宫颈细胞学为高度鳞状上皮内病变过度治疗的因素探讨

An Exploration of Overtreatment Predictors in Women with High-Grade Squamous Intraepithelial Lesion on Cervical Cytology

目的：探讨宫颈细胞学为高度鳞状上皮内病变（HSIL）过度治疗的影响因素，为临床工作提供参考价值。方法：回顾性分析2009年1月至2013年12月广东省人民医院初次细胞学筛查为HSIL，行锥切治疗的227例非妊娠妇女临床资料。以最高组织病理诊断级别≤低度鳞状上皮内病变（LSIL）为过度治疗标准，探讨年龄、绝经状况、高危型HPV-DNA负荷量、阴道镜检查、治疗策略与过度治疗的关系。结果：最高病理诊断未见CIN、LSIL、HSIL分别有9例（4．0％）、13例（5．7％）、199例（87．7％），宫颈鳞癌5例（2．2％），原位腺癌1例（0．4％）；总的过度治疗率为9．7％（22／227）。患者年龄、绝经状况、治疗策略与过度治疗均无明显关系。高危型HPV-DNA负荷量、阴道镜检查情况是HSIL过度治疗的影响因素；其中HPV-DNA≥1000pg／ml是HSIL过度治疗的保护因素，阴道镜检查提示为低度病变是其危险因素，两者的OR值分别为0．200（95％CI为0．042～0．950，P=0．043），8．897（95％CI为1．669—47．420，P=0．010）。结论：高危型HPV—DNA负荷量及阴道镜检查情况是宫颈细胞学为高度鳞状上皮内病变过度治疗的影响因素。

Objective ：To explore the potential predictors of overtreatment in women with high-grade squamous intraepithelial lesion （HSIL）on cervical cytology so as to offer reference for clinical management. Methods：Retro- spectively analyzed of 227 non-pregnant women with initially diagnosed HSIL on cervical cytology and received LEEP in Guangdong General Hospital between January 2009 and December 2013. Overtreatment,defined as patients who have subjected to LEEP diagnosed with low-grade squamous intraepithelial lesion（LSIL） or less pathological types. The relevance of patients＇age,menstrual status,the viral load of HPV-DNA,colposcopic impression and treatment protocol to overtreatment were investigated. Results：The most serious pathological diagnosis confirmed no CIN, LSIL, HSIL, squamous carcinoma of cervix（SCC） and adenocarcinoma in situ（AIS）were detected in 9 （4.0%）, 13 （ 5.7% ）, 199 （ 87.7% ）, 5 （ 2.2% ）, and 1 （ 0. 4% ） respectively. The overall overtreatment rate was 9.7%. Patients＇ age, menstrual status and treatment protocol have no statistical significance to overtreatment,while the viral load of HPV-DNA and colposcopic impression were significantly related to overtreatment. And HPV-DNA≥1000 pg/ml was the protective factor for overtreatment in HSIL, while colposcopic impression with low-grade lesion was the risk factor. The OR values were 0. 200 （95% CI：0. 042 - 0. 950, P = 0. 043） and 8. 897 （95% CI ： 1. 669 - 47. 420, P = 0. 010）, respectively. Conclusions.The viral load of HPV-DNA and the colposcop- ic impression were the influent factors on overtreatment of HSIL.