上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (09): 1213-1217.doi: 10.3969/j.issn.1674-8115.2020.09.008

• 论著·临床研究 • 上一篇    下一篇

转化区类型在评估阴道镜下未见宫颈病变者随机活检中的价值

仓 唯，洪祖蓓，顾李颖，狄 文，邱丽华   

  1. 上海交通大学医学院附属仁济医院妇产科，上海市妇科肿瘤重点实验室，上海 200127
  • 出版日期:2020-09-28 发布日期:2020-11-04
  • 通讯作者: 邱丽华，电子信箱：lilyqiulh@126.com。
  • 作者简介:仓 唯（1994—），女，硕士生；电子信箱：cangwei_21@163.com。
  • 基金资助:
    国家重点研发计划（2016YFC1302900）；上海市卫生和计划生育委员会“重中之重”临床重点学科项目（2017ZZ02016）；上海市科学技术委员会科研计划项目（18411963100）；上海市教育委员会高峰高原学科建设计划(20161412)。

Value of transformation zone type in the evaluation of random biopsy among patients without visible lesions under colposcopy

CANG Wei, HONG Zu-bei, GU Li-ying, DI Wen, QIU Li-hua   

  1. Shanghai Key Laboratory of Gynecology Oncology, Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2020-09-28 Published:2020-11-04
  • Supported by:
    National Key R&D Program of China (2016YFC1302900); Clinical Key Discipline Project of Shanghai Municipal Commission of Health and Family Planning (2017ZZ02016); Scientific Research Projects of Science and Technology Commission of Shanghai Municipality (18411963100); Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (20161412).

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摘要： 目的·探讨宫颈转化区类型在评估阴道镜下未见病变者是否采用随机活检诊断宫颈高级别鳞状上皮内病变（high-grade squamous intraepithelial lesion，HSIL）中的价值。方法·选取因人乳头瘤状病毒（human papillomavirus，HPV）高危亚型感染或液基薄层细胞学检测（thinprep cytologic test，TCT）结果异常而行阴道镜检查且未见病变患者517例，明确其宫颈转化区类型，并行宫颈随机活检，评估Ⅰ、Ⅱ、Ⅲ型宫颈转化区对诊断宫颈HSIL的价值。结果·阴道镜下未见病变者517例，其中Ⅲ型转化区396例，随机活检HSIL检出率为3.8%（15/396）；Ⅰ、Ⅱ型转化区121例，HSIL的检出率为8.3%（10/121）。与Ⅲ型转化区相比，Ⅰ、Ⅱ型转化区HSIL的检出率显著升高（P=0.000）。Logistics回归结果提示，TCT结果异常和转化区类型为Ⅰ、Ⅱ型是阴道镜下未见病变者检出HSIL的危险因素。结论·对于阴道镜下未见病变但转化区为Ⅰ、Ⅱ型及TCT异常的女性，随机多点活检可提升其宫颈HSIL的检出率。

关键词: 宫颈转化区, 宫颈高级别鳞状上皮内病变, 阴道镜, 随机活检

Abstract:

Objective · To explore the value of cervical transformation zone (TZ) type in assessing whether a random biopsy should be used to diagnose high-grade squamous intraepithelial lesion (HSIL) among patients without visible lesions under colposcopy. Methods · A total of 517 patients who underwent colposcopy (without visible lesions) due to high risk subtype infection of human papillomavirus (HPV) or thinprep cytologic test (TCT) abnormality were enrolled. TZ types were identified, random biopsies were performed, and the value of TZ typeⅠ, Ⅱand Ⅲ in the diagnosis of HSIL was evaluated. Results · There were 517 cases without visible lesions under colposcopy. Three hundred and ninety-six of them were TZ type Ⅲ , and the detection rate of HSIL was 3.8% (15/396) by random biopsy, while one hundred and twenty one of them were TZ type Ⅰ and Ⅱ, and the detection rate of HSIL was 8.3% (10/121). Compared with the TZ type Ⅲ, the detection rate of HSIL in the TZ type Ⅰ and Ⅱ was significantly increased (P=0.000). Logistic regression showed that TCT abnormality, TZ typeⅠ and Ⅱ were the risk factors for HSIL detection in patients without visible lesions under colposcopy. Conclusion · Random multipoint biopsy can significantly increase detection rate of cervical HSIL when no visible lesion is visualized under colposcopy, particularly in women with abnormal TCT results or TZ type Ⅰ and Ⅱ.

Key words: cervical transformation zone, cervical high-grade squamous intraepithelial lesion, colposcopy, random biopsy

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