高危型人乳头瘤病毒阴性/不典型鳞状细胞和低度鳞状上皮内病变患者的随访观察

摘要

目的：分析高危型人乳头瘤病毒( high-risk human papillomavirus,HR-HPV)阴性的不典型鳞状细胞( atypical squamous cells undetermined significance,ASCUS)和低度鳞状上皮内病变( low squamous intraepithelial lesion,LSIL)患者的随访结果,探讨HR-HPV阴性的ASCUS和LSIL患者的合理处理方法。方法回顾性分析2010年1月1日至2012年12月31日期间,就诊于首都医科大学附属北京朝阳医院妇科门诊,HR-HPV阴性、宫颈液基细胞学为ASCUS和LSIL的356例患者的病理资料,对HR-HPV阴性的ASCUS和LSIL经阴道镜及宫颈活检排除高级别病变的306例患者定期进行HR-HPV随访。 HR-HPV检测采用杂交检测法2代(hybird capture-Ⅱ,HC-Ⅱ)。结果 HR-HPV阴性/ASCUS和LSIL患者宫颈上皮内瘤变(cervical intraepithelial lesions,CIN)-Ⅲ及以上病变发病率分别为7.9%和9.1%。 HR-HPV阳性/ASCUS和LSIL患者CIN -Ⅲ及以上病变发病率分别是22.9%和17.9%。 HR-HPV阳性的ASCUS和LSIL患者CIN-Ⅲ及以上病变发病率明显高于HR-HPV阴性患者,差异具有统计学意义(P=0.000)。 HR-HPV阳性对ASCUS及LSIL患者宫颈高级别病变的阴性预测值分别为87.13%和84.42%。 HR-HPV阴性/ASCUS和LSIL患者CIN-Ⅱ及以上病变检出率是14.3%。不同年龄段的HR-HPV阴性/ASCUS和LSIL的患者,宫颈高级别病变患者的发生率不同,差异具有统计学意义(P<0.05)。30~39岁妇女宫颈高级别病变的发生率最高(18.2%)。结论 HR-HPV阴性的ASCUS和LSIL患者发生CIN-Ⅲ及以上病变分别是7.9%和9.1%,CIN-Ⅱ及以上病变达14.3%,30~39岁的HR-HPV阴性/ASCUS和LSIL患者宫颈高级别病变发生率达18%,建议对于HR-HPV阴性的ASCUS和LSIL患者应行阴道镜检查可疑病变部位活检。%Objective To evaluate the cervical pathology among high-risk human papillomavirus ( HR-HPV )-negative women with atypical squamous cells of undetermined significance ( ASCUS ) cells and low-grade squamous intraepithelial lesion ( LSIL ) , and to investigate the reasonable management strategies for HR-HPV-negative patients with ASCUS and LSIL. Methods In this retrospective study, 356 cases who visited the Department of Gynecology, Beijing Chaoyang Hospital Affiliated to Capital Medical University during January 1, 2010 to 31 December 2012, and were HR-HPV-negative/ASCUS and LSIL on Pap smear were included;306 patients were followed up. All the patients were examined by colposcopy and cervical biopsy if necessary. HR-HPV was detected by hybridization assay II, hybird capture Ⅱ(HC-Ⅱ). SPSS18. 0 statistical software was used. Results Of the 202 cases, 16(7. 9%) and 14 of 154(9. 1%) HR-HPV negative ASCUS and LSIL women developed CIN-Ⅲor worse compared with 32 of 140(22. 9%) and 40 of 223(17. 9%) HPV-positive ASCUS and LSIL women(P=0. 000). The negative predictive value of HR-HPV testing for CIN-Ⅲor worse in ASCUS and LSIL women were 87. 13% and 84. 42%, respectively. When cervical pathological data were further evaluated by age groups in HR-HPV-negative women with ASCUS and LSIL, the risk of ≧CIN-Ⅱ were significantly different in various age groups(P<0. 05) , the highest group was 30-39 years old patients(18. 2%) . Conclusion HR-HPV-negative patients with an ASCUS or LSIL Pap test result have a chance of being cervical high grade lesions, 7. 9% and 9. 1% of HR-HPV-negative patients with ASCUS or LSIL had CIN-Ⅲ or worse, and 14. 3% of these patients had CIN -Ⅱ or worse lesions, the negative predictive value of HR-HPV testing for CIN -Ⅲ or worse were lower. Colposcopy should be done for HR-HPV-negative patients with ASCUS or LSIL.