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目的:探索上海闵行地区宫颈疾病筛查最为经济可靠的模式。方法:以2008.07.01～2011.06.30录入电子病历信息管理系统(EHR)中的宫颈疾病筛查对象为研究对象(n=14 526),依社区健康教育督促(A组,n=2 507)、贫困妇女免费普查(B组,n=7 396)、因症就医机会性筛查(C组,n=4 623)3类筛查方式进行分组,通过队列研究比较3组间宫颈疾病筛查的效果。结果:所有研究对象中巴氏涂片≥Ⅲ级者占26.3%(3 781/14 526),B组高达29.20%(2 160/7 396),3组间构成比具有统计学差异(χ2=87.58,P<0.000 1)。因巴氏涂片≥Ⅲ级进一步行TCT+阴道镜+组织活检者共计3 491例,经组织病理学诊断为LSIL者占8.34%(291/3 491)、HSIL者占2.95%(103/3 491)、宫颈癌占1.17%(41/3 491);宫颈病变总体检出率各组间具有统计学差异(χ2=14.26,P=0.000 8),C组最高,达15.23%(141/926);不同级别宫颈病变检出率在各组间也具有统计学差异(χ2=14.52,P=0.02)。所有对象(剔除未能转诊的失随访者)中LSIL检出率为2.04%(291/14 236),HSIL检出率为0.72%(103/14 236),宫颈癌检出率为0.29%(41/14 236)。Logistic回归提示年龄增大及流动人口是筛查出HSIL及宫颈癌的风险因素,在C组对象中尤为明显。结论:贫困免费筛查以及因症就医机会性筛查对象是今后初筛人群选择的重点。机会性筛查因针对性更强,相对节约资源,或许能成为城市地区最为经济可靠的宫颈疾病长期筛查模式。
Objective: To explore the most economical and reliable cervical screening in Shanghai Minhang area. Methods: The subjects of cervical disease screening in EHR were enrolled from 2008.07.01 ~ 2011.06.30 (n = 14 526). According to community health education supervision (group A, n = 2 507) , The free census of poor women (group B, n = 7 396), screening for opportunistic screening due to illness (group C, n = 4 623), and the screening of cervical diseases among the three groups Effect. Results: Papanicolaou smear≥≥3 grade accounted for 26.3% (3 781/14 526) in all subjects, up to 29.20% (2 160/7 396) in group B, with statistical significance (χ2 = 87.58, P <0.000 1). In total, 3 491 cases of TCT + colposcopy + biopsy due to Pap smear≥Ⅲ, 8.34% (291/3 491) were diagnosed as LSIL by histopathology and 2.95% (103/3 491) by HSIL ), And cervical cancer accounted for 1.17% (41/3 491). The overall detection rate of cervical lesions was statistically significant among all groups (χ2 = 14.26, P = 0.0008), while the highest in group C was 15.23% (141/926) The detection rate of cervical lesions of different grades was also statistically significant among the groups (χ2 = 14.52, P = 0.02). The detection rate of LSIL was 2.04% (291/14 236), the detection rate of HSIL was 0.72% (103/14 236), and the detection rate of cervical cancer was 0.29% in all subjects (excluding those who missed the referral) (41/14 236). Logistic regression suggested that age and mobile population were the risk factors of screening for HSIL and cervical cancer, especially in C group. Conclusion: Free screening of poverty and opportunistic screening of patients due to illness are the focus of the population screening in the future. Opportunistic screening due to more targeted, relatively resource-saving, may be the most economical and reliable long-term screening of cervical disease in urban areas.