宫颈病变的早期筛查及绝经妇女异常筛查结果的临床分析

Early screening for cervical lesions and clinical analysis of abnormal screening results in postmenopausal women

目的:初步探讨绝经妇女宫颈病变早期筛查的必要性和策略。方法:2015年1月至2017年12月间在我院接受宫颈液基薄层细胞学检查(TCT)者共计7 205例,高危型人乳头瘤病毒(HR-HPV)检测者2 999例。其中1 915例绝经妇女行TCT检查,1 095例同时行HR-HPV检测。103例绝经妇女进一步行阴道镜下宫颈多点活检。结果:绝经妇女TCT阳性率(5. 01%)显著低于育龄女性(6. 62%)。不同年龄组HR-HPV检测的阳性率有显著性差异。绝经妇女异常阴道流血和接触性出血的发生率显著低于育龄女性,宫颈光滑的比率显著高于育龄女性。TCT级别越高,高级别宫颈病变的检出率越高。TCT(-) HPV(+)组、TCT(+)HPV(-)组和TCT(+) HPV(+)组患者宫颈高级别病变的检出率分别为11. 8%(6/51)、33. 3%(6/18)和58. 8%(20/34),有显著性差异。结论:绝经妇女应定期行宫颈筛查以早期发现宫颈病变,宫颈TCT和HRHPV联合筛查适用于绝经妇女。

Objective： To investigate the necessities and strategies of early screening for cervical lesions among postmenopausal women. Methods： Thinprep cytology test（ TCT） in 7 205 women was done in our hospital from January 2015 to December 2017. High-risk human papillomavirus（ HR-HPV） test was done in 2 999 women.Among all these persons,there were 1 915 postmenopausal women who were given TCT. 1 095 cases received both TCT and HR-HPV test. The cervical multi-point biopsy under colposcopy was performed in 103 patients for further test. Results： The positive rate of TCT was significantly lower in postmenopausal group than that in premenopausal group（ 5. 01% vs 6. 62%）. There were significant differences of HR-HPV infection rates among different age groups. Postmenopausal women were less likely to have vaginal bleeding or cervical contactive bleeding and were more likely to have smooth cervical appearance than premenopausal women. The detection rate of high-grade cervical lesion increased with the severity of TCT. In TCT（-） HPV（ ＋） group,TCT（ ＋） HPV（-） group and TCT（ ＋） HPV（ ＋） group,the detection rate of high-grade cervical lesion was 11. 8%（ 6/51）,33. 3%（ 6/18）and 58. 8%（ 20/34） respectively,with significant difference. Conclusion： It is important for postmenopausal women to receive regular cervical screening for early diagnosis. Co-test of TCT and HR-HPV is appropriate for postmenopausal women.