未切除子宫者阴道上皮内瘤变与高危型HPV、液基细胞学及宫颈病变的相关性分析

Correlation of vaginal intraepithelial neoplasia with high-risk HPV, liquid-based cytology and cervical lesions in patients without hysterectomy

目的探讨未切除子宫者阴道上皮内瘤变(vaginal intraepithelial neoplasia, VaIN)的检出情况、与高危型人乳头瘤病毒(human papillomavirus, HPV)及宫颈病变的相关性、液基细胞学在筛查VaIN中的作用及改进建议。方法回顾性分析2019年6月至2020年7月于本科门诊行阴道镜检查的3 084例患者中未行子宫切除术的96例VaIN患者的临床资料,统计VaIN的检出率、发病年龄、高危型HPV的感染情况、与宫颈病变的关系及液基细胞学在VaIN中的预测价值。结果 VaIN的检出率为3.11%(96/3 084),96例中高级别VaIN者占24例(25.0%),低级别VaIN者占72例(75.0%)。感染两种及以上HPV高危亚型的患者发生高级别VaIN的机率较感染单一型别者高(P=0.019)。是否合并宫颈病变与是否存在阴道壁高级别病变无相关性(P=0.904),细胞学检查结果在高级别VaIN及低级别VaIN组间差异无统计学意义(P=0.264)。结论在未行子宫切除的人群中,感染两种及以上HPV高危亚型的患者发生高级别VaIN的概率升高。是否合并宫颈病变与阴道壁病变的病变级别无相关性。对VaIN高危人群,可有针对性地单独对阴道壁进行细胞学采样。

Objective To investigate the detection rate of vaginal intraepithelial neoplasia(VaIN) in women without hysterectomy, and explore its correlation with high-risk types of human papillomavirus(HPV) and cervical lesions, and the role and suggestions of liquid-based cytology in screening VaIN. Methods The clinical data of 96 VaIN patients who did not have hysterectomy history selected from 3 084 patients undergoing colposcopy in our department from June 2019 to July 2020 were collected and retrospectively analyzed. The detection rate, onset age, type of susceptible HPV, the relationship between HPV and cervical lesions and the predictive value of liquid-based cytology in VaIN were analyzed. Results The detection rate of VaIN in people without hysterectomy was 3.11%(96/3 084), in which, 24 cases(25.0%) of high-grade VaIN and 72 cases(75.0%) of low-grade VaIN were found. The patients infected with 2 or more high-risk HPV subtypes had a higher incidence of high-grade VaIN than those infected with only 1 type(P=0.019). There was no correlation between cervical intraepithelial neoplasia and the presence of high-grade vaginal intraepithelial neoplasia(P=0.904). No difference in cytological results was seen between high-grade and low-grade VaIN groups(P=0.264). Conclusion The patients without hysterectomy with the infection of 2 or more sub-types of high-risk HPV have a higher risk of high-grade VaIN compared to those infected by only 1 high-risk sub-type. There is no relationship between cervical lesions and different grades of VaIN. For the high-risk population of VaIN, cytological sampling of vaginal wall can be carried out separately and specifically.