166例阴道上皮内瘤变的回顾性分析

Retrospective Analysis of 166 Cases of Vaginal Intraepithelial Neoplasia

摘要: 目的：通过探讨阴道上皮内瘤变(VaIN)的临床特点及相关危险因素，为VaIN的管理提供依据。方法：收集2018年1月至2022年1月在新疆医科大学附属肿瘤医院进行阴道镜检查并经活检确诊的VaIN住院患者资料进行回顾性分析。结果：① VaIN主要好发于48岁左右的女性。有子宫或宫颈相关手术治疗病史组的平均年龄(52岁)大于初诊VaIN患者的年龄，差异有统计学意义(P < 0.05)。② 97.6%的VaIN患者有HPV感染，感染率高的HPV型别主要为：HPV16、HPV52、PV53、HPV18及HPV58；HSIL组人乳头瘤病毒载量值，HPV16型的感染率较LSIL组更高，差异有统计学意义(P < 0.05)。③ 阴道镜检查VaIN患者提示阴道病变部位主要分布在阴道上1/3、穹窿及阴道残端处，且此部位发生阴道HSIL的概率更高，差异有统计学意义(P = 0.023)。④ 采用Kendall’s tau-b相关评价分析宫颈病变与阴道病变的关系，发现既往或合并宫颈病变的病理级别越高，VaIN的病理级别也越高，两者存在一定的正相关关系(既往宫颈病变：Kendall’s tau-b = 0.237，P < 0.05；初诊合并宫颈病变：Kendall’s tau-b = 0.066，P < 0.05)。⑤ 通过二元logistic回归分析，阴道上1/3及阴道残端部位发生阴道HSIL是阴道下2/3部位发生HSIL的2.143倍(P = 0.043，OR值 = 2.143，95% CI = 1.023~4.490)，且VaIN合并宫颈病变时发生阴道HSIL是单纯VaIN致阴道HSIL的2.293倍(P = 0.022，OR值 = 2.293，95% CI = 1.128~4.663)。⑥ 分析治疗病史组(宫颈锥切/子宫全切)术后至发现VaIN的间隔时间，有宫颈病变病史的妇女发现VaIN的间隔时间为1~3年，而既往无宫颈病变者间隔时间则为3~12年。子宫全切组间隔时间明显长于锥切组，非宫颈病变病史组间隔时间显著长于宫颈病变病史组，差异有统计学意义(P = 0.009)。结论：① 对于围绝经期女性，高危型HPV感染，有CIN病史，尤其是既往宫颈病变病理级别高、HPV16型感染，病毒载量高的患者前三年应注重VaIN的早期筛查。② 对高危人群在阴道镜下行阴道上1/3、穹窿或阴道残端处可疑病变的多点活检，以期达到VaIN的早期诊治。③ HPV检测和阴道镜下取活检是诊断VaIN可靠的手段。

Abstract: Objective: By exploring the clinical characteristics of vaginal intraepithelial neoplasia (VaIN) and the related risk factors, we can provide a basis for the management of VaIN. Methods: Data of VaIN hospitalized patients with biopsy confirmed biopsy in the Affiliated Cancer Hospital of Xinjiang Medical University from January 2018 to January 2022 were collected for retrospective analysis. Results: ① VaIN mainly occurs in women around 48. The mean age (52 years) in the group with uterine or cervical surgery was greater than the age of initial VaIN patients, with significant differ-ences (P < 0.05). ② 97.6% of VaIN patients had HPV infection, and HPV type with high infection rate was mainly: HPV16, HPV52, HPV 52, HPV53, HPV18 and HPV58; Human papillomavirus load and HPV16 infection rate was higher in the HSIL group than LSIL group (P < 0.05). ③ Colposcopy pa-tients with VaIN indicated that the vaginal lesions were mainly distributed in 1/3 of the vagina, the fornix and the vaginal stump, and the probability of vaginal HSIL at this site was higher, with the statistically significant difference (P = 0.023). ④ The relationship between cervical lesions and vaginal lesions was analyzed by Kendall’s tau-b correlation evaluation, and found that the higher the pathological grade of previous or combined cervical lesions, the higher the pathological grade of VaIN, and there was a positive relationship (Previous cervical lesions: Kendall’s tau-b = 0.237, P < 0.05; Initial diagnosis with cervical lesions: Kendall’s tau-b = 0.066, P < 0.05). ⑤ By binary logistic regression analysis, the occurrence of vaginal HSIL in the upper one-third and residual parts of the vagina is 2.143 times higher than that in the lower two-thirds of the vagina (P = 0.043, OR = 2.143, 95% CI = 1.023~4.490), and vaginal HSIL in VaIN and cervical lesions was 2.293 times vaginal HSIL caused by VaIN alone (P = 0.022, OR = 2.293, 95% CI = 1.128~4.663). ⑥ To analyze the interval between postoperative and detection of VaIN in the treatment history group (cervical coniza-tion/total hysterectomy). The interval between VaIN in women with a history of cervical lesions was 1~3 years and 3~12 years for non-cervical patients. The interval in the total hysterectomy group was significantly longer than the conical group, and the non-cervical history group was significantly longer than the cervical history group, with a statistically significant difference (P = 0.009). Conclu-sion: ① For perimenopausal women, high-risk HPV infection, a history of CIN, especially patients with high pathological grade, HPV16 infection and high viral load should pay attention to the early screening of VaIN in the first three years. ② Multi-point biopsy of high-risk people with suspicious lesions in the upper one-third, fornix, or vaginal stump under the colposcopy, in order to achieve the early diagnosis and treatment of VaIN. ③ HPV detection and colposcopy biopsy are reliable means to diagnose VaIN.