CAJ | 학술논문

目的：探讨宫颈非典型鳞状上皮-不除外高度病变(atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion，ASC-H)的妇女进行反馈性HPV(human papilloma virus. HPV)检查的临床意义。方法：回顾性分析2012年6月至2014年6月的197例ASC-H患者的反馈性HPV和病理组织学检查结果。结果：收取我院2012年6月至2014年6月我院所有宫颈细胞学检查诊断为ASC-H患者共197例，并有反馈性HPV检测和宫颈组织学检查结果共有124例；均为女性，年龄25~63岁，平均年龄约46岁；临床以宫颈糜烂、同房后出血、体检等方式就诊。其中HPV阳性患者共92例，组织病理学检查结果为炎症及正常的22例，约占23.91%，低级别子宫颈上皮内瘤变15例，约占16.3%，高级别子宫颈上皮内瘤变45例，癌10例，约占59.78%；HPV阴性患者共32例，其中组织病理学检查结果为炎症及正常的23例，约占71.88%，低级别子宫颈上皮内瘤变(CINI)8例，约占25%，高级别子宫颈上皮内瘤变(CINII)1例，约占3.12%，CINIII及鳞癌均未检出。由此可见HPV检测对宫颈高级别上皮内病变及癌有较高的预测值，HPV阳性的ASC-H患者发生高级别宫颈上皮内病变和宫颈癌的风险高于HPV阴性组(P<0.05)，差异有统计学意义。结论：对所有宫颈细胞学ASC-H患者进行反馈性HPV检测是非常有益的，有助于为患者提供合理的、个性化的治疗方案，避免过度检查及过度治疗，降低患者的焦虑感。
목적：탐토궁경비전형린상상피-불제외고도병변(atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion，ASC-H)적부녀진행반궤성HPV(human papilloma virus. HPV)검사적림상의의。방법：회고성분석2012년6월지2014년6월적197례ASC-H환자적반궤성HPV화병리조직학검사결과。결과：수취아원2012년6월지2014년6월아원소유궁경세포학검사진단위ASC-H환자공197례，병유반궤성HPV검측화궁경조직학검사결과공유124례；균위녀성，년령25~63세，평균년령약46세；림상이궁경미란、동방후출혈、체검등방식취진。기중HPV양성환자공92례，조직병이학검사결과위염증급정상적22례，약점23.91%，저급별자궁경상피내류변15례，약점16.3%，고급별자궁경상피내류변45례，암10례，약점59.78%；HPV음성환자공32례，기중조직병이학검사결과위염증급정상적23례，약점71.88%，저급별자궁경상피내류변(CINI)8례，약점25%，고급별자궁경상피내류변(CINII)1례，약점3.12%，CINIII급린암균미검출。유차가견HPV검측대궁경고급별상피내병변급암유교고적예측치，HPV양성적ASC-H환자발생고급별궁경상피내병변화궁경암적풍험고우HPV음성조(P<0.05)，차이유통계학의의。결론：대소유궁경세포학ASC-H환자진행반궤성HPV검측시비상유익적，유조우위환자제공합리적、개성화적치료방안，피면과도검사급과도치료，강저환자적초필감。
Objective: To discuss the clinical significance of HPV (human papilloma virus)-detection in women with cervical ASC-H (atypical squamous cell cannotexclude high-grade squamous intraepithelial lesion). Methods: Retrospective analysis of the HPV-feedback test and histopathological findings in 197 cases of patients with ASC-H from June 2012 to June 2014. Results: Collected 197 cases of ASC-H patients diagnosed through cervical cytology in our hospital from June 2012 to June 2014. 124 cases gave the feedback tests of HPV and cervical tissue examination results, who were female, aged 25-63 years, with an average age of about 46 years old;clinical manifestations include cervical erosion,the real bleeding,physical examinations and others. 92 cases with the HPV positive, including histopathological findings as inflammation and 22 normal cases,accounting for about 23.91%, 15 cases with the low level of cervical intraepithelial neoplasia (CINI) ,accounting for about 16.3% , 45 cases with advanced differentiation of cervical intraepithelial neoplasia (cervical intraepithelial neopsia. CINII/CINIII), 10 cases with carcinoma, accounted for 59.78%, 32 cases of HPV negative, including histopathological findings as inflammation and 23 cases of normal, accounting for about 71.88%,8 cases with the low level of cervical intraepithelial neoplasia (CINI),accounting for about 25%,1 case with advanced differentiation of cervical intraepithelial neoplasia (CINII), accounting for about 3.12%, CINIII and squamous cell carcinoma were detected negatively. Thus the HPV detection has higher predictive value for lesions in high grade cervical intraepithelial cancer , risk of high-grade cervical intraepithelial lesion in HPV positive ASC-H patients were higher than the negative group (P< 0.05). Conclusion HPV feedback inspection in all ASC-H patients is very useful. Treatments could be provided more reasonable and personalized, while excessive examinations and treatments could be avoided and the patients'anxiety could be reduced to some extent.