阴道上皮内瘤变对宫颈上皮内瘤变发生情况的影响

Influence of Vaginal Intraepithelial Neoplasia on the Occurrence of Cervical Intraepithelial Neoplasia

目的:观察阴道上皮内瘤变患者宫颈上皮内瘤变发生情况及人乳头瘤病毒(HPV)感染情况,分析宫颈上皮内瘤变与阴道上皮内瘤变的相关性。方法:回顾性分析2020年1月-2022年1月于福建中医药大学附属康复医院妇产科门诊就诊并明确诊断为阴道上皮内瘤变患者104例作为研究对象,均接受阴道脱落细胞学、HPV感染检查、阴道镜检查组织病理学等。观察并记录所有患者阴道上皮内瘤变级别分布构成,比较不同病变级别的阴道上皮内瘤变患者宫颈上皮内瘤变各病变级别检出情况及HPV感染情况,经相关性分析检验宫颈上皮内瘤变与阴道上皮内瘤变的相关性。结果:104例阴道上皮内瘤变患者检出阴道上皮内瘤变Ⅰ级(VaINⅠ)、阴道上皮内瘤变Ⅱ级(VaINⅡ)、阴道上皮内瘤变Ⅲ级(VaINⅢ或原位癌)患者分别为36例(34.62%)、40例(38.46%)、28例(26.92%);104例阴道上皮内瘤变患者共检出80例宫颈上皮内瘤变,检出子宫颈癌18例,不同阴道上皮内瘤变分级患者子宫颈癌检出率与整体检出率差异有统计学意义(P<0.05);104例阴道上皮内瘤变患者中检出HPV感染100例,感染率为96.15%,其中VaINⅠ级HPV感染率最低,而VaINⅡ级与VaINⅢ级患者HPV感染率均为100%,不同阴道上皮内瘤变分级患者HPV感染率比较,差异有统计学意义(P<0.05)。经Kendall’s tau-b相关性分析证实,阴道上皮内瘤病变与宫颈上皮内瘤变间呈正相关(r=0.531,P<0.001)。结论:阴道上皮内瘤变患者可能合并宫颈上皮内瘤变甚至子宫颈癌,临床应重视二者间的相关性,同时进行诊断,以避免漏诊。

Objective:To observe the occurrence of cervical intraepithelial neoplasia and human papilloma virus(HPV)infection in patients with vaginal intraepithelial neoplasia,and to analyze the correlation between cervical intraepithelial neoplasia and vaginal intraepithelial neoplasia.Method:Retrospective analysis was made on 104 patients with vaginal intraepithelial neoplasia who were diagnosed in the Outpatient Department of Obstetrics and Gynecology of the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine from January 2020 to January 2022.All of them received vaginal exfoliation cytology,HPV infection examination,colposcopy histopathology,etc.Observed and recorded the distribution and composition of vaginal intraepithelial neoplasia grades in all patients,compared the detection of cervical intraepithelial neoplasia grades and HPV infection in patients with vaginal intraepithelial neoplasia of different lesion grades,and examined the correlation between cervical intraepithelial neoplasia and vaginal intraepithelial neoplasia through correlation analysis.Result:Vaginal intraepithelial neoplasia grade Ⅰ(VaIN Ⅰ),vaginal intraepithelial neoplasia grade Ⅱ(VaIN Ⅱ),and vaginal intraepithelial neoplasia grade Ⅲ(VaIN Ⅲ or carcinoma in situ)were detected in all 104patients with vaginal intraepithelial neoplasia,which were 36 cases(34.62%),40 cases(38.46%)and 28 cases(26.92%),respectively.A total of 80 cases of cervical intraepithelial neoplasia were detected in 104 cases of vaginal intraepithelial neoplasia,and 18 cases of cervical cancer were detected.The detection rate of cervical cancer in patients with different grades of vaginal intraepithelial neoplasia was different from the overall detection rate,with a statistical significant difference(P<0.05).HPV infection was detected in 100 of 104 patients with vaginal intraepithelial neoplasia,and the infection rate was 96.15%.Among them,the infection rate of VaIN Ⅰ was the lowest,while that of VaIN Ⅱ and VaIN Ⅲ was 100%.The infection rate of HPV in patients with different grades of vaginal intraepithelial neoplasia was statistically significant(P<0.05).Kendall’s tau-b correlation analysis confirmed that there was a positive correlation between vaginal intraepithelial neoplasia and cervical intraepithelial neoplasia(r=0.531,P<0.001).Conclusion:Patients with vaginal intraepithelial neoplasia may be complicated with cervical intraepithelial neoplasia or even cervical cancer.Clinical attention should be paid to the correlation between the two,and diagnosis should be made at the same time to avoid missed diagnosis.