30岁以下女性宫颈高级别病变临床特点及宫颈管搔刮诊断价值研究

doi:10.12114/j.issn.1007-9572.2025.0114

中国全科医学 ›› 2026, Vol. 29 ›› Issue (23): 3315-3319.DOI: 10.12114/j.issn.1007-9572.2025.0114

30岁以下女性宫颈高级别病变临床特点及宫颈管搔刮诊断价值研究

陈菁¹, 王朝行², 钱睿亚¹^,^*(), 刘勇¹^,^*()

1．100026　北京市，首都医科大学附属北京妇产医院　北京妇幼保健院妇科
2．562400　贵州省兴义市人民医院妇科

收稿日期:2025-04-02 修回日期:2025-07-19 出版日期:2026-08-15 发布日期:2026-07-03
通讯作者: 钱睿亚, 刘勇
作者贡献：
陈菁负责文章构思与框架设计，数据分析，结果解释，撰写论文；王朝行负责整理数据，文章的修订；钱睿亚、刘勇负责文章的质量控制与审查，对文章整体负责，监督管理。
基金资助:
首都医科大学附属北京妇产医院科技创新及转化专项(FCYYLC202408)

The Clinical Characteristics of High-grade Squamous Intraepithelial Lesions and Diagnostic Value of Endocervical Curettage in Women Aged Under 30 Years

CHEN Jing¹, WANG Chaoxing², QIAN Ruiya¹^,^*(), LIU Yong¹^,^*()

1. Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
2. Department of Gynecology, Xingyi People's Hospital, Xingyi 562400, China

Received:2025-04-02 Revised:2025-07-19 Published:2026-08-15 Online:2026-07-03
Contact: QIAN Ruiya, LIU Yong

摘要/Abstract

摘要： 背景自2017年人乳头瘤病毒（HPV）疫苗国内批准上市以来，已有部分年轻女性完成HPV疫苗接种，HPV疫苗接种是否影响年轻女性宫颈高级别鳞状上皮内病变（HSIL）的检出以及阴道镜下宫颈管搔刮（ECC）诊断价值尚不明确。目的了解30岁以下女性宫颈HSIL检出的临床特征，并探讨阴道镜下ECC对HSIL检出的价值。方法回顾性分析2021年6月—2022年6月于首都医科大学附属北京妇产医院妇科门诊阴道镜室行阴道镜下宫颈活检和/或ECC且年龄<30岁的患者427例。患者均行细胞学和高危型HPV检测，因筛查异常转诊阴道镜检查。以病理结果为诊断金标准，宫颈上皮内病变的诊断采用WHO 2014年两级分类法HSIL及低级别鳞状上皮内病变（LSIL）标准诊断。HSIL诊断率定义为宫颈活检和/或ECC检出HSIL的病例数/总例数。活检诊断率定义为宫颈活检检出HSIL的病例数/总例数。ECC诊断率定义为ECC检出HSIL的病例数/总例数。ECC的额外HSIL诊断率定义为宫颈活检未发现HSIL，但ECC检出HSIL的病例数/总例数，以此评价ECC的诊断价值。采用多因素Logistic回归分析探讨30岁以下女性HSIL检出的影响因素。结果 427例患者中，仅宫颈活检155例（36.3%），检出HSIL 19例；同时行宫颈活检和ECC 272例（63.7%），检出HSIL 76例，其中2例为ECC额外检出。HSIL诊断率为22.2%（95/427），活检诊断率为21.8%（93/427），ECC诊断率为1.6%（7/427），ECC额外诊断率为0.5%（2/427）。多因素Logistic回归分析结果显示，细胞学高级别异常（OR=7.274，95%CI=1.901~27.828）、HPV 16/18阳性（OR=10.833，95%CI=1.317~89.135）是HSIL检出的危险因素（P<0.05）。结论在30岁以下女性人群中，细胞学高级别异常和HPV 16/18感染是HSIL检出的独立危险因素。ECC在30岁以下人群中HSIL的额外检出意义不大，建议除上述两个影响HSIL检出的独立危险因素外，均可不行ECC。

关键词: 宫颈高级别病变, 阴道镜, 宫颈管搔刮术, 人乳头瘤病毒疫苗, 30岁以下女性

Abstract:

Background

Since the approval of HPV vaccines in China in 2017, a portion of young women have been vaccinated. However, whether HPV vaccination affects the detection of HSIL in young women and the diagnostic value of ECC remains unclear.

