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 old 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 includes 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. Younger age group（<25 years），colposcopic transformation zone，and HPV vaccination are not relevant influencing factors for the detection of HSIL. ECC 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 old who do not have the two independent risk factors mentioned above，regardless of the transformation zone and vaccination status.

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

摘要： 背景　自2017年人乳头瘤病毒（HPV）疫苗国内批准上市，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的年龄<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/总例数。活检诊断率定义为宫颈活检检出HSIL的病例/总例数。ECC诊断率定义为ECC检出HSIL的病例/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/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，仅宫颈多点活检155例（36.3%），检出HSIL 19例；同时多点活检和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HSIL（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HSIL和HPV 16/18感染是HSIL检出的独立危险因素，更小年龄组（<25岁）、阴道镜转化区及HPV疫苗接种并非HSIL检出的相关影响因素。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，无论转化区及疫苗接种情况。

关键词: 宫颈高级别病变, 阴道镜, 宫颈管搔刮术, 人乳头状瘤病毒疫苗, <30岁女性