治疗宫颈癌前病变后不良的产科结局：一项比利时多中心研究。

Adverse obstetrical outcomes after treatment of precancerous cervical lesions: a Belgian multicentre study.

机构信息

Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium.

出版信息

BJOG. 2012 Sep;119(10):1247-55. doi: 10.1111/j.1471-0528.2012.03429.x. Epub 2012 Jul 17.

DOI:10.1111/j.1471-0528.2012.03429.x

PMID:22804838

Abstract

OBJECTIVE

To assess the impact of cervical intraepithelial neoplasia (CIN) treatment on the risk of (spontaneous) preterm delivery (PD) and small for gestational age (SGA) at birth.

DESIGN

A multicentre cohort study.

SETTING

Maternity wards of four academic hospitals in Belgium.

POPULATION

Ninety-seven exposed pregnant women (with a CIN treatment history) and 194 nonexposed pregnant women (without a history of CIN treatment).

METHODS

A questionnaire and check of obstetrical files included socio-demographic characteristics, risk factors for PD, obstetrical history for all women and characteristics of the CIN treatment for exposed women. Pregnancy outcomes were recorded after delivery. The influence of previous treatment of CIN on pregnancy outcomes, adjusted for confounding variables, was assessed by Cox regression and lifetables (for the outcome gestational age at birth) and by logistic regression (for the outcomes PD and SGA at birth).

MAIN OUTCOME MEASURES

Occurrence of PD and SGA at birth.

RESULTS

Seventy-nine per cent of the women in the database were multiparous; 16.3% of women with a previous excisional treatment spontaneously delivered preterm, compared with 8.1% of unexposed women [odds ratio (OR), 2.19; 95% confidence interval (CI), 0.97-4.99]. When adjusting for confounding factors (ethnicity, HIV status, education, age, smoking and parity), the OR for PD was 2.33 (95% CI, 0.99-5.49). Excisional treatment did not have an impact on SGA at birth (OR, 0.94; 95% CI,0.41-2.15). The depth of the cone was >10 mm in 63.5% of the documented cases. Large cones, more than 10 mm deep, were associated with a significantly increased risk of PD (adjusted OR, 4.55; 95% CI, 1.32-15.65) compared with untreated women, whereas smaller cones (≤ 10 mm) were not significantly associated with PD (OR, 2.77; 95% CI, 0.28-27.59). The associations seen for PD with respect to the cone size did not hold for SGA at birth.

CONCLUSIONS

There was an increased risk of (spontaneous) PD after excision of CIN, in particular when the cone depth exceeded 10 mm.

摘要

目的

评估宫颈上皮内瘤变（CIN）治疗对（自发性）早产（PD）和出生时小于胎龄儿（SGA）风险的影响。

设计

多中心队列研究。

地点

比利时四家学术医院的产科病房。

人群

97 名暴露孕妇（有 CIN 治疗史）和 194 名非暴露孕妇（无 CIN 治疗史）。

方法

问卷调查和产科病历检查包括社会人口统计学特征、PD 危险因素、所有妇女的产科史以及暴露妇女的 CIN 治疗特征。产后记录妊娠结局。采用 Cox 回归和生命表（出生时的妊娠年龄）和逻辑回归（出生时的 PD 和 SGA 结局）评估既往 CIN 治疗对妊娠结局的影响，调整混杂变量。

主要观察指标

出生时 PD 和 SGA 的发生情况。

结果

数据库中 79%的妇女为多产妇；16.3%的经宫颈锥切术治疗的妇女自发性早产，而非暴露组为 8.1%[比值比（OR），2.19；95%置信区间（CI），0.97-4.99]。调整混杂因素（种族、HIV 状态、教育程度、年龄、吸烟和产次）后，PD 的 OR 为 2.33（95%CI，0.99-5.49）。宫颈锥切术治疗对 SGA 出生时无影响（OR，0.94；95%CI，0.41-2.15）。记录的病例中，有 63.5%的锥切深度>10mm。与未治疗的妇女相比，深度>10mm 的大锥切与 PD 风险显著增加相关（调整 OR，4.55；95%CI，1.32-15.65），而深度≤10mm 的小锥切与 PD 无显著相关性（OR，2.77；95%CI，0.28-27.59）。PD 与锥切大小之间的关联不适用于 SGA 出生时。