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投稿时间：2022-01-07 网络发布日期：2022-06-20
投稿时间：2022-01-07 网络发布日期：2022-06-20
中文摘要: 目的 探讨子宫颈管搔刮术（ECC）在子宫颈高级别鳞状上皮内病变及以上病变（HSIL+）诊断中适用人群。方法 收集贵州医科大学附属医院2017年1月至2021年5月同时接受ECC和子宫颈多点活检患者病历资料进行回顾性分析，将610例患者分为ECC与多点活检病理结果一致组和结果不一致组，并将不一致组分为ECC病理结果高于多点活检和低于多点活检2个亚组，进行统计分析和多因素Logistic回归分析。结果 本研究共纳入610例患者，一致组392例（64.3%），不一致组218例（35.7%）；不一致组中ECC病理结果高于多点活检有55例（25.2%），低于多点活检有163例（74.8%）。两组年龄、民族、阴道分娩次数、绝经、合并高血压/糖尿病、细胞学HSIL+、无临床症状和阴道出血情况差异有统计学意义（P＜0.05）。多因素Logistic回归分析显示，少数民族（OR=1.718，95%CI：1.103～2.677）、细胞学无上皮内病变或肿瘤细胞（NILM）（OR=2.356，95%CI：1.405～3.949）、ASC-US（OR=2.356，95%CI：1.423～3.903）、ASC-H（OR=1.741，95%CI：1.081～2.805）、无临床症状（OR=2.137，95%CI：1.304～3.500）是ECC与多点活检结果不一致的独立危险因素。亚组比较显示，年龄40～59岁是ECC检出高于多点活检的独立危险因素（OR=2.460，95%CI：1.064～5.689）。结论 少数民族、宫颈细胞学、临床症状是ECC与多点活检结果不一致的影响因素，年龄40～59岁是ECC病理结果高于多点活检的危险因素。
Abstract:Objective To explore the suitable population for endocervical curettage (ECC) in the diagnosis of high-grade cervical squamous intraepithelial lesion or worse lesions (HSIL+). Methods The medical records of 610 patients received ECC and cervical multi-point biopsy in the Affiliated Hospital of Guizhou Medical University from January 2017 to May 2021 were collected for retrospective analysis. The patients were divided into consistent group (ECC being consistent with pathological results of multi-point biopsy) and inconsistent group (ECC being different from pathological results of multi-point biopsy). The inconsistent group was subdivided into group A (ECC pathological classification being more severe than multi-point biopsy) and group B (ECC pathological classification being less severe than multi-point biopsy). The multivariable Logistic regression analysis was performed. Results Out of 610 patients, there were 392 (64.3%) patients in consistent group and 218 (35.7%) patients in inconsistent group, in which there were 55 cases (25.2%) in group A and 163 cases (74.8%) in group B. There were significant differences in age, nationality, number of vaginal deliveries, menopause, history of hypertension/diabetes mellitus, cytological HSIL+, no clinical symptom and vaginal bleeding between two groups (P<0.05). Multivariable Logistic regression analysis showed that ethnic minorities (OR=1.718, 95%CI: 1.103-2.677), cytological negative for intraepithelial lesion or malignancy (NILM) (OR=2.356, 95%CI: 1.405-3.949), atypical squamous cells (ASC) of undetermined significance (ASC-US) (OR=2.356, 95%CI: 1.423-3.903), ASC cannot exclude HSIL (ASC-H) (OR=1.741,95%CI: 1.081-2.805), asymptomatic manifestations (OR=2.137, 95%CI: 1.304-3.500) were the independent factors influencing the consistency between ECC and cervical multi-point biopsy. Age 40-59 years old was an independent risk factor for higher detection of ECC than multi-point biopsy (OR=2.460, 95%CI: 1.064-5.689). Conclusion Ethnic minorities, cervical cytology and asymptomatic manifestations are the independent influencing factors for the inconsistency between ECC and cervical multi-spot biopsy. Age of 40-59 years old is an independent risk factor for higher pathological classification of ECC than that of multi-spot biopsy.
keywords: Endocervical curettage Cervical intraepithelial lesions Liquid-based cytology Ethnic minority
文章编号： 中图分类号：R711.74 文献标志码：A
基金项目:国家自然科学基金NSFC培育项目(gyfynsfc［2020］-35)；贵州医科大学附属医院院级临床研究课题（2021-GMHCT-006）
| 作者 | 单位 |
| 钟方梅1 | 1. 贵州医科大学临床医学院，贵州 贵阳 550004 |
| 周遵伦2 | 2. 贵州医科大学附属医院妇产科，贵州 贵阳 550004 |
| 郭桂芝2 | 2. 贵州医科大学附属医院妇产科，贵州 贵阳 550004 |
| 李建2 | 2. 贵州医科大学附属医院妇产科，贵州 贵阳 550004 |
| 聂蕾2 | 2. 贵州医科大学附属医院妇产科，贵州 贵阳 550004 |
| Author Name | Affiliation |
| ZHONG Fang-mei*, ZHOU Zun-lun, GUO Gui-zhi, LI Jiang, NIE Lei | *School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou 550004, China |
引用文本：
钟方梅,周遵伦,郭桂芝,等.子宫颈管搔刮术在子宫颈高级别鳞状上皮内病变及以上病变诊断中的应用[J].中国临床研究,2022,35(6):788-792,796.
钟方梅,周遵伦,郭桂芝,等.子宫颈管搔刮术在子宫颈高级别鳞状上皮内病变及以上病变诊断中的应用[J].中国临床研究,2022,35(6):788-792,796.