Armstrong B K, Allen O V, Brennan B A, Fruzynski I A, de Klerk N H, Waters E D, Machin J, Gollow M M
Br J Cancer. 1986 Oct;54(4):669-75. doi: 10.1038/bjc.1986.225.
Trends in prevalence of cytological evidence of cervical intraepithelial neoplasia (CIN) and cervical infection with human papilloma virus (HPV), as indicated by HPV infection and dyskeratosis, were studied in 2,992 new attenders at a sexually transmitted diseases (STD) clinic between 1978 and 1982. Crude prevalence of CIN increased from 1.3% to 4.3% (P less than 0.001) and crude prevalence of HPV infection increased from 2.8% to 9.3% (P less than 0.001). Age adjustment had little effect on these trends. Review, in 1984-85, of samples of smears taken in 1978 and 1982 showed that recognition of koilocytosis by the laboratory had increased substantially over time while a tendency had developed to downgrade nuclear changes in the presence of koilocytosis. Correction of the 1978 and 1982 smear results to the 1984-85 classifications suggested that prevalence of koilocytosis had increased little (from 13.4% to 16.1%, P = 0.20) while there had been a substantial real increase in CIN (0.8% to 2.4%, P less than 0.001). To try to explain the trend in CIN, other characteristics of a sample of attenders at the STD clinic were studied. There were no appreciable trends in prevalence of past STD, number of sexual partners in the last 3 months, method of contraception, genital warts and culture of N. gonorrhoea, T. vaginalis, C. albicans and Chlamydia sp. from the vagina. There was an increase in the proportions in socioeconomic group I, as classified by postcode of residence (17.0% to 26.9%, P = 0.04), referred as contacts rather than with symptoms (24.0% to 41.6%, P less than 0.001), with a clinical diagnosis of genital herpes (5.0% to 8.6%, P = 0.08) and with herpes virus cultured from the cervix (2.1% to 6.3%, P = 0.03). The trend in prevalence of herpes virus infection was not explained by the other trends. It may explain the trend in prevalence of CIN.
1978年至1982年间，对一家性传播疾病（STD）诊所的2992名新就诊者进行了研究，以观察宫颈上皮内瘤变（CIN）的细胞学证据流行趋势以及人乳头瘤病毒（HPV）感染导致的宫颈感染情况，后者通过HPV感染和角化不良来体现。CIN的粗患病率从1.3%升至4.3%（P<0.001），HPV感染的粗患病率从2.8%升至9.3%（P<0.001）。年龄调整对这些趋势影响不大。1984 - 1985年对1978年和1982年采集的涂片样本进行复查发现，随着时间推移，实验室对挖空细胞的识别能力大幅提高，而在存在挖空细胞的情况下，对核变化的分级有降低的趋势。将1978年和1982年的涂片结果按照1984 - 1985年的分类标准进行校正后发现，挖空细胞的患病率几乎没有增加（从13.4%升至16.1%，P = 0.20），而CIN却有显著的实际增加（从0.8%升至2.4%，P<0.001）。为了试图解释CIN的趋势，对STD诊所就诊者样本的其他特征进行了研究。既往STD患病率、过去3个月性伴侣数量、避孕方法、尖锐湿疣以及阴道内淋病奈瑟菌、阴道毛滴虫、白色念珠菌和衣原体培养物的患病率均无明显趋势。按照居住邮政编码分类的社会经济第一组人群比例有所增加（从17.0%升至26.9%，P = 0.04），作为接触者而非有症状者前来就诊的比例增加（从24.0%升至41.6%，P<0.001），临床诊断为生殖器疱疹的比例增加（从5.0%升至8.6%，P = 0.08），宫颈培养出疱疹病毒的比例增加（从2.1%升至6.3%，P = 0.
