高危型HPV感染患者轻微细胞学异常发生高级别子宫颈病变的临床分析

Clinical Analysis of High-grade Cervical Lesions in Patients with High-risk HPV Infection Exhibiting Minor Cytological Abnormalities

目的:分析高危型人乳头瘤病毒(Hr-HPV)感染患者中,轻微细胞学异常发生高级别子宫颈病变的即时风险和5年累计风险,同时验证2019年美国阴道镜和子宫颈病理学会指南的临床处理策略的本地适用性。方法:选择2017年2~11月在北京协和医院妇科门诊经Hr-HPV检测阳性,细胞学为无明确诊断意义的不典型鳞状细胞(ASC-US)或低级别鳞状上皮内病变(LSIL),并行阴道镜检查及活检的患者共565例进行高级别子宫颈病变[子宫颈上皮内瘤变(CIN)2^(+)]即时风险研究;对组织学为CIN1及以下且有5年随访数据的193例患者进行高级别子宫颈病变的5年累计风险研究。结果:①565例患者中,CIN2^(+)和CIN3^(+)的即时发生率分别为32.21%和12.39%。多因素Logistic回归分析表明,LSIL(35.54%)发生CIN2^(+)的即时风险为ASC-US(28.78%)的1.62倍(95%CI 1.12~2.36,P<0.05);HPV 16/18阳性(45.29%)发生CIN2^(+)的即时风险是Hr-HPV其他型阳性(23.68%)的2.89倍(95%CI 1.99~4.20,P<0.05)。②5年长期随访的193例患者中,CIN2^(+)和CIN3^(+)的5年累计发生率分别为6.2%和2.6%。Cox回归分析显示,不同的年龄、Hr-HPV感染类型和细胞学结果发生CIN2^(+)和CIN3^(+)的5年累计风险差异均无统计意义(P>0.05)。结论:LSIL较ASC-US患者仅在首次阴道镜活检CIN2^(+)病灶检出率更高;感染HPV 16/18患者发生高级别病变的即时风险显著高于Hr-HPV其他型患者,但阴道镜后的5年长期风险无显著性差异;年龄不是发生高级别病变风险的危险因素。

Objective:To analyze the immediate risk and 5-year cumulative risk of high-grade cervical lesions in high-risk human papillomavirus(Hr-HPV)positive patients with minor cytological abnormalities and to validate the local applicability of clinical management strategies in the 2019 American Society for Colposcopy and Cervical Pathology Guidelines.Methods:A total of 565 patients with positive Hr-HPV,cytology result of atypical squamous cells of undetermined significance(ASC-US)or low-grade squamous intraepithelial lesion(LSIL)and also underwent colposcopy and biopsy were selected from the gynecological clinic of Peking Union Medical College Hospital from February 2017 to November to analyze the immediate risk of high-grade cervical lesions(CIN2 and above).Besides,a total of 193 patients with histological results of CIN1 or below and 5-year follow-up data available were further analyzed for the 5-year cumulative risk of high-grade cervical lesions.Results:①In the 565 patients,the immediate incidence of CIN2^(+)and CIN3^(+)was 32.21%and 12.39%,respectively.Multivariate Logistic regression showed that the immediate risk of CIN2^(+)in the LSIL group(35.54%)was 1.62 times that in the ASC-US group(28.78%)(95%CI 1.12-2.36,P<0.05);the immediate risk of CIN2^(+)in HPV 16/18^(+)group(45.29%)was 2.89 times that in Hr-HPV other^(+)group(23.68%)(95%CI 1.99-4.20,P<0.05).②Among 193 patients with 5-year long-term follow-up,the 5-year cumulative incidence of CIN2^(+)and CIN3^(+)was 6.2%and 2.6%,respectively.Cox regression analysis results showed that there were no statistically significant differences in 5-year cumulative risk of CIN2^(+)and CIN3^(+)among different ages,Hr-HPV infection types and cytological results(P>0.05).Conclusions:LSIL had a higher detection rate of CIN2^(+)than ASC-US patients only in the first colposcopy biopsy;the immediate risk of high-grade cervical lesion was significantly higher in HPV16/18^(+)patients than in Hr-HPV other+patients,but no significant difference in the 5-year cumulative incidence of high-grade lesions after colposcopy was found.Age was not an independent risk factor for the development of high-grade lesions.