中东部3县7138例农村妇女宫颈癌筛查分析

Analysis of cervical cancer screening in 7138 women from three counties in mid-eastern china

目的了解不同农村地区宫颈病变及宫颈癌的发生情况。方法 2014年1月至8月在山西省古交市（县级市）、北京市密云县和河北省曲周县,根据国家宫颈癌检查项目的人群年龄要求在35~64岁,具有当地户口的农村妇女,共收集7 138例;其中古交市2 444例,密云县2 350例,曲周县2 344例。经研究对象知情同意后进行宫颈细胞学检查,对细胞学结果为ASCUS及以上的病例进行阴道镜检查。所有细胞学及组织病理学检测均委托第3方检验公司,并由医院专业医生对其进行质控。结果在7 138例检查人群中,检出细胞学在不典型增生（ASCUS）及以上的病例共计247例,检出率为3.5%;其中ASCUS119例、不典型鳞状上皮细胞（ASCH）19例、低度病变（LSIL）73例、高度病变（HSIL）34例、非典型腺上皮细胞（AGC）2例,检出率分别为1.7%、0.3%、1.0%、0.5%和0.03%。不同项目县细胞学异常的检出率不同,古交市细胞学异常的比例（5.3%）高于其他两县（2.4%和2.6%）,差异有统计学意义（χ2=36.984,P=0.000）。古交市患者的宫颈上皮内瘤变（CIN）Ⅱ及以上病变的检出率最高为1.35%,高于其他两县（0.30%和0.47%）,差异有统计学意义（χ2=23.725,P=0.000）。结论不同地区宫颈病变和宫颈癌的检出率有所不同;通过良好的质量控制能够提高细胞学异常及宫颈癌前病变的检出率。

Objective To get to know the incidence of cervical lesions and cervical cancer in rural areas. Methods A total of 7 138 local rural women aged from 35 to 64, the age range that was appropriate for national cervical cancer screening, were selected as research objects from January to August in 2014. All those women were from Gujiao City （county-level city） in Shanxi Province, Miyun County in Beijing or Quzhou County in Heibei Province. Among them, 2 444 women came from Gujiao City, 2 350 from Miyun County, and 2 344 from Quzhou County. All cases underwent cervical cytological examination after informed consent. As for women whose test results were confirmed as atypical squamous cells of undetermined significance （ASCUS） or above, colposcopy was performed. All the preceding cytological and pathological examinations were carried out by a third-party inspection company. Quality control of the test results was performed by professional doctors from hospital. Results Among 7 138 cases, 247 cases were identified as ASCUS or above, and the detection rate was 3.5%, including 119 cases of ASCUS, 19 cases of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion （ASC-H）, 73 cases of low-grade squamous intraepithelial lesion （LSIL）, 34 cases of high-grade squamous intraepithelial lesion （HSIL） , and 2 cases of atypical glandular cells （AGC）. The detection rate was 1.7% , 0.3% , 1.0% , 0.5% and 0.03% , respectively. The detection rate of cytological abnormality varied from country to county. Gujiao City （5.3%） had the highest proportion of cytological abnormality compared with other two counties （2.4% and 2.6% , respectively） , and the difference was of statistical significance （X2 = 36. 984, P = 0. 000）. Besides, Gujiao City （ 1.35% ） had the highest detection rate of cervical intraepithelial neoplasia （CIN） II or above compared with other two counties （0. 30% and 0.47% , respectively）. The difference was statistically significant （X2 = 23. 725, P = 0. 000）. Conclusion The detection rate of cervical lesions and cervical cancer varies from region to region. Sound quality control contributes to the increase of detection rate of cytological abnormality and precancerous lesions of uterine cervix.