Allen Gretchen L, Klobocista Merieme M, Sugarman Shannon, Gravel Katie, Feldman Deborah, Schnatz Peter F
University of Connecticut, Hartford Hospital, Hartford, CT, USA.
J Low Genit Tract Dis. 2009 Apr;13(2):63-5. doi: 10.1097/LGT.0b013e318186d76a.
To compare the prevalence of high-risk human papillomavirus (HPV) in patients with atypical squamous cells of undetermined significance (ASCUS) cytology in an inner-city clinic and a private office population to determine if HPV screening is useful in either group before colposcopy.
After an institutional review board approval at Hartford Hospital, we reviewed the charts of patients with ASCUS cytology and high-risk HPV DNA who were seen at the Community Health Services, Inc. in Hartford, CT (clinic patients), between January 1, 2000, and July 1, 2004, and at a private practice site in Hartford, CT (private patients), between January 1, 2004, and December 31, 2004. All charts were reviewed for demographic information, history of sexually transmitted diseases, tobacco, alcohol, and other drug use. A power analysis indicated that 32 patients would be needed in each group for a p <.05 with 80% confidence.
A total of 257 patient's charts were reviewed: 79 clinic charts and 178 private office charts. Three patients were eliminated due to a lack of HPV testing. High-risk HPV was identified in 94.9% of the clinic patients and 45.5% of the private patients. The populations were statistically different with regard to history of chlamydia (26.6% of clinic patients and 6.2% of private office patients; p <.0001), gonorrhea (11.4% clinic patients and 1.1% of private patients; p =.0005), and trichomonas (7.6% of clinic patients and 0% of private office patients; p =.0007). The prevalence of herpes simplex virus in clinic patients was 2.5%, whereas it was present in 6.2% of private patients (p =.35). Tobacco use was significantly higher in clinic patients (31.6% of clinic patients and 15.2% of private patients; p =.009).
In our study, 94.9% of the women in the clinic population with an ASCUS cytology had high-risk HPV compared with a rate of 45.5% in the private patients studied. Because most clinic patients with ASCUS have high-risk HPV, it is reasonable to defer reflex testing for HPV in these high-risk patients and proceed straight to colposcopy.
比较城市诊所和私人诊所中意义不明确的非典型鳞状细胞（ASCUS）细胞学患者的高危人乳头瘤病毒（HPV）感染率，以确定在阴道镜检查前HPV筛查对两组患者是否有用。
在哈特福德医院机构审查委员会批准后，我们查阅了2000年1月1日至2004年7月1日期间在康涅狄格州哈特福德社区卫生服务公司（诊所患者）以及2004年1月1日至2004年12月31日期间在康涅狄格州哈特福德私人诊所（私人患者）接受ASCUS细胞学检查和高危HPV DNA检测的患者病历。所有病历均查阅了人口统计学信息、性传播疾病史、烟草、酒精及其他药物使用情况。功效分析表明，每组需要32例患者才能在80%置信度下使p<0.05。
共查阅了257例患者病历：79例诊所病历和178例私人诊所病历。3例患者因未进行HPV检测而被排除。在诊所患者中，94.9%检测出高危HPV，在私人患者中这一比例为45.5%。两组患者在衣原体感染史（诊所患者为26.6%，私人诊所患者为6.2%；p<0.0001）、淋病（诊所患者为11.4%，私人患者为1.1%；p = 0.0005）和滴虫感染（诊所患者为7.6%，私人诊所患者为0%；p = 0.0007）方面存在统计学差异。诊所患者单纯疱疹病毒感染率为2.5%，而私人患者为6.2%（p = 0.35）。诊所患者吸烟率显著更高（诊所患者为31.6%，私人患者为15.2%；p = 0.009）。
在我们的研究中，诊所人群中ASCUS细胞学检查的女性患者94.9%感染高危HPV，而所研究的私人患者中这一比例为45.5%。由于大多数ASCUS诊所患者感染高危HPV，对于这些高危患者推迟HPV反射性检测并直接进行阴道镜检查是合理的。
