Agreement rate of grade 1 cervical intraepithelial neoplasia diagnosed by colposcopic cervical biopsy with pathological results and high risk factors of pathological upgrading
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摘要:目的 分析阴道镜下宫颈活检诊断子宫颈上皮内瘤变(CIN) 1级与病理结果的相符性及病理升级的高危因素。方法 回顾性分析310例阴道镜下活检诊断为CIN 1级的患者临床资料，均行宫颈环形电切术(LEEP), 计算所有患者术前活检诊断与术后组织病理学诊断的符合率。分析患者病理升级的相关因素。结果 术前活检诊断与LEEP术后病理结果的符合率为86.77%(269/310), 活检结果为CIN 1级患者中，病理诊断为CIN 2级及以上病变的病理升级率13.23%(41/310)。单因素分析显示，阴道镜检查前的宫颈细胞学异常、HPV16/18阳性、绝经、阴道镜检查不满意是阴道镜下活检诊断低级别鳞状上皮内病变(LSIL)患者术后病理升级的影响因素(P＜0.001)。多因素分析结果显示，宫颈细胞学异常、阴道镜检查不满意、绝经、HPV16/18阳性均是术后病理升级的独立高危因素(P＜0.001)。结论 阴道镜检查满意状况、宫颈细胞学异常以及绝经、HPV16/18阳性等是患者术后病理升级的影响因素。Abstract:Objective To analyze the agreement rate of grade 1 cervical intraepithelial neoplasia (CIN) diagnosed by colposcopic cervical biopsy with pathological results and the high risk factors of pathological upgrading.Methods The clinical materials of 310 patients with grade 1 CIN diagnosed by colposcopic biopsy were analyzed retrospectively, and loop electrosurgical excision procedure (LEEP) was performed for all patients. The agreement rate between preoperative biopsy diagnosis and postoperative histopathology diagnosis was calculated. The related factors of patients' pathological upgrading was analyzed.Results The agreement rate of preoperative biopsy diagnosis with postoperative pathological results of LEEP was 86.77% (269/310), and the pathological upgrading rate of CIN 2 and above by pathology resnlts in CIN 1 cases diagnosed by biopsy was 13.23% (41/310). Univariate analysis showed that abnormal cervical cytology before colposcopy, positive HPV16/18, menopause and unsatisfactory colposcopy were the influencing factors of pathological upgrading of patients with low grade squamous intraepithelial lesion (LSIL) diagnosed by colposcopy (P < 0.001). The results of multivariate analysis showed that abnormal cervical cytology, unsatisfactory colposcopy, menopause and positive HPV16/18 were the independent risk factors for postoperative pathological upgrading (P < 0.001).Conclusion Satisfactory colposcopy, abnormal cervical cytology, menopause and positive HPV16/18 are the influencing factors of postoperative pathological upgrading.
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表 1 阴道镜下活检诊断CIN 1级者术后病理升级的多因素Logistic回归分析
影响因素 B SE Walds P OR 95%CI 绝经 1.579 0.387 16.990 ＜0.001 5.029 2.056~8.348 宫颈细胞学异常 1.310 0.289 17.893 ＜0.001 3.627 1.056~6.348 阴道镜检查不满意 2.241 0.325 51.467 ＜0.001 9.348 5.056~17.348 HPV16/18阳性 1.134 0.462 7.032 ＜0.001 4.136 2.056~6.348 
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1. 刘欢，王青. 新生儿静脉留置针治疗期间基于失效模式与效应分析模式的护理管理研究. 实用临床医药杂志. 2020(18): 113-115 . 
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