2341例妊娠妇女宫颈筛查及产后随访

Cervical screenings and follow-up for 2341 pregnant women.

目的:分析孕期妇女宫颈细胞学检查、HPV检测、活检组织病理结果及产后自然转归状况。方法:选择2009年1月～2010年2月在北京大学人民医院接受孕期产检及分娩病例,孕前半年未行液基细胞学(TCT)检测,孕早期或中期均进行TCT检查,结果异常者部分行人乳头瘤病毒杂交捕获Ⅱ代(HPVHC-Ⅱ)法检测,阴道镜检查及病理学检查。结果:(1)2341例孕妇中宫颈细胞学意义不明的非典型鳞状上皮细胞(ASCUS)及以上患者60例(2.56%),其中高度鳞状上皮内病变(HSIL)8例(0.34%),低度鳞状上皮内病变(LSIL)4例(0.17%),ASCUS48例(2.05%);细胞学异常者中25例行HPV检测,阳性18例(72%);细胞学异常者28例接受阴道镜检查,病理活检者21例;病理学结果宫颈上皮内瘤变(CIN)共13例(0.56%):CINⅠ3例(0.13%);CINⅡ2例(0.085%),CINⅢ8例(0.34%);(2)产后随访了51例,细胞学正常/炎症41例(细胞学转阴率80.4%),ASCUS8例,LSIL1例,ASC-H1例。孕期HPV阳性者,13例产后复查,4例仍为阳性,孕期与产后比较有显著性差异(P=0.004)。孕期CIN11例中,产后仍为CIN6例(CINⅠ1例、CINⅡ1例、CINⅢ4例),无早期浸润癌发生。结论:(1)妊娠期宫颈细胞学异常在产后有较高的转阴率,同时妊娠期存在较高的HPV亚临床感染,产后转阴率高;(2)妊娠期CIN患者在密切随访下继续妊娠是安全的;(3)妊娠期CIN患者产后应密切随访,若产后仍为CIN应尽快治疗。

Objective ：To investigate the HPV infection, outcome of pathology and postpartum natural outcome of cervical neoplasia during pregnancy. Method： During Jan. 2009 to Feb. 2010,2341 deliveries were performed at Peking University People＇s Hospital. All women accepted cytology test,whose results were abnomal have got the HPV-HC- Ⅱ DNA examinationor colposcopy examination. Postpartum changes in the Pap smear and in a combined cytologic, histologic and HPV-HC- Ⅱ DNA were evaluated. Results ： （ 1 ） In 2341 samples, 60 cytological abnormal cases were found （2.56%）, including ASUCS 48/2341 cases （2.05 % ）, LSIL 4/2341 cases（0. 17% ）, HSIL 8/2341 cases （0.34%） ; Of the 60 pregnant patients, high-risk HPV DNA was detected in 25 cases （including 18 positive results）and colposcopy examination was performed in 28 cases （ including 21 pathology results） ; about the pathology results, CIN were detected in 13/2341cases （0. 56% ）, including CIN I 3/2341 （0. 13% ）, CIN H 2/2341 （0.085%） ,CINm 8/2341 （0.34%）. （2） A total of 51 cytological abnormal cases were followed up successfully. In 51 post-partum samples,there were atypical epithelial cells 10 cases, including ASUCS 8 cases, LSIL 1 cases, ASC-H 1 cases. The majority of cytological lesions showed a tendency to regress post-partum（ approximately 80.4% ）. There were 13 HPV positive cases during pregnancy in which only 4 cases still showed positive. There was obvious statisticaldifference of HPV between pregnancy and postpartum. Of the 51 pregnant patients, CIN were found in 11 pregnant women in which 6 postpartum women still showed CIN（CIN I 1 case,CIN Ⅱ1 case, CIN Ⅲ4 cases）. No case of invasive disease developed during the follow-up period. Conclusion ： （ 1 ） The majority of cytological lesions showed a tendency to regress post-partum. Pregnancy was associated with an increased risk for HPV infection,which mostly regress postpartum. （2）The expectant procedure for intraepithelial lesions is the most widely chosen and safe due to the possibility of regression in the postpartum period. （3）Patients with cervical dysplasia in pregnancy may be followed conservatively with colposcopy and biopsy. Treatment should be taken as soon as possible once post-partum biopsy still showed CIN.