山西省农村女性高级别宫颈病变独立危险因素分析

Analysis of independent risk factors for high-grade cervical lesions in rural women in Shanxi Province

目的 分析山西省农村女性宫颈上皮内瘤变(CIN)≥Ⅱ级(CINⅡ+)的独立危险因素,为精准化子宫颈癌筛查提供依据。方法 回顾性分析山西省农村地区2014-2019年宫颈癌筛查项目数据库数据资料,计算CINⅡ+宫颈病变检出率,logistic回归分析CINⅡ+宫颈病变的独立危险因素。结果 纳入的111 353名35~64岁女性中CINⅡ+宫颈病变1 006例(0.90%),其中84例(0.08%)为侵袭性宫颈癌。CINⅡ+宫颈病变的独立危险因素为年龄、筛查史、地域、检测年份、合并外生殖器尖锐湿疣、黏液脓性宫颈炎和其他妇科良性疾病,均P<0.05。年龄≥60岁与年龄<60岁相比,CINⅡ+宫颈病变风险增加53%(OR=1.53,95%CI:1.25~1.89);与<3年接受筛查相比,从未接受过筛查的风险增加47%(OR=1.47,95%CI:1.26~1.71),合并外生殖器尖锐湿疣、黏液脓性宫颈炎或其他妇科良性疾病患者的CINⅡ+风险分别增加9.28(OR=10.28,95%CI:1.31~80.60)、0.78(OR=1.78,95%CI:1.38~2.30)和0.94倍(OR=1.94,95%CI:1.41~2.67)。结论 山西省农村女性CINⅡ+宫颈病变发生率高,尤其应重视≥60岁、从未接受筛查以及合并外生殖器尖锐湿疣、黏液脓性宫颈炎或其他妇科良性疾病的女性筛查。

Objective To investigate the independent risk factors of cervical intraepithelial neoplasm Ⅱ(CIN Ⅱ) and severer lesions than CIN Ⅱ(CIN Ⅱ+) in rural women of Shanxi Province, providing basis for cervical accurate cancer screening.Methods The data from cervical cancer screening project database in rural areas of Shanxi Province from 2014 to 2019 were retrospectively analyzed, the detection rate of CIN Ⅱ+ cervical lesions was calculated, and the independent risk factors of CIN Ⅱ+ cervical lesions were identified by logistic regression.Results Among 111 353 women aged 35-64 years, 1 006 women had a CIN Ⅱ+ cervical lesion(0.90%),of which 84 cases(0.08%) were invasive cervical cancer.The independent risk factors for CIN Ⅱ+ cervical lesions were age, screening history, region, year of screening, and combined external genital condyloma, mucopurulent cervicitis or other benign gynecological diseases(P<0.05).Compared with those under 60,the risk of CIN Ⅱ+ cervical lesions in people aged 60 and over increased by 53%(OR=1.53,95%CI:1.25-1.89);Compared with screening within 3 years, the risk of never receiving screening increased by 47%(OR=1.47,95%CI:1.26-1.71),and the risk of CIN Ⅱ+ in patients with external genital condyloma acuminatum, mucopurulent cervicitis or other benign gynecological diseases increased by 9.28times(OR=10.28,95%CI:1.31-80.60),0.78times(OR=1.78,95%CI:1.38-2.30)or 0.94times,respectively(OR=1.94,95%CI:1.41-2.67).Conlusions The incidence of CIN Ⅱ + cervical lesions in rural women in Shanxi Province is high.Special attention should be paid to the screening of women aged 60and over who have never been screened and who are complicated with external genital condyloma acuminatum,mucopurulent cervicitis or other benign gynecological diseases.