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目的总结江苏省妊娠期宫颈癌(CC)筛查及母婴人乳头瘤病毒(HPV)垂直感染的多中心调查结果。方法应用宫颈病变“三阶梯”诊断原则筛查江苏5201例妊娠妇女宫颈病变,对诊断为宫颈上皮内瘤变(CIN)者进行孕期和产后随访,并对HPV阳性孕妇的新生儿进行口咽部和生殖器处黏膜及表面分泌物做HPV检测。结果 HPV阳性孕妇698例,孕妇HPV感染率13.42%。检出非典型鳞状上皮细胞增生(ASCUS)者59例(8.45%);低度上皮内瘤变(LSIL)者23例(3.30%);高度上皮内瘤变(HSIL)者5例(0.72%)。阴道镜活检结果:CIN1者16例,CIN2者12例,CIN3者5例,CCⅠa期及以上者3例。随访6个月后,17例HSIL产后HPV持续阳性,行宫颈锥切手术,术后病理显示8例进展。2例CCⅠa期患者引产后行根治术情况良好;1例CC患者孕31+周剖宫产后行根治术,化疗7个月时复发。母婴HPV垂直感染率24.44%。不同分娩方式HPV的垂直感染率无统计学差异(P>0.05)。结论孕妇接受宫颈病变筛查非常重要,以便及时诊断和有效处理妊娠期CIN和CC病变。母婴HPV垂直感染需要高度重视。
Objective To summarize the results of a multicenter survey of gestational cervical cancer (CC) screening in Jiangsu Province and vertical infection of human papillomavirus (HPV) in pregnant women. Methods The cervical lesions were detected in 5201 pregnant women with cervical intraepithelial neoplasia (CIN). The pregnancy and postpartum follow-up were performed. The newborns with HPV-positive pregnant women were also enrolled in this study. Pharynx and genital mucosa and surface secretion of HPV testing. Results 698 HPV-positive pregnant women, HPV infection rate of pregnant women was 13.42%. (ASCUS) were detected in 59 cases (8.45%), in 23 cases (3.30%) in low grade intraepithelial neoplasia (LSIL) and in high grade intraepithelial neoplasia (HSIL) %). Colposcopy biopsy results: CIN1 in 16 cases, CIN2 in 12 cases, CIN3 in 5 cases, CCⅠa and above in 3 cases. After 6 months follow-up, 17 cases of HSIL postpartum HPV positive, cervical conization surgery, postoperative pathology showed 8 cases of progress. In 2 cases of CCⅠa, the patients underwent radical mastectomy was in good condition. One CC patient underwent radical cesarean section after 31 weeks of pregnancy and recurred at 7 months after chemotherapy. Vertical HPV infection rate of 24.44%. There was no significant difference in HPV infection rates among different modes of delivery (P> 0.05). Conclusion Pregnant women undergoing screening for cervical lesions is very important in order to timely diagnosis and effective treatment of CIN and CC lesions during pregnancy. Vertical HPV infection requires high priority.