宫颈细胞学低级别鳞状上皮内病变的形态特征及其临床意义探讨

Study on morphological characteristics of low grade intraepithelial squamous lesions diagnosed by cervical cytology and their clinical significance

摘要:

目的：探讨宫颈细胞学检查不同细胞形态学表现的低级别鳞状上皮内病变（low grade squamous intraepithelial lesion，LSIL）的临床意义。方法：对2017年7月至2018年6月宫颈细胞学诊断为LSIL同时行宫颈人乳头瘤病毒（human papilloma virus，HPV）分型检测、阴道镜及宫颈活检的153例病例结果进行回顾性分析。结果：宫颈细胞学检查不同细胞形态的LSIL患者高危型HPV（high risk human papilloma virus，HR-HPV）感染率均较高（81.0%），挖空细胞型LSIL为77.0%，非挖空细胞型LSIL为83.7%。其中异常细胞为非挖空细胞型LSIL患者的HPV16/18感染率为18.5%（17/92），明显高于挖空细胞型LSIL患者的6.6%（4/61）。非挖空细胞型LSIL患者的活检病理诊断≥宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）Ⅱ的检出率为28.3%（26/92），明显高于挖空细胞型LSIL患者的8.2%（5/61），差异均具有统计学意义（P＜0.05）。结论：非挖空细胞型LSIL患者更可能存在或进展为CINⅡ及以上病变，更应该引起临床医生重视。

Abstract:

Objective：To investigate the clinical significance of low grade squamous intraepithelial lesions（LSIL） in different cell morphology by applying cervical cytology. Methods：Results of 153 patients diagnosed with LSIL by cervical cytology and underwent human papilomavirus（HPV） typing detection，colposcopy and cervical biopsy from July 2017 to June 2018 were retrospectively ana－lyzed. Results：The LSIL patients with different cell morphology diagnosed by cervical cytology had high infection rates of high-risk HPV（HR-HPV）（81.0%）；the infection rate of LSIL patients with koilocyte was 77.0%，while of LSIL patients with non-koilocytotic cell was 83.7%. Among them，the HPV16 and HPV18 infection rates of LSIL patients with abnormal cells being non-koilocytotic cell were 18.5%（17/92），significantly higher than those of koilocyte type LSIL patients（6.6%，4/61）. The detection rate of biopsy patho－logical diagnosis ≥ intraepithelial lesion of cervix（CIN）Ⅱ among LSIL patients with non-koilocytotic cells was 28.3%（26/92），sig－nificantly higher than that among LSIL patients with koilocyte type（8.2%，5/61），with were statistically significant differences（P<0.05）. Conclusion：The LSIL patients with non-koilocytotic cells are more likely to have or progress into CIN Ⅱ and more severe lesions，therefore，clinicians should pay more attention to it.