低度鳞状上皮内病变的处理对策研究

Management strategy for low-grade squamous intraepithelial lesions of uterine cervix

目的探讨低度鳞状上皮内病变(low-grade squamous intraepithelial lesions,LSIL)的处理方法。方法回顾性分析799例LSIL患者中HPV各亚型患者中CINⅡ+的比例,对病理学CINⅡ-的患者进行2年随访,用Kaplan-Meier法分析HPV亚型阳性组和阴性组疾病进展率。结果 HPV亚型阳性组CINⅡ+占18. 2%(125/687),阴性组CINⅡ+占3. 4%(3/88),两者比较,差异具有统计学意义(P <0. 05)。HPV16亚型阳性患者中CINⅡ级和CINⅢ级76例(44. 2%),其他HPV亚型患者中CINⅡ级和CINⅢ级49例(9. 5%),两者比较,差异具有统计学意义(P <0. 05)。HPV亚型阳性、HPV16亚型阳性及其他HPV亚型阳性对于CINⅡ+的阳性预测值分别是18. 2%、44. 2%和9. 5%,HPV阴性预测值在CINⅡ+中为96. 6%。580例病理结果为阴性及CINⅠ级的患者,随访2年,HPV亚型阳性组发生CINⅡ+共14. 2%(74/522),阴性组为3. 5%(3/85),两者比较,差异具有统计学意义(P <0. 05)。结论应加强低度鳞状上皮内病变患者的管理,尤其是合并HPV16亚型阳性者,建议行阴道镜检查+子宫颈活检。LSIL合并HPV亚型阳性活检病理结果为阴性及CINⅠ级的患者,在随访期间,应引起重视。

Objective To explore the management strategy for low-grade squamous intraepithelial lesions (LSIL) of uterine cervix. Methods The ratio of CINⅡ + in different HPV subtypes of 799 LSIL patients was retrospectively examined. Patients with pathologically diagnosed CINⅡ-were followed up for 2 years. Kaplan-Meier method was used to analyze the rate of disease progression in HPV positive and HPV negative groups. Results CINⅡ + accounted for 18. 2% (125/ 687) in HPV positive group ,and 3. 4% (3/88) in HPV negative group (P <0. 05). For HPV16 positive subtype,the rate of CINⅡ + and CINⅢ + was 44. 2% (76/172),which was significantly higher than that of patients with other HPV subtypes (9. 5%,49/516;P < 0. 05). The positive predictive values of HPV subtype positive,HPV16 subtype positive and other HPV subtype positive for CINⅡ + were 18. 2%,44. 2% and 9. 5%,respectively. Additionally,the negative predictive value of HPV negative was 96. 6% in CINⅡ + patients. Finally,among the 580 patients with negative or CINⅠ pathological results who were followed up for 2 years,a total of 14. 2% (74/522) patients progressed to CINⅡ + in the HPV positive group,and 3. 5% (3/85) in the HPV negative group (P <0. 05). Conclusion The management of patients with LSILs of the uterine cervix should be enhanced,especially for those who are HPV16 positive,and colposcopy and cervical biopsy are recommended for these patients. Attention should also be paid to LSIL patients with HPV negative and/or CINⅠ during follow-up.