国际妇产科学杂志

国际妇产科学杂志 ›› 2012, Vol. 39 ›› Issue (4): 337-340.

• 论著 • 上一篇    下一篇

宫颈上皮内低度病变患者的自然转归及其研究


乌兰娜, 荣 晅 ,李瑞珍, 刘志红, 李 鹃, 王 纯, 刘 淼 , 唐国亮   

  1. 518036 北京大学深圳医院宫颈癌早诊早治中心[乌兰娜,荣晅(现工作单位为陕西省人民医院妇产科),李瑞珍,刘志红,李鹃,王纯,刘淼,唐国亮]
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2012-08-15 发布日期:2012-08-15

Study of Natural History of Cervical Intraepithelial Neoplasia Grade

WULAN Na，RONG Xuan，LI Rui-zhen，LIU Zhi-hong ，LI Juan，WANG Chun，LIU Miao，TANG Guo-liang   

  1. The Center of Early Diagnosis and Early Treatment for Cervical Carcinoma， Shenzhen Hospital of Peking University，Shenzhen 518036，Guangdong Province，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2012-08-15 Online:2012-08-15

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摘要： 目的：了解宫颈上皮内瘤变Ⅰ级（CINⅠ）的自然转归情况。方法：对经病理诊断为CINⅠ的548例患者进行为期24～48个月的定期随访。以液基细胞学检查（LCT）联合高危型人乳头瘤病毒（HPV）检测（HC-Ⅱ）作为监测手段。当LCT诊断为意义不明的不典型鳞状细胞（ASCUS）及以上病变且高危型HPV阳性或LCT诊断为低度鳞状上皮内病变（LSIL）以上病变，进行阴道镜下多点活检，以病理结果为最终诊断，评价CINⅠ在6，12，24和36个月的自然转归情况。以寿命表法计算病变转归率。结果：①随访36个月时的累积失访率为10.22%。②随访36个月，CINⅠ向高级别进展的为16例，持续不变29例，病变逆转447例。CINⅠ随访6个月时病变进展、持续存在和逆转为正常的百分率分别为0.57%，67.05%和37.36%； 12个月时分别为1.15%，48.08%和55.56%； 24个月时分别为2.30%，20.88%和77.20%； 36个月时分别为3.07%，5.56%和85.63%。③高危型HPV阳性的CINⅠ患者6，12，24和36个月HPV累计自然清除率分别为52.76%，61.84%，82.64%和94.52%。结论：①CINⅠ患者病变累计进展率和累计逆转率在36个月内均随时间增加而增高。②在高危型HPV阳性的CINⅠ患者中， HPV的自然清除率随着时间的增加逐渐增高。③CINⅠ可能由高危型HPV的一过性感染所致，高危型HPV感染的CINⅠ患者，CINⅠ病变逆转趋势与高危型HPV清除趋势一致。

关键词: 宫颈上皮内瘤样病变, 癌前状态, 乳头状瘤病毒科, 细胞诊断学, 宫颈肿瘤

Abstract: Objective：To investigate the natural history of CINⅠ lesions. Methods：548 patients were enrolled into the cohort. They were followed up for 24-48 months without any treatment. Every 6 to 12 months， the patients were called back to have the Liquid-based Cytological Test and High-risk Human papillomavirus Test（HC-Ⅱ）. If the LCT was ASCUS and HR-HPV was positive or LCT was higher than ASCUS， then colposcopy was used to assess the disease situation and multi-point biopsies were made at the same time. The biopsy results were the gold standard to assess the outcome if it was progression， resistance or regression. Results： ①The 36 months dropout rate was 10.22%. ②At the end of the follow-up， 16 patients had progressed to higher grade lesions， including 11 CINⅡ and 5 CINⅢ. No one had progressed to invasive cervical cancer. 29 patients whose CINⅠ lesions had resistant and 477 patients had regressed. Within 6 months， the CINⅠ progression rate， resistance rate and regression rate was separately 0.57%， 67.05%， and 37.36%. Within 12 months， the CINⅠ progression rate， resistance rate and regression rate was separately 1.15%， 48.08%， and 55.56%. Within 24 months， the CINⅠ progression rate， resistance rate and regression rate was separately 2.30%， 20.88%， and 77.20%. Within 36 months， the CINⅠ progression rate， resistance rate and regression rate was separately 3.07%， 5.56%， and 85.63%. ③The 6， 12， 24， 36 months HR-HPV cultivate clearance rate of HR-HPV positive CINⅠ was separately 52.76%， 61.84%， 82.64%， and 94.52%. Conclusions： ① Most of the CINⅠ lesions （85.71%） can regress themselves during 36 months， only few part（3.07%） of them will progress to high grade lesions. The cultivate progression rate and regression rate became higher and higher along with the time during the 36 months follow-up. ②The cultivate rate of HR-HPV clearance became higher and higher with the time during the 36 months follow-up. ③CINⅠ were caused by transient HR-HPV infection，HR-HPV positive CINⅠ lesions had the same regression trend with HR-HPV clearance.

Key words: Cervical intraepithelial neoplasia, Precancerous conditions, Papillomaviridae, Cytodiagnosis, Uterine cervical neoplasms