山西省襄垣县2009～2015年农村女性宫颈癌筛查项目结果分析

Results of Cervical Cancer Screening Program for Rural Women in Xiangyuan County During 2009 to 2015

[目的]通过分析襄垣县2009~2015年农村妇女宫颈癌筛查结果,为国家宫颈癌筛查项目的评价和优化提供理论依据。[方法]对襄垣县35~64岁妇女开展宫颈癌筛查。2009~2013年采用醋酸/碘染色后肉眼观察(VIA/VILI),2014年开始部分引入人乳头状瘤病毒(HPV)检测,2015年又引入新柏氏液基细胞学(TCT)检测,根据卫生资源情况在不同人群中分别使用三种方法。任意筛查结果阳性者转诊阴道镜,镜下有病变时取活检,以病理诊断为金标准。通过评价不同方法对宫颈上皮内瘤变(CIN)2级及以上病变的检出率评价不同方法对宫颈癌的筛查效果。[结果]2009~2015年共筛查62 618名女性,其中CIN2级及以上(CIN2+)病变的患病率为0.76%,早诊率为90.53%,下生殖道感染率为25.68%,其中滴虫性阴道炎、细菌性阴道炎和宫颈炎与HPV感染相关。根据2014及2015年数据,VIA/VILI的CIN2+病变检出率为0.74%,TCT的病变检出率为0.70%,两者相似,但均低于HPV检测,其病变检出率为1.37%。[结论 ]HPV检测是首选的宫颈癌初筛方法 ,在资源匮乏地区,培训合格的基层医生使用VIA/VILI或TCT方法对适龄妇女开展宫颈癌筛查是有效的备选方案。

[Purpose ] To analyze the results of Cervical Cancer Screening Program tbr Rural Wom- en in Xiangyuan county,Shanxi province during 2009 to 2015. [Methods] According to the proto- col of the National Cervical Cancer Screening Program in Rural China, women aged 35 to 64 in Xiangyuan county were recruited for screening. Visual inspection with acetic acid and Lugol＇s io- dine（VIA/VILI） was used in 2009 to 2013,human papillomavirus（HPV） DNA test was introduced in 2014 and then thin-Prep cytology（TCT） was introduced in 2015. Colposcopic examination was per- formed if the result was positive. Cervical lesions were diagnosed by direct biopsy under the eol- poscopy,and the pathological diagnosis was used for gold standard. The screening effectiveness was evaluated by the detection rates of cervical intraepithelial neoplasia degree 2 or above（CIN2＋）. [Results] Total 62 618 women in Xiangyuan county underwent screening during 2009 to 2015 ,the detection rate of CIN2＋ was 0.76% with an early detection rate of 90.53% ,and lower reproductive tract infection rate was 25.68%. Trichomonas vaginitis,baeterial vaginosis and cervieitis were associated with HPV infection. According to the data of 2014 and 2015 ,the CIN2＋ detection rate of VIA/VILI was 0.74%,and that of TCT was 0.70%. CIN2＋ detection rate of HPV DNA was 1.37%, which was significantly higher than those of VIA/VILI or TCT. [Conclusion] HPV test should be a top priority for cervical cancer preliminary screening as a more objective method. In resource-lim- ited rural areas,VIA/VILI and TCT are alternative screening methods for eligible women when used by trained primary care doctors.