宫颈脱落细胞学阴性生殖道高危型人乳头瘤病毒阳性患者的临床病理特征

目的 探讨宫颈脱落细胞学阴性（pap smear negative，Pap-）、人乳头瘤病毒阳性（high risk human papilloma virus positive，HPV+）女性的临床病理特征。方法 纳入1 128例Pap-/HPV+女性，阴道镜下可疑部位活检。分析Pap-/HPV+状态下HPV的流行病学特征及宫颈病变的临床病理特征。结果 Pap-/HPV+女性HPV的流行特征，HPV-16所占比例较高（χ²=16.81，P=0.000），患者年龄偏大（χ²=20.72，P=0.000），单一病毒感染比例较高（χ²=8.93，P=0.01）。506例患者接受阴道镜下活检，高度鳞状上皮病变（high grade squamous intraepithelial lesion，HSIL）病例254例（50.19%），其中7例宫颈浸润癌。HSIL的发生率与年龄有关，年轻患者HSIL比例更高，与年龄呈负相关（r=-0.254，P=0.000）。各HPV亚型发生HSIL的比例不同，HPV-16型发生HSIL的比例最高（64.7%）。与对照组比较，Pap-/HPV+女性感染HPV-16、18、31、33、52、58型显著增加HSIL病变的危险。结论 Pap-/HPV+女性HPV的流行病学特征不同，具有宫颈高级别病变的危险。

Cervical pathological features in cytological-negative/HPV-positive women

Objective To evaluate the cervical pathological features of cytological negative(Pap-)/high-risk human papillomavirus (HR-HPV+) positive women.Methods This study recruited 1 128 women aged 20-79 years who had undergone cervical screening by liquid-based cytology and HR-HPV test (13 HR-HPV types) at Beijing Chaoyang Hospital during Jan 2014 to Dec 2015. Colposcopy and cervical biopsy were carried out in 506 women. Results The prevalence of HPV in Pap negative/HPV positive (Pap-/HPV+) women was different from that of all HPV positive population at the same time, and the proportion of HPV-16 was higher. Pathological features:506 patients received colposcopic biopsy, 247 cases (50.19%) were diagnosed as HSIL, while 7 patients were diagnosed as invasive cervical cancer. The incidence of HSIL was related to the age. The younger, the higher risk of HSIL. There was a significant negative correlation between the age and the rate (r=-0.254, P=0.000). HSIL incidence was associated with different types of HPV infection, with HPV-16 being the highest (64.7%). Compared with the control group, women infected by HPV-16, 18,31,33,52 and 58 in the Pap-/HPV+increased significantly the risk of HSIL lesions. Conclusion Overall, 50.19% of Pap-/HPV+women had significant cervical lesions. Pap-/HPV+women showed different epidemiological characteristics in HPV and were at high risk of HSIL lesions.