2018年至2021年郑州市宫颈癌筛查情况及发病趋势分析

Cervical cancer screening and incidence trend in Zhengzhou from 2018 to 2021

目的探讨郑州市女性生殖道微生态感染情况、宫颈癌初筛及宫颈病变发病率情况,分析趋势变化,为制定宫颈癌筛查方案提供理论依据。方法回顾性分析2018年至2021年郑州市30~64岁女性行常规妇科检查、宫颈脱落细胞学涂片巴氏染色及阴道镜和组织病理学检查结果,卡方检验对比分析组间差异。结果四年来郑州市女性下生殖道感染总阳性率为79.21%,市区每年总发病率呈下降趋势,而郊区明显升高;宫颈炎发病率最高(52.69%),再依次是细菌性阴道病(17.33%)、外阴阴道假丝酵母菌病(6.67%)和滴虫性阴道炎(2.50%),郊区发病率升高并逐渐高于市区(P<0.001)。宫颈细胞学初筛总阳性率为4.55%,非典型鳞状上皮细胞(ASCUS)阳性率最高为3.52%,再依次为低度鳞状上皮内病变(LSIL)0.62%、非典型鳞状上皮细胞-不除外高度鳞状上皮内病变(ASC-H)0.19%、高度鳞状上皮内病变(HSIL)及以上0.18%,鳞状细胞癌及不典型腺上皮细胞(AGC)及以上0.03%,且郊区明显高于市区(P<0.001)。宫颈活检上皮内病变和癌总发病率为41.64%,低级别病变28.20%,高级别病变12.43%,原位腺癌0.61%,微小浸润癌0.39%,浸润癌0.65%,早诊率高达95.42%,每年市区呈下降趋势,郊区呈升高趋势,每年各级病变郊区均显著高于市区(P<0.001)。结论宫颈癌筛查显著提高宫颈癌及癌前病变检出率和早诊率,而郊区发病率逐渐升高,需加强郊区宫颈癌防治各项措施。

【Objective】To explore the situation of female genital tract microecological infection,and the incidence of preliminary screening of cervical cancer and cervical lesions in Zhengzhou,analyzing the trend of change,so as to provide a theoretical basis for the development of cervical cancer screening.【Methods】Retrospective analysis was made on the results of routine gynecological examination,Pap staining of cervical exfoliative cytology smear,colposcopy and histopathology of 30–64 year old women in Zhengzhou from 2018 to 2021.Chi square test was used to compare and analyze the differences between groups.【Results】In the past four years,the total positive rate of female lower genital tract infection in Zhengzhou was 79.21%.The annual total incidence rate in urban areas showed a downward trend,while that in suburban areas increased significantly.The incidence of cervicitis was the highest(52.69%),followed by bacterial vaginosis(17.33%),vulvovaginal candidiasis(6.67%)and trichomonal vaginitis(2.50%).The incidence rate in suburbs was higher than that in urban areas(P<0.001).The total positive rate of cervical cytology was 4.55%.The highest positive rate of ASCUS was 3.52%,followed by LSIL 0.62%,ASC-H 0.19%,HSIL and above 0.18%,AGC and above 0.03%,and the positive rate in suburbs was significantly higher than that in urban areas(P<0.001).The total incidence of cervical intraepithelial lesions and cancers was 41.64%.low-grade lesions 28.20%,high-grade lesions 12.43%,adenocarcinoma in situ 0.61%,microinvasive carcinoma 0.39%,invasive carcinoma 0.65%,and the early diagnosis rate was as high as 95.42%.Every year,the urban area showed a downward trend while the suburban area showed an upward trend.Nearly every year,the lesions at all levels in suburban area were significantly higher than those in urban area(P<0.001).【Conclusion】Cervical cancer screening significantly improved the detection rate of cervical cancer and precancerous lesions and early diagnosis rate.The incidence rate in the suburbs gradually increased,so it is necessary to strengthen the prevention and treatment measures of cervical cancer in the suburbs.