Objective

To understand the clinical characteristics of high-grade squamous intraepithelial lesion (HSIL) in women under 30 years and to explore the value of endocervical curettage (ECC) under colposcopy in detecting HSIL.

Methods

A retrospective analysis was performed on patients under 30 years of age who underwent colposcopy-guided cervical biopsy and/or ECC in the Colposcopy Room of the Gynecological Clinic, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from June 2021 to June 2022. A total of 427 cases were enrolled. All patients underwent cytology and high-risk HPV testing, and were referred for colposcopy due to abnormal screening results. With pathological results as the gold standard for diagnosis, the diagnosis of cervical intraepithelial lesions was made in accordance with the WHO 2014 two classification system, which included high-grade squamous intraepithelial lesion (HSIL) and low-grade squamous intraepithelial lesion (LSIL). The HSIL detection rate was defined as the number of cases with HSIL detected by cervical biopsy and/or ECC divided by the total number of cases. The biopsy detection rate was defined as the number of cases with HSIL detected by cervical biopsy divided by the total number of cases. The ECC detection rate was defined as the number of cases with HSIL detected by ECC divided by the total number of cases. The additional HSIL detection rate of ECC was defined as the number of cases with HSIL detected by ECC but not found in cervical biopsy divided by the total number of cases, so as to evaluate the diagnostic value of ECC. Multivariate Logistic regression analysis was used to explore the clinical characteristics of HSIL detection in women under 30 years old.

Results

Among the 427 patients, 155 cases (36.3%) underwent only multi-point cervical biopsy, with 19 cases diagnosed with HSIL; 272 cases (63.7%) underwent both multi-point biopsy and ECC, with 76 cases diagnosed with HSIL, among which 2 cases were additionally detected by ECC. The overall HSIL detection rate was 22.2% (95/427), the biopsy detection rate was 21.8% (93/427), the ECC detection rate was 1.6% (7/427), and the additional HSIL detection rate by ECC was 0.5% (2/427). Results of multivariate Logistic regression analysis showed that cytological HSIL (OR=7.274, 95%CI=1.901-27.828) and positive HPV 16/18 (OR=10.833, 95%CI=1.317-89.135) were risk factors for HSIL detection (P<0.05).

Conclusion

In women under 30 years old, cytology HSIL and HPV 16/18 infection are two independent risk factors affecting HSIL detection. ECC has little additional significance in detecting HSIL in people under 30 years old. It is suggested that ECC may not be necessary for women under 30 years who do not have the two independent risk factors mentioned above.

Key words: High-grade squamous intraepithelial lesion, Colposcopy, Endocervical curettage, Human papillomavirus vaccines, Women under 30 years

中图分类号:

R 711.74

陈菁,王朝行,钱睿亚,等. 30岁以下女性宫颈高级别病变临床特点及宫颈管搔刮诊断价值研究[J]. 中国全科医学, 2026, 29(23): 3315-3319. DOI: 10.12114/j.issn.1007-9572.2025.0114.
CHEN Jing,WANG Chaoxing,QIAN Ruiya, et al. The Clinical Characteristics of High-grade Squamous Intraepithelial Lesions and Diagnostic Value of Endocervical Curettage in Women Aged Under 30 Years[J]. Chinese General Practice, 2026, 29(23): 3315-3319. DOI: 10.12114/j.issn.1007-9572.2025.0114.

