高级别宫颈鳞状上皮内病变患者宫颈环形电切术后病理阴性的相关因素分析

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摘要目的：探讨高级别宫颈鳞状上皮内病变（CIN2-3）患者宫颈环形电切术（LEEP）后病理阴性的相关影响因素。方法：选取自2011年3月至2012年12月间嘉兴市妇幼保健院因宫颈病变经阴道镜下活检诊断为CIN2-3而行LEEP术的患者263例，并对年龄、宫颈细胞学、HPV病毒载量、阴道镜下活检病理分级等进行回顾性分析，评价上述因素与CIN2-3患者LEEP术后病理阴性的相关性。结果：单因素分析显示HPV低病毒载量（＜400 RLU/CO）、液基细胞学检查（TCT）低级别组、镜下活检CIN2与CIN2-3患者LEEP术后病理阴性结果相关（P=0.008，P=0.012，P=0.02），而年龄与阴性病理结果相关性无统计学意义（P=0.172），多因素分析显示低HPV病毒载量为术后病理阴性的独立影响因素（P=0.019，OR=3.752，95%CI 1.247～11.293）。三因素（HPV病毒载量、TCT、活检病理诊断）共同预测CIN2-3术后病理阴性发生的受试者工作特征曲线（ROC曲线）曲线下面积（AUC）为0.727。结论：HPV低病毒载量与LEEP术阴性病理结果相关。联合术前HPV低病毒载量、TCT低级别、镜下活检CIN2三因素具有较高预测术后病理阴性的效能。

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	吕加敏1
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	朱雪琼1

关键词 ：高级别宫颈鳞状上皮内病变, 环形电切术, 病理阴性

Abstract：Objective: To investigate the related factors of the negative pathological results of loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical squamous intraepithelial lesions (CIN2-3). Methods: Totally 263 patients diagnosed as CIN2-3 by colposcopy-assisted biopsy and treated with LEEP in Jiaxing Maternity and Child Care Hospital from March 2011 to December 2012 were selected, and the relation of the negative pathological results of LEEP with age, cervical cytology, HPV load and pathological grading was analyzed. Results: Univariate analysis showed that low HPV load (<400 RLU/CO), low-grade of TCT, biopsy-confirmed CIN2 were associated with the prediction of the negative pathology of LEEP specimens (P=0.008, P=0.012, P=0.02), however, age was not related to the negative result of LEEP (P=0.172). Multivariate logistic analysis showed that low HPV load was the independent factor of the negative pathological results of LEEP (P= 0.019, OR=3.752, 95%CI 1.247～11.293). The area under ROC curve was 0.727 for three factors (HPV load, TCT and biopsy pathology diagnosis) predicting negative pathological result of LEEP. Conclusion: Low HPV load is related to the negative pathological results of LEEP. Combining low HPV load with low-grade of TCT and biopsy-confirmed CIN2 has a high predictive effect on negative pathological results of LEEP.

Key words： high-grade cervical squamous intraepithelial lesions loop electrosurgical excision procedure negative pathology

收稿日期: 2015-04-19

通讯作者: 朱雪琼，主任医师，教授，硕士生导师，Email：zjwz zxq@163.com。

作者简介: 吕加敏（1984-），女，浙江嘉兴人，主治医师，在职硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2015/V45/I9/665

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