闵行区宫颈疾病筛查模式效果的回顾性研究

目的:探索上海闵行地区宫颈疾病筛查最为经济可靠的模式。方法:以2008.07.01～2011.06.30录入电子病历信息管理系统(EHR)中的宫颈疾病筛查对象为研究对象(n=14 526),依社区健康教育督促(A组,n=2 507)、贫困妇女免费普查(B组,n=7 396)、因症就医机会性筛查(C组,n=4 623)3类筛查方式进行分组,通过队列研究比较3组间宫颈疾病筛查的效果。结果:所有研究对象中巴氏涂片≥Ⅲ级者占26.3%(3 781/14 526),B组高达29.20%(2 160/7 396),3组间构成比具有统计学差异(χ2=87.58,P<0.000 1)。因巴氏涂片≥Ⅲ级进一步行TCT+阴道镜+组织活检者共计3 491例,经组织病理学诊断为LSIL者占8.34%(291/3 491)、HSIL者占2.95%(103/3 491)、宫颈癌占1.17%(41/3 491);宫颈病变总体检出率各组间具有统计学差异(χ2=14.26,P=0.000 8),C组最高,达15.23%(141/926);不同级别宫颈病变检出率在各组间也具有统计学差异(χ2=14.52,P=0.02)。所有对象(剔除未能转诊的失随访者)中LSIL检出率为2.04%(291/14 236),HSIL检出率为0.72%(103/14 236),宫颈癌检出率为0.29%(41/14 236)。Logistic回归提示年龄增大及流动人口是筛查出HSIL及宫颈癌的风险因素,在C组对象中尤为明显。结论:贫困免费筛查以及因症就医机会性筛查对象是今后初筛人群选择的重点。机会性筛查因针对性更强,相对节约资源,或许能成为城市地区最为经济可靠的宫颈疾病长期筛查模式。

Cervical Screening in Shanghai: A Cohort Study on Population Sources and Screening Protocols

Objective: To investigate an economic and reliable screening method for cervical lesions.Methods: Electric history system(EHS) enrolled 14 526 women with different sources for cervical lesion screening,they were divided into three groups,group A: by educational sessions(n=2 507);group B: by free screening for the underprivileged(n=7 396);group C: by opportunistic screening(n=4 623).A cohort study was conducted to compare the screening results.Results: About 26.3%(3781/14 526) of the women enrolled were positive following classical Pap,highest in group B(29.20%,2 160/7 396;χ2=87.58,P<0.00 1).All Pap(+) women should accept TCT,colposcopy and biopsy(3 491 women accepted actually).For the Pap(+) women,pathologically 8.34%(291/3 491) were LSIL,2.95%(103/3 491) were HSIL,and 1.17%(41/3 491) were cervical carcinoma,highest in group C(15.23%,141/926;χ2=14.52,P=0.02).Despite those Pap(+) women who refused further tests,totally 2.04%(291/14 236) were LSIL,0.72%(103/14 236) were HSIL and 0.29%(41/14 236) were cervical carcinoma.Logistic regression indicated "aging" and "internal migrant" as the risk factors to HSIL and cervical carcinoma,of which the ORs were highest in group C.Conclusions: Free screening for the underprivileged and opportunistic screening were proved effective,while opportunistic screening would be more reliable for urban regions.