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目的探讨适用于我国农村地区宫颈癌筛查人乳头瘤病毒(HPV)阳性女性的分流策略。方法选取2015年7月至2015年10月间,在山西省襄垣县和阳城县招募35~64岁女性进行宫颈癌及其癌前病变筛查,采用宫颈癌快速筛查技术(care HPV检测法)进行初筛,后采用随机数表法将初筛结果阳性女性(248例)分成三组:细胞学分流(82例)、醋酸或碘染色肉眼观察法(VIA/VILI)分流(83例)和不分流直接转诊阴道镜(83例)。细胞学和VIA/VILI检查阳性者转诊阴道镜。阴道镜异常者在病变处取活检进行病理诊断。结果共有1 503名女性参加筛查,HPV阳性检出率为16.5%(248/1503),中度及以上宫颈上皮内瘤样病变(CIN2+)的检出率为0.7%(11/1503),248例中有237例完成分流检查,依从率为95.6%(237/248),细胞学分流组、VIA/VILI分流组和不分流直接阴道镜组检查的人数分别为81例、79例和77例。细胞学分流组中,分流结果阳性率、CIN2+检出率和阳性预测值依次为:19.8%、1.2%和11.1%;VIA/VILI分流组中上述指标依次为:17.5%、3.6%和21.4%;不分流直接阴道镜组中上述指标依次为:19.5%、8.4%和9.5%。上述阳性检出率和CIN2+检出率差异均无统计学意义(均P>0.05)。随着年龄的增加,HPV阳性率趋于上升趋势,而直接阴道镜组阳性检出率趋于下降趋势,差异均有统计学意义(均P<0.05)。细胞学分流组和VIA/VILI分流组随年龄的增加未发现显著的变化趋势,差异无统计学意义(P>0.05)。结论三组方法中,VIA/VILI较适用于我国农村地区宫颈癌筛查HPV阳性女性的分流。
Objective To explore the triage strategy applicable to cervical cancer screening of human papillomavirus (HPV) positive women in rural areas in China. Methods From July 2015 to October 2015, women aged 35-64 years were enrolled in Xiangyuan County and Yangcheng County of Shanxi Province for cervical cancer screening and precancerous lesions screening. Cervical cancer rapid screening test (care HPV test (248 cases) were divided into three groups: cytological shunt (82 cases), acetic acid or iodine staining visual examination (VIA / VILI) shunt (83 cases ) And indwelling direct referral colposcopy (83 cases). Cytology and VIA / VILI positive examination referral colposcopy. Colposcopy abnormalities in the lesion biopsy for pathological diagnosis. Results A total of 1 503 women participated in the screening. The positive rate of HPV was 16.5% (248/1503), and the positive rate of CIN2 + was 0.7% (11/1503) in women with moderate and severe cervical intraepithelial neoplasia. Of the 248 patients, 237 had a shunt, with a compliance rate of 95.6% (237/248). The number of cytological, VIA / VILI, and indirect colposcopy was 81, 79, and 77 example. In the cytologic shunt group, the positive rate of shunt, the positive rate of CIN2 + and the positive predictive value of CIN2 were 19.8%, 1.2% and 11.1%, respectively, and those of VIA / VILI shunt group were 17.5%, 3.6% and 21.4% ; Indifferent direct colposcopy group in the above indicators were: 19.5%, 8.4% and 9.5%. There was no significant difference between the positive detection rate and the detection rate of CIN2 + (all P> 0.05). With the increase of age, the positive rate of HPV tends to increase, while the positive rate of direct colposcopy group tends to decline, the differences were statistically significant (P <0.05). Cytology shunt group and VIA / VILI shunt group showed no significant change trend with age, the difference was not statistically significant (P> 0.05). Conclusion Among the three groups, VIA / VILI is more suitable for shunting HPV-positive women with cervical cancer screening in rural areas in China.