611例高危型人乳头瘤病毒感染转诊阴道镜患者的病理结果数据分析

Analysis of Pathological Results in 611 Referral Patients with High-Risk Human Papillomavirus Infection Undergoing Colposcopy

摘要: 目的：通过分析高危型人乳头瘤病毒感染转诊阴道镜患者的检查结果，为临床提供依据。方法：选取2019年9月至2020年11月贵阳市妇幼保健院宫颈癌筛查为HR-HPV感染并转诊阴道镜行组织活检的611例女性患者，收集年龄、TCT、HPV及阴道镜下活检病理结果进行统计学分析。结果：HPV16/18阳性患者中，TCT(−)与TCT(+)相比较，宫颈LSIL−、HSIL+占比差异均俱有统计学意义(P < 0.05)；其它16型HR-HPV阳性中，TCT(−)与TCT(+)患者中，宫颈LSIL−、HSIL+占比差异均具有统计学意义(P < 0.05)；HR-HPV16/18型感染患者中宫颈HISL+检出率高于其他16型HR-HPV感染患者，有统计学意义(P < 0.05)。将HR-HPV阳性者按照≤30、31~40、41~50、51~60、>60岁进行分组，各年龄组间HSIL差异无统计学意义(P > 0.05)。各年龄组间宫颈癌占比差异有统计学意义(χ² = 45.133, P < 0.05)。不同程度细胞学异常中宫颈活检为HSIL+的检出率差异有统计学意义(χ² = 92.384, P < 0.05)。结论：1) 本中心宫颈HR-HPV阳性并转诊阴道镜患者中，合并TCT阳性转阴道镜者HSIL+病检检出率高；TCT阴性转诊阴道镜者可检出宫颈病变，行HR-HPV、TCT联合阴道镜检查提高宫颈病变检出率，并需长期规范管理该类人群。2) 宫颈癌的发生率随着年龄的增长呈明显上升趋势，60岁以上人群检出率最高，60岁后宫颈高级别病变检出率有降低趋势。故对于适龄女性，注重宫颈癌三级预防的宣教。为降低宫颈病变的漏诊、误诊率及过度诊疗，增加患者精神、心理、经济负担，需根据患者病情增加相关实验室检查。

Abstract: Objective: To provide clinical evidence by analyzing the examination results of patients with high-risk human papillomavirus infection referred for colposcopy. Methods: 611 female patients who were screened for HR-HPV infection and referred for colposcopic tissue biopsy in Guiyang Maternal and Child Health Care Hospital from September 2019 to November 2020 were selected, and age, TCT, HPV and pathological results of colposcopic biopsy were collected for statistical analysis. Results: In HPV16/18 positive patients, there were significant differences in the proportion of cervical LSIL− and HSIL+ between TCT(−) and TCT(+) in HPV16/18 positive patients, there were significant differences in the proportion of cervical LSIL− and HSIL+ between TCT(−) and TCT(+) (P < 0.05). There was a significant difference in the proportion of cervical LSIL− and HSIL+ between TCT(−) and TCT(+) patients with other 16 types of HR-HPV, and the detection rate of cervical HISL+ in patients with HR-HPV16/18 infection was significantly higher than that in other 16 HR-HPV infection patients (P < 0.05). The HR-HPV positive patients were divided into groups according to ≤30, 31~40, 41~50, 51~60 and >60 years old, and there was no statistically significant difference in HSIL among all age groups (P > 0.05). There was a significant difference in the proportion of cervical cancer among all age groups (χ² = 45.133, P < 0.05). HSIL and SCC detected by colposcopy with different degree of TCT abnormalities were statistically significant (χ² = 92.384, P < 0.05). Conclusion: 1) Among the patients with positive cervical HR-HPV and referred to colposcopy, the positive rate of HSIL+ in patients with positive TCT transferred to colposcopy is high; those with negative TCT referral to colposcopy can detect cervical lesions, and HR-HPV and TCT combined with colposcopy examination can improve the detection rate of cervical lesions, and it is necessary to regulate the management of this kind of population for a long time. 2) The incidence of cervical cancer increased obviously with the increase of age, the detection rate was the highest in people over 60 years old, and decreased after 60 years old. Therefore, for women of the right age, we should pay attention to the education of tertiary prevention of cervical cancer. In order to reduce the missed diagnosis, misdiagnosis rate and excessive diagnosis and treatment of cervical lesions, and increase the mental, psychological and economic burden of the patients, it is necessary to increase the relevant laboratory examination according to the patient's condition.