阴道上皮内瘤变的临床特征及治疗和预后分析

王亚飞; 王立群; 叶国柳

doi:10.16766/j.cnki.issn.1674-4152.003067

阴道上皮内瘤变的临床特征及治疗和预后分析

doi: 10.16766/j.cnki.issn.1674-4152.003067

蚌埠医学院第一附属医院妇产科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究项目 KJ2019A0343

蚌埠医学院2019年自然科学重点项目 BYKY2019119ZD

详细信息

通讯作者:
王立群，E-mail：1204675442@qq.com

中图分类号: R711.73 R737.3
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出版历程
- 收稿日期: 2022-09-12
- 网络出版日期: 2023-08-28

Clinical features, treatment and prognosis of vaginal intraepithelial neoplasia

Department of Obstetrics and Gynecology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的研究阴道上皮内瘤变(VAIN)的一般临床特征及治疗方法和预后情况。方法回顾性收集2019年1月—2022年2月就诊于蚌埠医学院第一附属医院的168例经组织学确诊的VAIN患者的临床资料，比较不同筛查方法对诊断VAIN的敏感度，以及经过治疗后病变的消退情况。结果患者年龄为(49.52±11.63)岁，其中45岁及以上115例(68.5%)，57.1%的患者已绝经，细胞学、HPV、阴道镜及细胞学联合HPV的筛查敏感度分别为61.5%、92.4%、84.6%及95.0%，HPV筛查的总体敏感度显著高于细胞学检查(P=0.001)。子宫切除术后患者的细胞学检查敏感度与未行子宫切除患者的细胞学筛查敏感度差异无统计学意义(P=0.718)。阴道镜检查的病理符合率较细胞学检查高(P=0.001)。VAIN病变级别与合并宫颈病变的级别间存在正相关趋势(r=0.162，P=0.036)。HPV16是VAIN感染率最高的基因型。随访到的97例患者经过治疗后，病变降级和病变消退者共83例(85.6%)，其中2例患者病变消退后再次复发，经再次治疗后均好转，共有5例患者(5.2%)病变进展，其中1例VAIN 3患者进展为阴道癌，VAIN患者的预后可能与年龄相关。结论细胞学、HPV及阴道镜检查仍可作为VAIN的诊断程序, 经过积极治疗随访，大部分患者病变消退，预后良好。
- 阴道上皮内瘤变 /
- 人乳头瘤病毒 /
- 阴道镜 /
- 治疗方式 /
- 预后
Abstract: Objective To study the general clinical characteristics, treatment and prognosis of vaginal intraepithelial neoplasia (VAIN). Methods The clinical data of 168 patients with histologically confirmed VAIN admitted to the First Affiliated Hospital of Bengbu Medical College from January 2019 to February 2022 were retrospectively collected. The sensitivity of different screening methods to the diagnosis of VAIN and the regression of lesions after treatment were compared. Results The average age of the patients was (49.52±11.63) years old, of which 115 cases (68.5%) were 45 years old and above, and 57.1% of the patients were postmenopausal. The screening sensitivity of cytology, HPV, colposcopy, and cytology combined with HPV were 61.5%, 92.4%, 84.6% and 95.0%, respectively. The overall sensitivity of HPV screening was significantly higher than that of cytology (P=0.001). There was no significant difference in the sensitivity of cytological screening between patients after hysterectomy and those without hysterectomy (P=0.718). The pathological coincidence rate of colposcopy was higher than that of cytology (P=0.001). There was a positive correlation between the grade of VAIN and the grade of cervical lesions (r=0.162, P=0.036). HPV16 was the most common genotype of VAIN. Among the 97 patients who were followed up after treatment, 83 patients (85.6%) had lesion degradation and regression, of which 2 patients relapsed again after regression and improved after re-treatment. Five patients (5.2%) had lesion progression, of which 1 patient with VAIN3 progressed to vaginal cancer. The prognosis of VAIN patients may be related to age. Conclusion Cytology, HPV and colposcopy can still be used as a diagnostic procedure for VAIN. After active treatment and follow-up, most patients have a good prognosis.
- Vaginal intraepithelial neoplasia /
- Human papillomavirus /
- Colposcopy /
- Treatment /
- Prognosis

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图 1 VAIN的HPV分型

Figure 1. HPV typing of VAIN

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表 1 VAIN患者的一般临床特征[例(%)]

Table 1. General clinical characteristics of VAIN patients [case (%)]

临床资料	VAIN 1级	VAIN 2~3级	χ²值	P值
细胞学结果(n=143)			0.523	0.469
NILM	34(41.0)	21(35.0)
≤LSIL	44(53.0)	27(45.0)
≥ASC-H	5(6.0)	12(20.0)
HPV结果(n=158)			0.693	0.405
阳性	85(90.4)	61(95.3)
阴性	9(9.6)	3(4.7)
阴道镜诊断(n=136)			10.700	0.001
阴性	19(24.1)	2(3.5)
低度病变	54(68.4)	27(47.4)
高度病变	6(7.6)	28(49.1)
合并宫颈病变(n=167)			1.177	0.278
有	70(72.2)	45(64.3)
无	27(27.8)	25(35.7)
子宫切除史(n=166)			1.951	0.162
有	15(15.6)	17(24.3)
无	81(84.4)	53(75.7)

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表 2 宫颈病变与阴道上皮内瘤变的关系[例(%)]

Table 2. Relationship between cervical lesions and vaginal intraepithelial neoplasia [case (%)]

病变类型	例数	无合并	宫颈LSIL	宫颈HSIL	宫颈癌
VAIN 1级	97	27(27.8)	33(34.0)	32(33.0)	5(5.2)
VAIN 2~3级	70	25(35.8)	5(7.1)	32(45.7)	8(11.4)

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表 3 VAIN患者的治疗结局[例(%)]

Table 3. Treatment outcome of VAIN patients [case (%)]

病变等级	例数	病变消退	病变降级	病变稳定	病变进展
VAIN1	54	44(81.5)	0	7(12.9)	3(5.6)
VAIN 2~3	43	30(69.8)	9(20.9)	2(4.7)	2(4.7)
合计	97	74(76.3)	9(9.3)	9(9.3)	5(5.2)

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