石河子地区1080例TCT和HPV双筛异常阴道镜活检患者宫颈病变特点

Characteristics of cervical lesions in 1080 patients with abnormal colposcopic biopsies of TCT and HPV double screening in Shihezi region

目的探讨近两年新疆石河子地区女性患者宫颈病变特点,为临床工作和当地宫颈癌筛查提供指导。方法回顾性分析2017年5月至2019年3月在石河子大学医学院第一附属医院妇科门诊行人乳头瘤病毒(HPV)和子宫颈脱落细胞检查(TCT)双筛异常,行阴道镜子宫颈组织活检的1080例患者的临床病理资料及其特点,logistic回归分析宫颈病变的影响因素。结果(1)未接受过学校教育(OR=2.267),有阴道不规则出血(OR=3.275)和性伴侣个数≥3个(OR=3.052)是发生宫颈病变的独立危险因素。(2)上皮内瘤变(CIN)在30~39岁组检出率最高(57.54%),子宫颈癌在≥60岁组检出率最高(14.15%),其次是40~49岁年龄组(2.20%)。(3)40~49岁年龄组HPV阳性构成比和高危HPV16/18阳性率均最高,分别是33.18%和39.38%。不同年龄组间HPV病毒载量差异无统计学意义(均P>0.05)。(4)HPV16/18阳性组CIN3和子宫颈癌的检出率均高于HPV其他亚型且TCT≥不典型鳞状上皮细胞(ASC-US)组(18.34%vs 11.33%,4.30%vs 1.82%,均P<0.05)。高载量组≥CIN2的检出率(28.44%)高于中载量组(25.32%)和低载量组(15.79%),三组间比较差异有统计学意义(P<0.05)。(5)TCT为ASC-US且HPV阳性人群中,HPV16/18阳性组CIN3的检出率显著高于HPV其他亚型阳性组(21.43%vs 8.33%,P<0.05)。结论石河子地区宫颈癌筛查时应对老年女性、未接受过学校教育人群提高宣传力度,加强健康知识宣教。石河子地区CIN和宫颈癌变者与高危型HPV感染密切相关,尤其是HPV16/18感染。HPV阳性年龄主要集中在40~49岁年龄组,CIN和宫颈癌分别在30~39岁和≥60岁年龄组检出率最高。HPV16/18分型和高病毒载量人群≥CIN2检出率高于HPV其他亚型阳性和中低载量人群。如何有效分流HPV阳性且TCT≥ASC-US人群,有待于进一步研究。

Objective To explore the characteristics of cervical lesions in female patients in the Shihezi region of Xinjiang in the past two years and provide guidance for clinical work and local cervical cancer screening.Methods The clinicopathological data and characteristics of 1080 patients with abnormal double screening of human papilloma virus(HPV)and cervical exfoliative cell test(TCT)and vaginal mirror cervical tissue biopsy in the gynecology department of the First Affiliated Hospital of Medical College of Shihezi University from May 2017 to March 2019 were analyzed retrospectively.The influencing factors of cervical lesions were analyzed by logistic regression.Results(1)Uneducated[odds ratio(OR)=2.267],irregular vaginal bleeding(OR=3.275)and number of sexual partners≥3(OR=3.052)were independent risk factors for cervical lesions.(2)Cervical intraepithelial neoplasia(CIN)was detected most frequently in the 30-39 age group(57.54%),and cervical cancer was detected most frequently in the≥60 age group(14.15%),followed by the 40-49 age group(2.20%).(3)The proportion of HPV positive and the positive rate of high-risk HPV16/18 in the 40-49 age group were the highest,33.18%and 39.38%respectively.There was no statistically significant difference in HPV viral load between the different age groups(P>0.05).(4)The detection rates of CIN3 and cervical cancer were higher in the HPV16/18-positive group than in the HPV-positive and TCT≥atypical squamous epithelial cells of undermined significance(ASC-US)group(18.34%vs 11.33%,4.30%vs 1.82%),with statistically significant difference(all P<0.05),respectively.The detection rate of CIN2 was higher in the high-load group(28.44%)than in the medium-load group(25.32%)and the low load group(15.79%).(5)The detection rate of CIN3 in the HPV-positive TCT for the ASC-US populations was significantly higher in the HPV16/18-positive group than in the other subtypes of HPV-positive group(21.43%vs 8.33%,P<0.05).Conclusions During cervical cancer screening in Shihezi region,we should strengthen the publicity of elderly women and uneducated people.CIN and cervical carcinoma in Shihezi region are closely associated with high-risk HPV infection,especially HPV16/18 infection.HPV-positive age is mainly concentrated in the age group of 40-49 years,and the detection rate of CIN and cervical cancer is the highest in the age group of 30-39 years and≥60 years,respectively.The detection rate of≥CIN2 in HPV16/18 fraction and high viral load population is higher than that of other HPV subtypes positive and low to medium load populations.How to effectively shunt HPV positive TCT is an important problem in ASC-US population,which needs further research.