张莉, 热米拉·热扎克, 胡尚英, 董丽, 赵爽, 赵雪莲, 徐小倩, 潘秦镜, 张询, 乔友林, 赵方辉. 阴道镜结果正常或低度病变妇女发生宫颈癌前病变的前瞻性风险分层研究[J]. 中国肿瘤临床, 2019, 46(15): 768-772. DOI: 10.3969/j.issn.1000-8179.2019.15.549
引用本文: 张莉, 热米拉·热扎克, 胡尚英, 董丽, 赵爽, 赵雪莲, 徐小倩, 潘秦镜, 张询, 乔友林, 赵方辉. 阴道镜结果正常或低度病变妇女发生宫颈癌前病变的前瞻性风险分层研究[J]. 中国肿瘤临床, 2019, 46(15): 768-772. DOI: 10.3969/j.issn.1000-8179.2019.15.549
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Zhang Li, Remila·Rezhake, Hu Shangying, Dong Li, Zhao Shuang, Zhao Xuelian, Xu Xiaoqian, Pan Qinjing, Zhang Xun, Qiao Youlin, Zhao Fanghui. Long-term risk stratification study of women with normal status or low-grade lesion identified by colposcopy[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(15): 768-772. DOI: 10.3969/j.issn.1000-8179.2019.15.549
Citation: Zhang Li, Remila·Rezhake, Hu Shangying, Dong Li, Zhao Shuang, Zhao Xuelian, Xu Xiaoqian, Pan Qinjing, Zhang Xun, Qiao Youlin, Zhao Fanghui. Long-term risk stratification study of women with normal status or low-grade lesion identified by colposcopy[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(15): 768-772. DOI: 10.3969/j.issn.1000-8179.2019.15.549
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阴道镜结果正常或低度病变妇女发生宫颈癌前病变的前瞻性风险分层研究

Long-term risk stratification study of women with normal status or low-grade lesion identified by colposcopy

    摘要
  • 摘要:
      目的  探讨细胞学、高危型人乳头瘤病毒（high risk human papillomavirus，hrHPV）分型对于阴道镜结果正常或低级别鳞状上皮内病变（low-grade squamous intraepithelial lesion，LSIL）妇女的风险预测作用。
      方法  基于1999年6月在山西省建立的宫颈癌筛查队列，以2005年随访时阴道镜结果为正常或低度病变的596例妇女为研究对象，于2010年和2014年进行随访。分析hrHPV阴性组、hrHPV阳性组、HPV16/18阳性组、细胞学LSIL以下组和细胞学LSIL及以上组发生宫颈上皮内瘤样病变2级及以上（cervical intraepithelial neoplasia grade 2 or worse，CIN2+）的瞬时、5年和9年累积风险和相对危险度。
      结果  细胞学LSIL以下组发生CIN2+的瞬时、5年和9年累积风险分别为0.2%、2.8%和4.2%，细胞学LSIL及以上组相应的风险分别为14.7%（RR=73.8，95% CI为9.7~561.5）、40.0%（RR=16.0，95% CI为8.2~31.1）和51.4%（RR=15.0，95% CI为8.3~27.0）。hrHPV阴性组发生CIN2+的瞬时风险、5年和9年累积风险较低，分别为0.6%、2.7%和3.8%，hrHPV阳性和HPV16/18阳性组发生CIN2+的风险逐渐升高，其中HPV16/18阳性组的相应风险分别为13.2%（RR=23.4，95% CI为5.1~106.9）、36.9%（RR=15.4，95% CI为6.9~34.3）和42.6%（RR=14.1，95% CI为6.8~29.2）。
      结论  阴道镜结果正常或LSIL妇女，若细胞学结果为LSIL及以上或HPV16/18阳性，未来进展为高度宫颈癌前病变的风险较高，细胞学和HPV16/18分型可用于该人群的临床分流管理。

     

    Abstract:
      Objective  To evaluate the predictive value of cytology and high risk human papillomavirus (hrHPV) genotyping for cervical precancer among women with normal status or low grade lesions identified by colposcopy examination.
      Methods  This study was based on a cervical cancer screening cohort in 1999 in Shanxi province. The analysis included 596 women with normal status or low grade lesions detected via colposcopy in 2005. These women were followed up in 2010 and 2014, and the immediate, 5-year, 9-year risks, the RR (relative risk) of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) stratified by cytology and hrHPV results were estimated.
      Results  The immediate, 5-year, 9-year cumulative risks of CIN2+, were 0.2%, 2.8%, 4.2% among women with less than lowgrade squamous intraepithelial lesion (LSIL) cytology results; 14.7% (RR=73.8, 95% CI:9.7-561.5), 40.0% (RR=16.0, 95% CI:8.2-31.1), 51.4% (RR=15.0, 95%CI:8.3-27.0) among women with LSIL or worse; 0.6%, 2.7%, 3.8% (which were relatively low) among women with negative hrHPV results; and 13.2% (RR=23.4, 95%CI:5.1-106.9), 36.9% (RR=15.4, 95%CI:6.9-34.3), 42.6% (RR=14.1, 95%CI:6.8-29.2) among women with HPV16/18 positive results, which were relatively high.
      Conclusions  Although the colposcopy results were normal or LSIL, the CIN2+ risk was quite high for those with cytological LSIL results or worse, or with a HPV16/18 positive result, indicating that cytology and HPV16/18 genotyping could be used to triage these women.

     

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