筛查细胞学高级别鳞状上皮内病变合并人乳头瘤病毒16/18阳性即查即治效果分析

Analysis of effect of detection and immediate treatment for patients suffering from high-grade squamous intraepithelial lesions combined with human papilloma virus 16/18 positive based on screening cytology

目的探讨宫颈细胞学筛查结果为高级别鳞状上皮内病变合并人乳头瘤病毒16/18型阳性患者诊治一体化策略效果。方法回顾性分析2021年1月—2023年10月本院收治的宫颈细胞学筛查结果为宫颈细胞学高级别异常(ASC-H、HSIL)且年龄为25~65岁的120例患者的临床资料,依据宫颈细胞学筛查结果将120例患者分为A组(宫颈细胞学筛查结果为ASC-H,56例)和B组(宫颈细胞学筛查结果为HSIL,64例)两组。对所有患者进行人乳头瘤核酸检测及阴道镜宫颈组织病理学活检。分析所有患者HPV感染情况分布、阴道镜宫颈组织病理学活检分布。结果A组和B组HPV筛查结果分布有统计学差异(P<0.05);组织病理学结果为HSIL(≥CINⅡ)、HSIL(≥CINⅢ)检出率在宫颈HPV检测结果为HPV阴性、非16/18高危型HPV阳性、HPV16/18阳性中逐步提高,差异有显著统计学意义(P<0.001)。两组组织病理学活检结果分布有统计学差异(P<0.05),其中组织病理学结果为LSIL(≤CINⅠ)A组显著高于B组;组织病理学结果为HSIL(≥CINⅡ)、HSIL(≥CINⅢ)A组显著低于B组(P<0.001)。两组HR-HPV阳性组织病理学分布有统计学差异(P<0.05)。其中B组HPV16/18阳性组织病理学结果为HSIL(≥CINⅡ)、HSIL(≥CINⅢ)检出率均高于相应对照组,差异有统计学意义(P<0.05)。结论对25岁至65岁无生育要求初筛宫颈细胞学为高级别鳞状上皮内病变且人乳头瘤病毒16/18型阳性患者,实施诊治一体化策略是可行的。

Objective To explore the effectiveness of the integrated diagnosis and treatment strategy for patients suffering from high-grade squamous intraepithelial lesions combined with human papilloma virus 16/18 positive based on cervical cytology screening results.Methods A retrospective analysis was conducted on the clinical data of 120 patients with high-grade cervical cytology abnormalities(ASC-H,HSIL)and aged between 25 and 65 years,who were admitted to our hospital from January 2021 to October 2023.Patients were divided into Group A(56 cases with ASC-H on cervical cytology)and Group B(64 cases with HSIL on cervical cytology).HPV nucleic acid testing and cervical tissue pathological biopsy under colposcopy were performed on all patients.The distribution of HPV infection and cervical tissue pathological biopsy under colposcopy was analyzed.Results There was a statistical difference in HPV screening results between Group A and Group B(P<0.05).The detection rate of HSIL(≥CINⅡ)and HSIL(≥CINⅢ)increased progressively among HPV-negative,non-16/18 high-risk HPV-positive,and HPV 16/18-positive groups,with significant statistical differences(P<0.001).The distribution of histopathological biopsy results between the two groups showed statistical differences(P<0.05),with Group A having a significantly higher proportion of LSIL(≤CIN I)and a significantly lower proportion of HSIL(≥CINⅡ)and HSIL(≥CINⅢ)compared to Group B(P<0.001).There was also a statistically significant difference in the histopathological distribution of HR-HPV positivity between the two groups(P<0.05).Group B had higher detection rates of HSIL(≥CINⅡ)and HSIL(≥CIN III)in HPV 16/18-positive cases,with statistically significant differences(P<0.05).Conclusions It is feasible to implement an integrated diagnosis and treatment strategy for patients aged 25 to 65 with no fertility requirements and initially screened for high-grade squamous intraepithelial lesions with HPV 16/18 positive.