HPV 亚型感染与液基非典型腺细胞涂片的临床探讨

摘要

目的：根据人乳头瘤病毒（HPV）感染亚型和组织学病理结果探讨非典型腺细胞（AGC）的临床结局。方法收集2009年1月1日至2014年2月28日在上海市长宁区妇幼保健院妇科门诊检查及治疗的102例 AGC 患者的宫颈液基细胞学（LBP）、HPV 和组织学资料，进行临床结果分析。结果67218名接受 LBP 检查患者中，AGC 患者102例，发病率为0．15％。AGC 无特异性（NOS）患者中，正常或良性病变67例，癌前和恶性病变11例；AGC 倾向于肿瘤患者中，良性病变、癌前和恶性病变分别为7例、14例和3例。同时，AGC-NOS 患者中，HPV 感染64例，其中高危型感染57例（16、52、45型），低危型感染7例（6、11型），单项感染、双重感染、三重感染分别为54、6、4例；AGC 倾向于肿瘤的患者中，HPV 感染19例，其中高危型感染18例（52、16、18型），低危型感染1例（6型），单项感染、双重感染分别为15、4例。结论 AGC 对宫颈恶性病变的预测起到了重要作用，不同 HPV 亚型感染在 AGC 相关肿瘤中的结果对宫颈不良病变的预测也发挥了一定作用，两者结合分析是判断妇科宫颈癌前病变和恶性肿瘤发生的重要信号，即 AGC 结合相应的 HPV 感染亚型，不仅为宫颈病变作出判断，也对妇科恶性肿瘤高风险存在的预测提供依据，对中国区域性宫颈癌的疫苗制造与推广提供建设性意见。%Objective To research the clinical outcome of atypical glandular cell (AGC)according to various subtypes of HPV infection and histological pathology results.Methods The data of the liquid-bases cytology (LBP),HPV infection and histology in 102 cases of AGC at the gynecology outpatient department of our hospital from January 1 ,2009 to February 28,2014 were collected and performed the analysis on their clinical outcomes.Results Among 67 218 cases of LBP detection,102 cases were AGC with the total incidence rate of 0.15%.In the cases of AGC-NOS,67 cases were normal or benign lesions,11 cases were precancerous lesion and malignant lesions;in the cases of AGC treading to tumor,the benign,precancerous and malignant lesions were in 7,14 and 3 ca-ses respectively.At the same time in the cases of AGC-NOS,HPV infection was in 64 cases,in which 57 cases were high risk infec-tion(type 16,52,45)and 7 cases were low risk infection(type 6,11 ).The single infection,double infection and multiple infection were in 54,6 cases respectively;in the cases of AGC trends to neoplasm,HPV infection was in 19 cases,in which 18 cases were high risk infection(type 52,16,18)and 1 case was low risk infection(type 6),single infection and double infection were in 15 cases and 4 cases respectively.Conclusion AGC may play an important role for the forecast of cervical malignant lesions.The results of differ-ent HPV subtypes infection in AGC related tumors also play a certain role in the prediction of cervical neoplasia.Their combined a-nalysis is the important signal for judging the occurrence of gynecological cervical precancerous lesion and malignant tumor,i.e., AGC combining with the corresponding HPV subtype infection not only can make a judgement for the cervical lesions,but also pro-vides the basis for predicting the high risk existence of gynecological malignant tumor and provides constructive suggestions for Chi-na regional cervical carcinoma vaccine manufacturing and promotion.