CAJ | 학술논문

目的：探讨妇产科门诊宫颈病变筛查的意义及管理策略。方法选择2010年1月至2012年12月于大连医科大学附属第一医院妇产科门诊行宫颈薄层液基细胞学(TCT)检查的31372受检者中TCT 结果示意义不明的非典型鳞状细胞(ASC-US)及以上级别的1865例患者为研究对象。本研究遵循的程序符合大连医科大学附属第一医院人体试验委员会所制定的伦理学标准,得到该委员会批准,并征得受试对象本人的知情同意,与之签署临床研究知情同意书。对 TCT 结果为 ASC-US 及以上级别者经高危型人乳头状瘤病毒(HR-HPV)检测分流,对有宫颈癌高危因素者进行阴道镜或宫颈锥切术行活组织病理学检查。结果①2010-2012年接受 TCT 检查的患者数和异常宫颈涂片患者数均呈逐年增加趋势。②低度鳞状上皮内病变(LSIL)和高度鳞状上皮内病变(HSIL)患者的 HR-HPV(+)检出率较ASC-US患者明显升高,前二者分别与后者比较,差异有统计学意义(P <0.01),而 LSIL 与 HSIL 患者的 HR-HPV(+)检出率比较,差异无统计学意义(χ2=0.716,P >0.05)。③HR-HPV(+)患者的 CINⅡ及以上级别病变检出率随着 TCT 细胞学级别上升而增高,而 ASC-US,LSIL,HSIL 患者的该检出率分别为28.2%,38.2%,68.3%,三者间两两比较,差异均有统计学意义(P <0.01)。④ HR-HPV(+)患者的 CINⅡ及以上级别病变检出率显著高于 HR-HPV(-)患者,二者比较,差异有统计学意义(P <0.01),而 HR-HPV(-)患者与未检测 HPV 患者比较,差异也有统计学意义(P <0.01)。结论宫颈 TCT 检查结合 HR-H PV 基因检测是筛查早期宫颈病变的有效方法。建立、健全妇产科门诊宫颈病变筛查规范化流程,重视对 ASC-US 及以上级别患者的干预,以及 HR-HPV 检测在 ASC-US 中的分流作用,是门诊宫颈病变筛查的工作重点,可降低宫颈癌发生率。
목적：탐토부산과문진궁경병변사사적의의급관리책략。방법선택2010년1월지2012년12월우대련의과대학부속제일의원부산과문진행궁경박층액기세포학(TCT)검사적31372수검자중TCT 결과시의의불명적비전형린상세포(ASC-US)급이상급별적1865례환자위연구대상。본연구준순적정서부합대련의과대학부속제일의원인체시험위원회소제정적윤리학표준,득도해위원회비준,병정득수시대상본인적지정동의,여지첨서림상연구지정동의서。대 TCT 결과위 ASC-US 급이상급별자경고위형인유두상류병독(HR-HPV)검측분류,대유궁경암고위인소자진행음도경혹궁경추절술행활조직병이학검사。결과①2010-2012년접수 TCT 검사적환자수화이상궁경도편환자수균정축년증가추세。②저도린상상피내병변(LSIL)화고도린상상피내병변(HSIL)환자적 HR-HPV(+)검출솔교ASC-US환자명현승고,전이자분별여후자비교,차이유통계학의의(P <0.01),이 LSIL 여 HSIL 환자적 HR-HPV(+)검출솔비교,차이무통계학의의(χ2=0.716,P >0.05)。③HR-HPV(+)환자적 CINⅡ급이상급별병변검출솔수착 TCT 세포학급별상승이증고,이 ASC-US,LSIL,HSIL 환자적해검출솔분별위28.2%,38.2%,68.3%,삼자간량량비교,차이균유통계학의의(P <0.01)。④ HR-HPV(+)환자적 CINⅡ급이상급별병변검출솔현저고우 HR-HPV(-)환자,이자비교,차이유통계학의의(P <0.01),이 HR-HPV(-)환자여미검측 HPV 환자비교,차이야유통계학의의(P <0.01)。결론궁경 TCT 검사결합 HR-H PV 기인검측시사사조기궁경병변적유효방법。건립、건전부산과문진궁경병변사사규범화류정,중시대 ASC-US 급이상급별환자적간예,이급 HR-HPV 검측재 ASC-US 중적분류작용,시문진궁경병변사사적공작중점,가강저궁경암발생솔。
Objective To study the significance and management strategies of cervical lesion screening in obstetrics and gynecology outpatients.Methods From January 2010 to December 2012,the clinical data of 1 865 patients with atypical squamous cell of undetermined significance (ASC-US)and above lesions were included in the study.High risk human papillomavirus (HR-HPV)were detected in those patients.And electronic colposcope biopsy of the cervix or cervical conization were taken in patients with high risk factors. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of the First Affiliated Hospital of Dalian Medical University.Informed consent was obtained from each participants. Results ①The number of patients with TCT examination were increased from 2010 to 2012.Meanwhile the number of patients with abnormal cervical smears were also increased.②The incidence rate of HR-HPV(+) in patients with low-grade squamous intraepithelial lesion(LSIL)and high-grade squamous intraepithelial lesion(HSIL)were significantly higher than that of ASC-US patients respectively(P <0.01).But there was no significant difference in the incidence rate of HR-HPV(+)between LSIL and HSIL patients(P >0.05).③The detection rates of CINⅡand above lesions in ASC-US,LSIL and HSIL patients were 28.2%,38.2%, 68.3%,respectively,and significant differences were found among them (P < 0.01 ).④ There was significant differences in detection rates of CINⅡ and above lesions between HR-HPV(+)and HR-HPV (-)patients.The detection rates of CINⅡ and above lesions in patients with HR-HPV(-)was obviously higher than those of nondetected HPV patients(P <0.01).Conclusions Combination of TCT inspection of the cervix and HR-HPV detection are effective methods for cervical lesions screening.So establish and improve the standardization of outpatient cervical lesion screening process,pay more attention to HR-HPV detection in patients with ASC-US and above lesions,can reduce the incidence rate of invasive cervical cancer.