子宫颈1级阴道镜异常表现中检出CINⅡ+的影响因素分析

Analysis of related factors for cervical intraepithelial neoplasiaⅡ+detection in grade 1 abnormal colposcopic finding of cervix

目的通过分析子宫颈1级阴道镜异常表现(G1)中检出子宫颈上皮内瘤变(CIN)Ⅱ及以上病变(CINⅡ+)的相关影响因素,筛选出存在CINⅡ+的高风险因素,为阴道镜检查的个体化管理提供参考依据。方法回顾性分析2017年4月至2021年1月在南京医科大学第一附属医院因子宫颈癌联合筛查(指高危型HPV检测联合细胞学检查)阳性转诊阴道镜检查患者的临床和阴道镜检查资料,将阴道镜仅表现为G1的患者纳入本研究。对影响G1中检出CINⅡ+的相关因素进行单因素和多因素分析。结果(1)本研究共纳入403例阴道镜仅表现为G1的患者,其中位年龄为38岁(范围:22~67岁)。403例G1患者中,检出CINⅡ+110例,检出率为27.3%(110/403);其中高级别鳞状上皮内病变108例、原位腺癌1例、普通型子宫颈内膜腺癌1例。(2)单因素分析显示,G1中CINⅡ+的检出率,年龄≥50岁患者显著高于<50岁者(分别为38.3%、25.4%;χ^(2)=4.328,P=0.037),HPV 16型阳性患者显著高于非HPV 16型阳性者(分别为41.8%、21.8%;χ^(2)=16.080,P<0.01);CINⅡ+检出率随着子宫颈细胞学结果严重程度的增加(χ^(2)趋势=6.775,P=0.009)和G1累及象限数的增多而显著增高(χ^(2)趋势=31.117,P<0.01);而不同图像特征(包括薄醋酸白色上皮、细镶嵌、细点状血管)的G1中CINⅡ+检出率比较,差异无统计学意义(χ^(2)=0.323,P=0.851)。多因素分析显示,年龄≥50岁(OR=2.504,95%CI为1.299~4.830,P=0.006)、HPV 16型阳性(OR=3.353,95%CI为2.004~5.608,P<0.01)及G1累及象限数增多(OR=1.899,95%CI为1.518~2.376,P<0.01)是影响G1中检出CINⅡ+的独立因素。(3)综合分析显示,HPV 16型阳性、G1累及4个象限时,G1中CINⅡ+的检出率(73.7%)最高;非HPV 16型阳性、G1仅累及1个象限时,G1中CINⅡ+的检出率(10.4%)最低。结论年龄≥50岁、HPV 16型阳性及G1累及象限数增多是G1中检出CINⅡ+的独立因素。实施G1中不同风险人群的个体化管理,其重点是对存在高风险因素的G1患者进行充分活检,可避免CINⅡ+的漏检。

Objective To screen out high risk factors of cervical intraepithelial neoplasia(CIN)of gradeⅡor worse(CINⅡ+)by analyzing related factors for CINⅡ+detection in grade 1 abnormal colposcopic finding(G1)of cervix and provide reference for individual management of colposcopic performance.Methods A retrospective study was performed on patients who were reffered to colposcopy for abnormal results of cervical cancer screening and only had G1 colposcopic findings of cervix at the First Affiliated Hospital of Nanjing Medical University,from April 2017 to January 2021.The factors influencing the detection of CINⅡ+were analyzed by univariate and multivariate analysis.Results(1)A total of 403 patients were included in this study whose median age was 38 years old(range:22-67 years old),and utimately 108 had high-grade squamous intraepithelial lesion,1 had adenocarcinoma in situ and 1 had adenocarcinoma.The overall detection rate of CINⅡ+was 27.3%(110/403).(2)Univariate analysis showed that the detection rate of CINⅡ+,in patients≥50 years old was higher than that in patients<50 years old(38.3%vs 25.4%;χ^(2)=4.328,P=0.037),and in HPV 16 positive cases was higher than that in non-HPV 16 positive cases(41.8%vs 21.8%;χ^(2)=16.080,P<0.01);as the cytological severity(χ^(2)=6.775,P=0.009)and the number of involving quadrants(χ^(2)=31.117,P<0.01)increased,the risk of CINⅡ+detection increased;but the types of colpolscopic signs were not related to detection of CINⅡ+(χ^(2)=0.323,P=0.851).Multivariable analysis showed that the age of≥50 years old(OR=2.504,95%CI:1.299-4.830,P=0.006),HPV 16 positive type(OR=3.353,95%CI:2.004-5.608,P<0.01)and the increase of involving quadrants(OR=1.899,95%CI:1.518-2.376,P<0.01)were independent risk factors.(3)The detection rate of CINⅡ+was highest in the women with HPV 16 positive type and four quadrants of G1(73.7%),while lowest in the women with non-HPV 16 positive type and one quadrant of G1(10.4%).Conclusions The age of≥50 years old,HPV 16 positive type and the increase of involving quadrants are independent risk factors of detecting CINⅡ+in G1 colposcopic findings.So the key point of the individual management of G1 groups with different risk stratification is to adequately biopsy in high-risk group to avoid miss diagnosis of CINⅡ+.