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目的对比分析两种方法检出宫颈疾病的差异,为进一步制定宫颈癌的筛查策略提供依据。方法按整群抽样的方法,对2014年新密市35~64岁的农村妇女分两组进行宫颈癌筛查:一组采用VIA/VILI结合巴氏涂片的方法 (绝经前妇女使用VIA/VILI筛查,绝经后妇女使用巴氏涂片);另一组妇女采用高危型HPV检测法筛查。VIA/VILI异常、巴氏涂片结果≥不明确意义的非典型鳞状细胞(ASC-US)及HPV阳性者转诊阴道镜,并对镜下异常处取活检,活检结果 CIN2及以上病变的妇女需手术治疗。结果 VIA/VILI结合巴氏涂片筛查6 694例妇女,平均年龄(48.71±8.25)岁,阳性率17.28%,CINⅠ、CINⅡ、CINⅢ及宫颈癌的检出率分别是0.19%、0.16%、0.13%、0.03%。高危型HPV筛查妇女18 345例,平均年龄(47.58±8.39)岁,阳性率10.80%,50岁以上妇女的阳性率较高;CINⅠ、CINⅡ、CINⅢ及宫颈癌的检出率分别是0.56%、0.31%、0.39%、0.08%。与VIA/VILI结合巴氏涂片法比较,高危型HPV对宫颈癌前病变的检出率高(P<0.01)。结论 2014年新密市宫颈癌前病变及宫颈癌检出率较高;HPV筛查能够提高宫颈癌前病变的检出率,基层单位有能力独立完成筛查,应作为宫颈癌筛查方法推广使用。
Objective To compare and analyze the differences of cervical diseases detected by the two methods and provide evidences for further screening strategies of cervical cancer. Methods According to the cluster sampling method, rural women aged 35-64 years old in Xinmi were enrolled in two groups for cervical cancer screening in 2014. One group adopted VIA / VILI combined with Pap smear (pre-menopausal women used VIA / VILI screening, postmenopausal women using Pap smear); another group of women using high-risk HPV screening test. VIA / VILI abnormalities, Pap smear results ≥ indeterminate significance of atypical squamous cells (ASC-US) and HPV-positive colposcopy, and microscopic examination of biopsies, biopsy results CIN2 and above lesions Women need surgery. Results The VIA / VILI combined Pap smear screening 6 694 women, the average age (48.71 ± 8.25) years old, the positive rate of 17.28%, CIN Ⅰ, CIN Ⅱ, CIN Ⅲ and cervical cancer detection rates were 0.19%, 0.16% 0.13%, 0.03%. 18 345 cases of high-risk HPV screening, the average age (47.58 ± 8.39) years, the positive rate was 10.80%, the positive rate of women over the age of 50 high; CINⅠ, CINⅡ, CINⅢ and cervical cancer detection rates were 0.56% , 0.31%, 0.39%, 0.08%. Compared with VIA / VILI combined with Pap smear, high-risk HPV detected a high incidence of cervical precancerous lesions (P <0.01). Conclusions The detection rate of cervical precancerous lesions and cervical cancer is higher in Xinmi in 2014. HPV screening can improve the detection rate of cervical precancerous lesions. The primary unit has the ability to independently screen and should be popularized as a screening method of cervical cancer use.