图/表 3

参考文献 25

[1]	Stuebs F A, Gass P, Dietl A K, et al. Human papilloma virus genotype distribution in women with premalignant or malignant lesions of the uterine cervix[J]. Arch Gynecol Obstet, 2021, 304(3): 751-758. DOI: 10.1007/s00404-021-05986-z.
[2]	Revathidevi S, Murugan A K, Nakaoka H, et al. APOBEC: a molecular driver in cervical cancer pathogenesis[J]. Cancer Lett, 2021, 496: 104-116. DOI: 10.1016/j.canlet.2020.10.004.
[3]	Stuebs F A, Koch M C, Dietl A K, et al. Cytology and high-risk human papillomavirus test for cervical cancer screening assessment[J]. Diagnostics, 2022, 12(7): 1748. DOI: 10.3390/diagnostics12071748.
[4]	魏丽惠, 吴久玲. 子宫颈癌检查质量保障及质量控制指南[M]. 北京: 人民卫生出版社, 2015.
[5]	毕蕙, 赵更力. 子宫颈癌综合防控技术培训教程[M]. 北京: 人民卫生出版社, 2015.
[6]	UK National Screening Committee. Guidance cervical screening: program overview[EB/0L].[2023-12-29].
[7]	Dickinson J, Tsakonas E, Gorber S C, et al. Recommendations on screening for cervical cancer[J]. CMAJ, 2013, 185(1): 35-45. DOI: 10.1503/cmaj.121505.
[8]	中国优生科学协会阴道镜和子宫颈病理学分会, 中华医学会妇科肿瘤学分会, 中国抗癌协会妇科肿瘤专业委员会, 等. 中国子宫颈癌筛查指南(一)[J]. 现代妇产科进展, 2023, 32(7): 481-487. DOI: 10.13283/j.cnki.xdfckjz.2023.07.001.
[9]	王临虹, 赵更力. 子宫颈癌综合防控指南[M]. 2版. 北京: 人民卫生出版社, 2023.
[10]	Nayar R, Wilbur D C. The pap test and Bethesda 2014: "the reports of my demise have been greatly exaggerated.(after a quotation from Mark Twain)"[J]. J Low Genit Tract Dis, 2015, 19(3): 175-184. DOI: 10.1097/LGT.0000000000000115.
[11]	Bornstein J, Bentley J, Bösze P, et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy[J]. Obstet Gynecol, 2012, 120(1): 166-172. DOI: 10.1097/AOG.0b013e318254f90c.
[12]	卢朝辉, 陈杰. WHO女性生殖器官肿瘤学分类(第4版)解读[J]. 中华病理学杂志, 2014, 43(10): 649-650. DOI:10.3760/cma.j.issn.0529-5807.2014.10.001.
[13]	World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention[EB/OL].[2024-12-29].
[14]	Perkins R B, Guido R S, Castle P E, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors[J]. J Low Genit Tract Dis, 2020, 24(2): 102-131. DOI: 10.1097/LGT.0000000000000525.
[15]	徐书航. 30岁以下女性宫颈癌筛查的回顾性分析[D]. 杭州: 浙江大学, 2020.
[16]	米兰, 颛佳, 张岱, 等. 阴道镜下宫颈管搔刮术对宫颈高级别病变检出的作用[J]. 中国妇产科临床杂志, 2019, 20(2): 128-131. DOI: 10.13390/j.issn.1672-1861.2019.02.011.
[17]	Liu A H, Walker J, Gage J C, et al. Diagnosis of cervical precancers by endocervical curettage at colposcopy of women with abnormal cervical cytology[J]. Obstet Gynecol, 2017, 130(6): 1218-1225. DOI: 10.1097/AOG.0000000000002330.
[18]	Pretorius R G, Belinson J L, Peterson P, et al. Which colposcopies should include endocervical curettage?[J]. J Low Genit Tract Dis, 2015, 19(4): 278-281. DOI: 10.1097/LGT.0000000000000119.
[19]	张永霞. 年轻女性宫颈癌筛查意义探讨[D]. 南昌: 南昌大学, 2022.
[20]	Falcaro M, Castañon A, Ndlela B, et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study[J]. Lancet, 2021, 398(10316): 2084-2092. DOI: 10.1016/S0140-6736(21)02178-4.
[21]	St Laurent J, Luckett R, Feldman S. HPV vaccination and the effects on rates of HPV-related cancers[J]. Curr Probl Cancer, 2018, 42(5): 493-506. DOI: 10.1016/j.currproblcancer.2018.06.004.
[22]	Jach R, Mazurec M, Trzeszcz M, et al. COLPOSCOPY 2020-COLPOSCOPY PROTOCOLS: a summary of the clinical experts consensus guidelines of the Polish Society of Colposcopy and Cervical Pathophysiology and the Polish Society of Gynaecologists and Obstetricians[J]. Ginekol Pol, 2020, 91(6): 362371. DOI: 10.5603/GP.2020.0075.
[23]	宋祎凡, 刘晓雪, 尹遵栋, 等. 2018—2020年中国9-45岁女性人乳头瘤病毒疫苗估算接种率[J]. 中国疫苗和免疫, 2021, 27(5): 570-575. DOI: 10.19914/j.CJVI.2021101.
[24]	郭靖, 庞佩, 高迪, 等. HPV疫苗接种对阴道镜下组织学子宫颈高级别上皮内病变检出的影响[J]. 中国妇产科临床杂志, 2024, 25(6): 504-507. DOI: 10.13390/j.issn.1672-1861.2024.06.007.
[25]	Massad L S, Perkins R B, Naresh A, et al. Colposcopy standards: guidelines for endocervical curettage at colposcopy[J]. J Low Genit Tract Dis, 2023, 27(1): 97-101. DOI: 10.1097/LGT.0000000000000710.

