322例高危人群宫颈癌检查后的随访研究

Follow-up study of 322 high-risk women after cervical cancer screening

目的探索宫颈癌高危人群随访的必要性和方法。方法选择2016年1月至6月在山西省古交市、北京市密云县和河北省曲周县参加2014年政府免费宫颈癌检查的425名宫颈上皮内瘤病变(CINⅠ)及以下的高危人群进行随访,共计召回合格病例322例,实际随访率为75.76%。对于所有研究对象进行HPV分型检测和宫颈细胞学检查,任一阳性病例进行阴道镜检查,必要时活检,所有检查结果填写到问卷中。结果研究对象的平均年龄48.6±8.2岁(30~69岁),高危型HPV感染共计110例,检出率为34.16%。细胞学异常病例检出率为5.90%(19/322),采用HPV和细胞学的联合筛查检出CINⅡ及以上病例9例,检出率为2.80%(9/322),CINⅡ及以上病例中HPV高危阳性的比例明显高于HPV阴性的比例(χ2=12.089,P<0.05)。结论宫颈癌高危人群感染以单一感染为主,其宫颈病变的检出率明显高于普通人群,对其进行随访十分必要,并建议采用HPV+细胞学联合筛查进行随访。

Objective To explore the necessity and methods of follow-up for cervical cancer high-risk women. Methods From January to June 2016, 425 women participating free cervical cancer screening progarmme in 2014 were selected from Gujiao county in Shanxi Province, Miyun county in Beijing and Quzhou county in Hebei Province for follow-up. They were high-risk population diagnosed with CIN Ⅰ or below. Totally 322 qualified cases were recalled, and the actual follow-up rate was 75.76%. All the subjects received HPV and cytology test. If any of the tests was positive, they should get colposcopy and biopsy in necessity. All results were kept down in questionnaires. Results The average age was 48.6±8.2 years old （30 69 years old）, and 110 cases were HR-HPV positive with detective rate of 34.16%. The cytology abnormal detective rate was 5.90% （19/322）. The detective rate of CIN II or above was 2.80 G （9/322）by using HPV combining cytology testing. The percent of high-risk HPV positive in the cases of CIN Ⅱ or above was higher than that of HPV negative（χ2= 12.089,P〈0.05）. Conclusion Cervical cancer high-risk women are mainly single HPV gynotype infection, and the detective rate of cervical lesion is higher than that of common people obviously. It is necessary to follow up for these high-risk women and HPV combined with cytology testing is recommended.