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目的探讨宫颈病变的临床特点及液基薄层细胞学检测术(TCT)在宫颈病变筛查中的作用。方法对10272例门诊及住院患者行TCT检测。细胞学检查阳性者继行阴道镜检查及多点活检,并送组织病理学检查和免疫组化高危型人乳头状瘤病毒(HPV)16或/和18的检测。结果在10272例TCT检测中,1172例属于非典型鳞状细胞(ASC)及其以上病变,其中ASC534例,非典型腺细胞(AGC)12例,低度鳞状上皮内病变(LSIL)242例,高度鳞状上皮内病变(HSIL)338例,宫颈癌46例。组织学诊断宫颈上皮内瘤变(CIN)1为309例,CIN2为151例,CIN3为277例,宫颈癌为112例。组织学与TCT的符合率在LSIL为30.99%(75/242),HSIL为65.38%(221/338),宫颈癌为82.61%(38/46)。CIN的高发阶段为31～40岁,其次为41～50岁年龄段;宫颈癌的高发阶段为41～50岁,其次为31～40岁年龄段。在10272例中,宫颈糜烂4491例,伴CIN426例;滴虫感染503例,伴CIN57例;霉菌感染693例,伴CIN72例;HPV阳性944例,伴CIN760例。结论宫颈病变具有十分明显的年轻化趋势,HPV感染者的CIN发生率显著高于宫颈糜烂、滴虫感染、霉菌感染者,宫颈病变与HPV感染有明显关联性。降低HPV感染,治疗并阻止CIN病变升级,是降低宫颈癌发病率的重要环节。
Objective To investigate the clinical features of cervical lesions and the role of liquid-based thin-layer cytology (TCT) in the screening of cervical lesions. Methods 10272 outpatients and inpatients underwent TCT testing. Cytology positive persons were followed by colposcopy and multipoint biopsy, and sent for histopathological examination and immunohistochemical detection of high-risk human papillomavirus (HPV) 16 or / and 18. Results Among 10272 cases of TCT, 1172 cases belonged to atypical squamous cell (ASC) and the above lesions, of which ASC534 cases, atypical glandular cells (AGC) 12 cases and low grade squamous intraepithelial lesion (LSIL) 242 cases, 338 cases of high grade squamous intraepithelial lesion (HSIL), 46 cases of cervical cancer. Histological diagnosis of cervical intraepithelial neoplasia (CIN) 1 was 309 cases, CIN2 was 151 cases, CIN3 was 277 cases, cervical cancer was 112 cases. The coincidence rate between histology and TCT was 30.99% (75/242) in LSIL, 65.38% (221/338) in HSIL and 82.61% (38/46) in cervical cancer. The incidence of CIN was 31-40 years old, followed by 41-50 years old. The incidence of cervical cancer was 41-50 years old, followed by 31-40 years old. Among 10272 cases, 4491 cases of cervical erosion were accompanied by CIN426 cases; 503 cases of trichomoniasis were infected with 57 cases of CIN; 693 cases of mold infection were found with 72 cases of CIN; 944 cases of HPV were positive with CIN760 cases. Conclusions Cervical lesions have a tendency of younger age. The incidence of CIN in HPV infected patients is significantly higher than that in cervical erosion. Trichomonas infection, mold infection, cervical lesions and HPV infection are obviously correlated. Reduce HPV infection, treatment and prevent the progression of CIN lesions is an important part of reducing the incidence of cervical cancer.