项目	例数	组织病理学HSIL	χ²值	P值
年龄			2.660	0.103
<25岁	68	10（14.7）
25~29岁	359	85（23.7）
细胞学检查			11.181	<0.001
低级别异常	416	88（21.2）
高级别异常	11	7（63.6）
HPV状态			13.69	0.001
非16/18的高危型HPV阳性	186	30（16.1）
HPV 16/18阳性	220	64（29.1）
HPV阴性	21	1（4.7）
HPV疫苗			0.051	0.821
已接种	148	32（21.6）
未接种	279	63（22.6）
阴道镜下转化区类型			1.044	0.307
充分（1型转化区）	223	54（24.2）
不充分（2/3型转化区）	204	41（20.1）

项目	例数	组织病理学HSIL	χ²值	P值
年龄			2.660	0.103
<25岁	68	10（14.7）
25~29岁	359	85（23.7）
细胞学检查			11.181	<0.001
低级别异常	416	88（21.2）
高级别异常	11	7（63.6）
HPV状态			13.69	0.001
非16/18的高危型HPV阳性	186	30（16.1）
HPV 16/18阳性	220	64（29.1）
HPV阴性	21	1（4.7）
HPV疫苗			0.051	0.821
已接种	148	32（21.6）
未接种	279	63（22.6）
阴道镜下转化区类型			1.044	0.307
充分（1型转化区）	223	54（24.2）
不充分（2/3型转化区）	204	41（20.1）

变量	β	SE	Wald χ²值	P值	OR值（95%CI）
细胞学（以低级别异常为参照）
高级别异常	1.984	0.685	8.402	0.004	7.274（1.901~27.828）
HPV状态（以HPV阴性为参照）
非16/18的高危型HPV阳性	1.599	1.079	2.196	0.138	4.949（0.597~41.037）
HPV 16/18阳性	2.383	1.075	4.910	0.027	10.833（1.317~89.135）

变量	β	SE	Wald χ²值	P值	OR值（95%CI）
细胞学（以低级别异常为参照）
高级别异常	1.984	0.685	8.402	0.004	7.274（1.901~27.828）
HPV状态（以HPV阴性为参照）
非16/18的高危型HPV阳性	1.599	1.079	2.196	0.138	4.949（0.597~41.037）
HPV 16/18阳性	2.383	1.075	4.910	0.027	10.833（1.317~89.135）

ECC病理诊断	宫颈活检病理诊断		总计
ECC病理诊断	LSIL	HSIL	总计
LSIL	196（72.1）	69（25.4）	265（97.5）
HSIL	2（0.7）	5（1.8）	7（2.5）
总计	198（72.8）	74（27.2）	272（100.0）

30岁以下女性宫颈高级别病变临床特点及宫颈管搔刮诊断价值研究

The Clinical Characteristics of High-grade Squamous Intraepithelial Lesions and Diagnostic Value of Endocervical Curettage in Women Aged Under 30 Years

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 25

相关文章 5

编辑推荐

Metrics

留言

[1]	乔慧, 韦艳, 刘玉, 白瑞, 杨萍. 新疆石河子市2019—2021年宫颈癌筛查结果对比分析[J]. 中国全科医学, 2024, 27(23): 2897-2903.
[2]	武爱媛, 热米拉·热扎克, 乔友林. 人工智能在宫颈病变诊断及治疗中的应用进展与挑战[J]. 中国全科医学, 2022, 25(18): 2215-2222.
[3]	刘玉, 韦艳, 杨萍. 2019年和2020年新疆石河子城区宫颈癌筛查结果对比研究[J]. 中国全科医学, 2022, 25(18): 2223-2230.
[4]	韦艳，白瑞，阮阳阳，孙倩玉，刁博文，杨萍. 新疆维吾尔自治区石河子市城区18 378例子宫颈癌筛查人群的hrHPV感染状况研究[J]. 中国全科医学, 2021, 24(29): 3763-3768.
[5]	孙明霞，蒋鹏程，于峰，刘彩霞，范桂莲，张辉. 经阴道彩色多普勒超声联合血清miRNA-18a和miRNA-92a诊断宫颈癌的价值研究[J]. 中国全科医学, 2019, 22(12): 1436-1441.