【作者】 田亚丽；

【导师】 于黎明；

【作者基本信息】 宁夏医科大学 ， 妇产科学， 2009， 硕士

【摘要】 目的分析与宫颈上皮内瘤样变(cervical Intraepithelial Neoplasia CIN)发生的相关因素与危险因素,探讨降低传统宫颈刮片漏诊率的策略,寻找本地区宫颈癌筛查的有效途径。方法对宁夏医科大学附属医院妇科2007年1月-2008年10月经宫颈刮片检查诊断为巴氏II级[1]200例患者的临床资料进行分析,用Logistic回归、卡方检验、t检验对数据进行分析。结果(1)200例巴氏II级患者中炎症143例,CINⅠ28例,CINⅡ18例,CINⅢ9例(包括原位癌4例),宫颈癌2例,假阴性率为28.5%。(2)Logistic回归分析得出CIN、宫颈癌与患者年龄、初次性生活年龄、患者所处地区具有相关性(P<0.05)。(3)初次性生活年龄在≥25岁与≤20岁的患者CIN、宫颈癌发生率具有显著不同(P<0.05)。(4)阴道异常出血患者CIN、宫颈癌发生率在各种主诉中比例最高,为40%,且不同年龄段发生有差别,具有统计学意义(P<0.05),其中年龄在35-44岁的患者发生率最高,为55%。(5)CIN、宫颈癌在宁夏各周边地区发生率不同,具有统计学意义(P<0.05),其中固原地区发病率最高,为52.4%。(6)从未做过宫颈刮片检查的患者CIN的发生率较做过宫颈刮片检查的明显升高(χ2=14.33,P<0.01)。(7)80例患者行TCT检查,TCT对CIN诊断的敏感性为81.0%(17/21),特异性为88.1%(52/59),阳性预测值为70.8% (17/24),阴性预测值为88.1% (52/59)。TCT检查的阳性率为30.0%(24/80),病理组织学阳性率为26.3%(21/80),二者相比无显著性差异(χ2=0.261,P>0.05)。TCT与病理总符合率为86.3%(69/80),宫颈刮片与病理组织学符合率为73.8%(59/80),二者差别有统计学意义(P<0.05)。(8)65例行HC2检测,HPV阳性者CIN的发生率为81.8%,HPV阴性者CIN的发生率为18.6%,HPV阳性者CIN发生率明显升高,二者相比有统计学意义(P<0.05)。(9)TCT与HC2联合检查者38例,细胞学与HPV检查均阴性者CIN检出率为6.3%,细胞学与HPV检查均阳性者CIN检出率为77.8%,二者均阴性的CIN的检出率显著低于二者均阳性的CIN的检出率,二者相比有统计学意义(P<0.05)。结论(1)宫颈刮片检查有一定的假阴性率,但在本地区宫颈刮片仍然是行之有效的方法而在临床广泛使用。(2)妇科医生要重视CIN、宫颈癌发生的相关因素及患者的临床表现,是提高CIN、宫颈癌诊断率,弥补宫颈刮片假阴性率的重要环节。(3)液基细胞学检查敏感度、特异度均较高,是一种较好的筛查方法,应该在临床推广使用,但是要提高取材质量及诊断水平。(4)HPV-DNA检测与宫颈刮片结合用于宫颈癌的筛查,可以降低宫颈刮片的假阴性率,是宫颈刮片的重要补充。(5)TCT联合HC2是理想的筛查方案但由于价格高,难以在经济欠发达地区普遍应用。更多还原

【Abstract】 Objective Analysis of the related factors and risk factors in the occurrence of cervical Intraepithelial Neoplasia (CIN), in order to explore the strategy of reducing the rate of missed diagnosis in conventional Pap smears, looking for an effective way in cervical cancer screening in this region.Methods 200 cases come from department of gynecology Pap smear diagnosed as Pap II in the affilliated to Ningxia Medical University during July 2007 to October 2008 were analyzed with logistic regression,Chisquar test,t test. Results (1) 200 cases pathologically diagnosed as cervicitis 143 cases, CINⅠ28 cases, CINⅡ18 cases, CINⅢ9 cases(Including carcinoma in situ 4 cases), carcinoma 2 cases, false negative rate was 28.5%. (2) Lgistic regression analysis showed the correlative factors for CIN include age,age of initial sexual life,the region of patients. The strongest risk factors was age of initial sexual life (OR=15.57). (3) The incidence of CIN,cervical cancer was statistical significance in age of initial sexual life between≥25 years old and≤20-year-old (P<0.05). (4) The highest incidence rate of CIN,cervical cancer in all complait was abnormal vaginal bleeding, the rate was 40%, there was statistical significance in different age groups (P<0.05), the highest rate was 35-44 years old, the rate was 55%. (5)The incidence of CIN,cervical cancer was different with statistical significance in the Ningxia region and it’s surrounding areas(P<0.05), the highest incidence is Guyuan region, the rate is 52.4%. (6)The incidence of CIN,ceivcal cancer was significantly higher in patients who had never been deteced by Pap smear, there was statistical significance comparing to those who had detected by Pap smear (χ2=14.33,P<0.01). (7) 80 cases had been checked by Liquid based Cytology Testing (TCT), thesensitivity of TCT diagnosis of CIN was 81.0%, the specificity was 8.1%(52/59), positive predictive value was 70.8% (17/24), negative predictive value was 88.1% (52/59), the positive rate of TCT detection was 30.0%(24/80),the positive rate of pathological histology detection was 26.3%(21/80), difference did not exist statistical significance (χ2=0.261, P>0.05). The total coincidence between TCT and pathological histology was 86.3% (69/80), the total coincidence between Pap smear and pathological histology was 73.8% (59/80), difference existed statistical significance (P<0.05). (8) 65 cases had been checked by Hybrid Capture2 (HC2 ), the incidence of CIN in HPV-positive was 81.8%, the incidence in HPV-negative was 18.6%, the incidence of CIN in HPV-positive was significantly higher than in HPV-negative, difference exist statistical significance (P<0.05). (9) Combined use of TCT and HC2, the detection rate of CIN was 6.3% when two value were negative, and the rate was 77.8% when two value were positive, there was statistical significance. (P<0.05). Conclusion (1) Pap smear has the false negative rate, but in this region it is a well-established method widely used in clinical. (2)Attention should be paid to related factors of CIN,cervical cancer and patients’clinical manifestations by gynecologist, which is important part to improve the rate of CIN,cancer diagnosis and make up for false-negative rate of conventional Pap smears. (3) The sensitivity and specificity of Liquid-based Cytology are high, it has a greater advantage compared to conventional Pap smears(CPS), it is a better screening methods should be promoted in clinic, but should raise the level of specimens quality and the diagnosis level. (4) The combined use of HC2 and Pap smear for cervical cancer screening can reduce the false negative rate of Pap smear, is an important supplement for Pap smear. (5) The combined use of Liquid based Cytology and HC2 testing is more efficient to detect cervical cancer, but as a result of high prices, it is difficult to use generally in economically underdeveloped areas.更多还原