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绝经后妇女高危人乳头瘤病毒感染和子宫颈病变筛查与管理临床研究
黄君婷, 孔令华, 楼伟珍, 师晓华, 金力
中国实用妇科与产科杂志 ›› 2025, Vol. 41 ›› Issue (5) : 548-552.
PDF(871 KB)
PDF(871 KB)
绝经后妇女高危人乳头瘤病毒感染和子宫颈病变筛查与管理临床研究
A clinical study on screening and management of high-risk HPV infections and cervical lesions in postmenopausal women
目的 探讨绝经后妇女高危人乳头瘤病毒（high-risk human papilloma virus，HR-HPV）感染和子宫颈病变筛查与管理的有效方案。方法 回顾性分析2021年1月至2022年9月因绝经后发现子宫颈HR-HPV感染和（或）薄层液基细胞学检查（thinprep cytologic test，TCT）异常在北京协和医院妇科行阴道镜活检及手术治疗的289例患者，对比不同筛查方法的灵敏度，并通过logistic回归方法分析子宫颈高级别病变的危险因素、术后病理升级的危险因素。结果 绝经后妇女发现子宫颈病变的主要路径是健康体检（含HPV检测及TCT筛查），占80.3％（232/289）。HPV检测对于筛查绝经后妇女子宫颈低级别鳞状上皮内病变（low-grade squamous intraepithelial lesions，LSIL）及以上的灵敏度显著优于TCT检测（94.1% vs. 76.0%）。HPV16型、52型、58型、18型依次为绝经后妇女常见的HPV感染亚型，HPV亚型对于子宫颈病变级别差异无统计学意义。TCT结果为无明确诊断意义的非典型鳞状细胞（atypical squamous cells of undetermined significance，ASC-US）的患者阴道镜活检病理提示LSIL及以上病变的比例高达95.5%（105/110）。绝经时长是术后病理为高级别鳞状上皮内病变（high-grade squamous intraepithelial lesions，HSIL）及以上的危险因素（OR=1.2，95％CI 1.02~1.42，P=0.028），但不增加术后病理升级的风险。首发病变时长≥1年的患者，术后病理较阴道镜活检病理升级的风险明显升高（OR=2.385，95％CI 1.245~4.569，P=0.007）。结论 对绝经后人群子宫颈病变的筛查与管理应更加注重HPV检测结果，并相应放宽阴道镜检查指征。必要时进行诊断性手术，以明确病变的性质和范围。
Objective To explore the more effective screening methods and management strategies for high-risk human papilloma virus（HR-HPV） infections and cervical lesions in postmenopausal women. Methods A retrospective analysis was conducted on 289 postmenopausal patients who underwent colposcopic biopsy and surgical treatment at the Department of Gynecology，Peking Union Medical College Hospital，between January 2021 and September 2022，due to HR-HPV infection and/or abnormalities in ThinPrep cytologic test （TCT） results. The sensitivity of different screening methods was compared，and logistic regression analysis was used to identify risk factors for high-grade cervical lesions and for pathological upgrading after surgery. Results Health examinations，including HPV and TCT screenings，is the primary approach to identifying cervical lesions in postmenopausal women，accounting for 80.3% （232/289）. HPV testing demonstrated significantly higher sensitivity than TCT （94.1% vs. 76.0%）in detecting low-grade squamous intraepithelial lesions（LSIL）and above. HPV16，52，58，and 18 were the most prevalent HPV subtypes in postmenopausal women，with no significant difference in lesion grade across these types. Among patients with atypical squamous cells of undetermined significance(ASC-US) TCT results, 95.45% (105/110) of colposcopic biopsies revealed low-grade squamous intraepithelial lesion(LSIL) or higher-grade lesion. Menopause duration was a risk factor for postoperative high-grade squamous intraepithelial lesions（HSIL）and above（OR=1.20，95% CI 1.02-1.42，P=0.028），but did not elevate the likelihood of pathological upgrading after surgery. Patients with first-time lesions persisting for≥1 year had a significantly increased risk of pathological escalation by colposcopic pathology compared to postoperative pathology （OR=2.385，95% CI 1.245-4.569，P=0.007）. Conclusions Greater emphasis should be placed on HPV test outcomes in screening and managing cervical lesions in postmenopausal women，and the threshold for recommending colposcopy should be lowered accordingly. Diagnostic surgery is advised when necessary to clarify the nature and extent of cervical lesions.
绝经后人群 / 子宫颈病变 / 人乳头瘤病毒筛查 / 薄层液基细胞学检查筛查 / 阴道镜评估
postmenopausal population / cervical lesions / HPV screening / TCT screening / colposcopic evaluation
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