肯尼亚人乳头瘤病毒（HIV）感染的女性行宫颈管内上皮内瘤变时行环形电切术（LEEP）加帽状活检。
Loop electrosurgical excision procedure (LEEP) plus top hat for HIV-infected women with endocervical intraepithelial neoplasia in Kenya.
机构信息
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Department of Medicine, Emory University, Atlanta, GA, USA.
出版信息
Int J Gynaecol Obstet. 2021 Jan;152(1):118-124. doi: 10.1002/ijgo.13466. Epub 2020 Dec 11.
OBJECTIVE
To determine the utility of detecting endocervical cervical intraepithelial neoplasia (CIN) 2+ with endocervical curettage (ECC) and treating with loop electrosurgical excision procedure (LEEP) plus top hat (+TH) among women with HIV.
METHODS
Cytology was followed by coloscopy-directed biopsy if participants had HSIL or ASC-H and biopsy plus ECC if there were glandular cells present. CIN2/3 on ECC and/or inadequate colposcopy (ENL) was treated with LEEP+TH, while CIN2/3 on ectocervix (ECL) received LEEP alone. Recurrent CIN2+ were compared over a 2-year follow-up.
RESULTS
Of 5330 participants, 160 underwent ECC, 98 were CIN2/3 on ECC, and 77 received LEEP+TH. ECC detected 15 (9%) more women with CIN2/3 than biopsy alone. Women were more likely to have ENL if they were older (≥45 vs <35 years) (adjusted relative risk [aRR] 2.14; P = 0.009) and on antiretroviral treatment longer (≥2 vs <2 years) (aRR 3.97; P < 0.001). Over the 2-year follow-up, 35 (29%) ENL had recurrent CIN2+ after TH compared to 19 (24%) ECL after LEEP (hazard ratio 1.32; 95% confidence interval 0.75-2.31; P = 0.338).
CONCLUSION
Among HIV-infected women, adding ECC did not increase detection of pre-cancerous disease significantly and treatment with LEEP+TH for ENL was comparable to treatment with LEEP for ECL.
目的
确定在 HIV 感染妇女中，通过宫颈管搔刮（ECC）检测宫颈内上皮瘤样病变（CIN）2+并采用环形电切术（LEEP）联合帽状活检（+TH）治疗的效果。
方法
细胞学检查后，如果有高度鳞状上皮内病变（HSIL）或不典型腺细胞（ASC-H），则进行阴道镜引导下活检；如果存在腺细胞，则进行活检加 ECC。ECC 发现 CIN2/3 或阴道镜检查不满意（ENL）时，采用 LEEP+TH 治疗，而 ECC 发现外宫颈（ECL）CIN2/3 时，仅采用 LEEP 治疗。在 2 年的随访期间比较复发 CIN2+的情况。
结果
在 5330 名参与者中，160 人接受了 ECC，98 人 ECC 发现 CIN2/3，77 人接受了 LEEP+TH 治疗。ECC 比单独活检多发现了 15 例（9%）CIN2/3 患者。年龄较大（≥45 岁与<35 岁）（调整后相对风险 [aRR] 2.14；P=0.009）和接受抗逆转录病毒治疗时间较长（≥2 年与<2 年）（aRR 3.97；P<0.001）的患者更有可能出现 ENL。在 2 年的随访期间，TH 治疗后 35 例（29%）ENL 出现复发 CIN2+，而 LEEP 治疗后 19 例（24%）ECL 出现复发 CIN2+（风险比 1.32；95%置信区间 0.75-2.31；P=0.338）。
结论
在 HIV 感染妇女中，ECC 并不能显著提高癌前病变的检出率，LEEP+TH 治疗 ENL 的效果与 LEEP 治疗 ECL 相当。
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