216例宫颈细胞学为ASCUS的临床意义及处理探讨

Clinical Significance and Management Strategy with Atypical Squamous Cells of Undetermined Significance in 216 Cases

目的:探讨宫颈细胞学诊断为意义未明的不典型鳞状细胞(ASCUS)的临床意义及处理方法。方法:2008年1月—2009年12月,对天津医科大学总医院妇科门诊的216例宫颈细胞学诊断为ASCUS的患者行阴道镜评估与镜下活检,其中140例同时接受了人乳头瘤病毒(HPV)检测。结果:①ASCUS患者宫颈上皮内瘤样病变(CIN)的发生率为44.44%,高级别CIN与宫颈癌发生率为20.37%。②高级别CIN及宫颈癌发病平均年龄为(44.57±11.23)岁,明显高于湿疣和低级别CIN者(均P<0.05)。③发生宫颈高级别CIN及宫颈癌的ASCUS患者高危HPV亚型以16型最常见,出现概率为41.67%,HPV58、18、52型感染率排在第2～4位。④HPV阳性者CIN检出率为55.56%,明显高于HPV阴性者的31.25%和直接阴道镜检的38.16%(均P<0.05)。⑤HPV检测高度鳞状上皮内病变(HSIL)阴性预测值为93.75%。结论:ASCUS病理类型复杂,32岁以下年轻患者发生宫颈湿疣可能性大,40岁以上特别是合并HPV16、58、18、52型感染者应警惕高级别CIN及宫颈癌的可能。ASCUS患者应先行HPV检测分流,阳性者联合阴道镜检查以提高CIN检出率,阴性者可定期重复细胞学检查。

Objective：To explore the clinical significance and management strategy with atypical squamous cells of undetermined significance. Methods：A total of 216 cases involved in this study were out-patients who were diagnosed ASCUS by LCT test and further biopsied under the colposcope from January,2008 to December,2009 in Tianjin Medical University General Hospital. 140 cases of them were combined by HPV-DNA test. Results：①The incidence rate of CIN,high-grade CIN and cervical cancer was 44.44% and 20.37%. ②The average age of high-grade CIN and cervical cancer was（44.57±11.23）years old,which was older than wart（31.56±9.69）years old and low-grade CIN（39.48±12.20）years old（P0.05）. ③The highest probility of hr-HPV subtype in ASCUS with high-grade CIN and cervical cancer was HPV16 with percentage of 41.67%. HPV58,18,52 are other common subtypes. ④The relevant ratio of CIN in ASCUS patient with positive HPV-DNA test is 55.56%,which was higher than both immediate colposcope without HPV-DNA test with the ratio of 38.16%（χ2=5.41,P0.05）and negative HPV-DNA test with the ratio of 31.25%（χ2=5.83,P0.05）. ⑤The Negative Predictive Value of HSIL of HPV test was 93.75%. Conclusions：The pathologic type of ASCUS was complicated. Warts were more xommon in patients younger than 32ys. Patients older than 40ys especially combined with HPV16, 58, 18, 52 infection were supposed to be noticed that whether there were high-grade cervical lesions and cervical cancer. ASCUS patients should take HPV test firstly and positive patients taking colposcope could increase the relevance ratio of CIN. Repeated LCT was feasible for negative HPV patients.