05）.结论 对39～55岁、文化程度低、经济状况差的妇女,应重点加强定期宫颈癌筛查,从而有效预防和控制宫颈癌的危害.

Objective To discuss the epidemiology of cervical cancer in community women in Guandu District of Kunming in order to provide a scientific basis for prevention and treatment of cervical cancer in this area. Methods From February to September 2009, 2506 women from age 25 to 55 years（average age of 38.7-year-old） who had sex behavior from Guandu District of Kunming city were recruited voluntarily for a cervical cancer screening program. The screening of cervical cancer was conducted by the conventional Pap smear cytology and visual inspection assay （VIA）. The positive case were detected by 13 types of high-risk human papilloma virus （HPV）, at the same time, colposcopy and biopsy pathology were used to diagnose cervical intraepithelial neoplasia （CIN） and cervical cancer. The different income, age, education level were analyzed in different detection rates of cervical cancer. Informed consent was obtained from all participants. Results Of the 2506 histologic diagnoses, Pap smear cytology positive rate was 3.91% （98/2506）, human papilloma virus positive.rate was 0.52% （13/2506）, detection rate of cervical cancer was 0 （0/2506）, detection rate of cervical lesions （pathological diagnosis of ≥CIN I ） was 0. 199% （5/2506）. Women with a higher educational level had a lower Pap smear cytology positive rate, which showed a significant difference （P〈0.05）, women in a worse economic condition had a higher Pap smear cytology positive rate （P〈 0.05）, women aged 39- to 55-year-old had a higher Pap smear cytology than women younger than 39 years old （P〈0.05）. Conclusions Women in 39-55 years old with low education level, and lower economic status should be pay more attention to health care education and regular screening in order to prevent and control cervical cancer effectively.