目的:探讨子宫颈细胞学检查未见异常的HPV高危亚型感染者的管理模式.方法:收集2010年1月至2012年12月在北京大学第一医院妇产科门诊同时行宫颈细胞学检查及HPV DNA分型检测的妇女的资料,分析初次检出细胞学未见异常者的HPV高危亚型16、18、31、33感染者,其检出CIN2及以上病变的风险以及与感染亚型的相关性.结果:993例细胞学检查未见异常但HPV16、18、31、33型阳性者中,共检出CIN1 76例(7.7％),CIN2 50例(50/993,5.0％),CIN3 27例(27/993,2.7％);其中HPV16(+)感染者532例(532/993,53.6％),检出CIN2 34例(34/532,6.4％),CIN3 21例(21/532,3.9％);HPV18(+)HPV16(-)感染者142例(142/993,14.3％),检出CIN2 2例(2/142,1.4％),CIN3 1例(1/142,0.7％);HPV31(+)HPV1618(-)感染者137例(137/993,13.8％),检出CIN2 9例(9/137,6.6％),CIN3 2例(2/137,1.5％);HPV33(+)HPV1618(-)感染者182例(182/993,18.3％),检出CIN2 5例(5/182,2.7％),CIN3 3例(3/182,1.6％).按是否检出CIN2+进行Logistic回归分析,发现HPV16型感染与CIN2+有相关性[OR值=2.353(95％CI1.004～5.516),P=0.049].结论:对筛查中初次检出宫颈细胞学未见异常,但HPV高危亚型感染者应予以重视,对于HPV16、18型感染者建议立即行阴道镜检查.%Objectives:To discuss the management model of HR-HPV subtype infected women with negative cervical cytology results.Methods:The data of patients who choose the combination test of TCT and HPV-DNA genotyping for cervical screening from January 2010 and December 2012 in our hospital were analyzed to get the risk of CIN2 and higher level lesion and correlation between CIN2 and HR-HPV subtype infection.Results:There were 993 patients who suffered HPV1618 31 33 infection but cytology test result was negative,of which there were 76 cases of CIN1 (7.7％),50 cases of CIN2 (50/993,5.0％) and 27 cases of CIN3 (27/993,2.7％).There were 532 cases of HPV 16 infection (532/993,53.6％),of which there were 34 cases of CIN2 (34/532,6.4％) and 21 cases of CIN3 (21/532,3.9％).There were 142 cases of HPV 18 infection without HPV 16 infection (142/993,14.3 ％),of which there were 2 cases of CIN 2 (2/142,1.4％) and a case of CIN 3 (1/142,0.7％).There were 137 cases of HPV 31 infection (137/993,13.8 ％) with no HPV 1618 infection,of which there were 9 cases of CIN 2 (9/137,6.6％) and 2 cases of CIN 3 (2/137,1.5％).There were 182 cases of HPV 33 infection (182/993,18.3 ％) with no HPV 1618 infection,of which there were 5 cases of CIN 2 (5/182,2.7％) and 3 cases of CIN 3 (3/182,1.6％).According to CIN2/3 detection result,Logistic regression analysis showed HPV16 conrelated with CIN2 (OR =2.353 (95％ CI 1.004 ～ 5.516),P =0.049).Conclusion:More attention should be paid to women whose cervical cytology result is negative but HPV high risk subtype infection is positive,and immediate colposcopy should be given to patients with HPV1618 infection.
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