巴氏涂片检测的阴性预测值：对人类免疫缺陷病毒（HIV）女性筛查间隔的影响。
Negative predictive value of pap testing: implications for screening intervals for women with human immunodeficiency virus.
机构信息
Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
出版信息
Obstet Gynecol. 2012 Oct;120(4):791-7. doi: 10.1097/AOG.0b013e31826a8bbd.
OBJECTIVE
To estimate the accuracy of Pap testing for women who are human immunodeficiency virus (HIV)-seropositive, with a focus on negative predictive value.
METHODS
Participants in the Women's Interagency HIV Study were monitored with conventional Pap tests every 6 months. After excluding those with abnormal Pap test results before study, cervical disease, or hysterectomy, women with negative enrollment Pap test results were monitored for development of precancer within 15 or 39 months, defined as a Pap test result read as high-grade squamous intraepithelial lesion, atypical glandular cells favor neoplasia, or adenocarcinoma in situ, or a cervical biopsy read as cervical intraepithelial neoplasia 2 or worse. Correlations between one or more consecutive negative Pap test results and subsequent precancer were assessed using Cox proportional hazards models.
RESULTS
Among 942 HIV-infected women with negative baseline Pap test results, eight (1%) developed precancer within 15 months and 40 (4%) within 39 months. After three consecutive negative Pap test results, precancer was rare, with no cases within 15 months and 10 of 539 (2%) within 39 months. No women developed precancer or cancer within 39 months after 10 consecutive negative Pap test results. Risks for precancer within 15 months after negative Pap test result included current smoking (adjusted hazard ratio [HR] 1.5, 95% confidence interval [CI] 1.2-2.0 compared with nonsmokers), younger age (adjusted HR 1.5, 95% CI 1.1-2.1 for women aged younger than 31 years compared with older than 45 years), and lower CD4 count (adjusted HR 11.8, 95% CI 1.3-2.3 for CD4 200-500/microliter, adjusted HR 2.2, 95% CI 1.6-2.9 for CD4 less than 200/microliter, compared with CD4 more than 500/microliter).
CONCLUSION
Annual Pap testing appears safe for women infected with HIV; for those with serial negative tests, longer intervals are appropriate.
LEVEL OF EVIDENCE
II.
目的
评估人类免疫缺陷病毒（HIV）阳性妇女巴氏涂片检测的准确性，重点关注阴性预测值。
方法
妇女艾滋病研究机构间研究的参与者每 6 个月接受一次常规巴氏涂片检查。在排除研究前巴氏涂片检查结果异常、宫颈疾病或子宫切除的参与者后，对阴性入组巴氏涂片检查结果的女性进行随访，以在 15 或 39 个月内发现癌前病变，定义为巴氏涂片检查结果为高级别鳞状上皮内病变、非典型腺细胞倾向于肿瘤、或原位腺癌，或宫颈活检结果为宫颈上皮内瘤变 2 级或更高级别。使用 Cox 比例风险模型评估一个或多个连续阴性巴氏涂片检查结果与随后的癌前病变之间的相关性。
结果
在 942 名基线巴氏涂片检查结果阴性的 HIV 感染女性中，8 名（1%）在 15 个月内发生癌前病变，40 名（4%）在 39 个月内发生癌前病变。在连续三次阴性巴氏涂片检查结果后，癌前病变很少见，在 15 个月内无病例，在 39 个月内 539 例中有 10 例（2%）。在连续 10 次阴性巴氏涂片检查结果后，39 个月内无女性发生癌前病变或癌症。阴性巴氏涂片检查结果后 15 个月内发生癌前病变的风险因素包括当前吸烟（与不吸烟者相比，调整后的危险比 [HR] 1.5，95%置信区间 [CI] 1.2-2.0）、年龄较小（与年龄大于 45 岁的女性相比，年龄小于 31 岁的女性调整后的 HR 1.5，95% CI 1.1-2.1）和较低的 CD4 计数（CD4 为 200-500/μl 时调整后的 HR 为 11.8，95% CI 为 1.3-2.3，CD4 小于 200/μl 时调整后的 HR 为 2.2，95% CI 为 1.6-2.9，与 CD4 大于 500/μl 相比）。
结论
对于感染 HIV 的女性，每年进行巴氏涂片检查似乎是安全的；对于那些连续检测为阴性的患者，延长间隔是合适的。
证据水平
II。
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