分析山东省东明县已婚女性宫颈癌筛查结果，为该地区宫颈癌预防提供科学依据。

回顾性汇总分析2016年9月至2017年6月期间，于济南金域医学检验中心病理室行宫颈癌筛查的东明县23 088名已婚女性的细胞学检测结果。年龄范围为19~90岁，分为5组：<30岁组810例、30~39岁组5174例、40~49岁组9301例、50~59岁组5707例、≥60岁组2096例。同时对其中细胞学异常者随访，得到高危型人乳头状瘤病毒(high-risk human papillomavirus，hrHPV)检测结果61例和组织活检结果438例，进行分析。

23 088名已婚女性经细胞学检测，检出异常细胞学者1177例(5.1%)，其中：不能明确判读的非典型鳞状细胞(atypical squamous cells of unknown significance，ASC-US)者729例(3.2%)，不能排除高级别鳞状上皮内病变的非典型鳞状细胞(atypical squamous cells cannot exclude HSIL，ASC-H)/非典型腺细胞(atypical glandular cells，AGC)者43例(0.2%)，低级别鳞状上皮内病变(low grade squamous intraepithelial lesions，LSIL)者289例(1.3%)，高级别鳞状上皮内病变(high grade squamous intraepithelial lesions，HSIL)者116例(0.5%)。随访细胞学异常者hrHPV检测阳性率为50.0%(31/61例)，组织活检阳性率为45.6%(200/438例)。不同年龄组间不同异常细胞学病变阳性率比较，ASC-US (χ²=5.502，P=0.019)和LSIL(χ²=3.956，P=0.047)阳性率存在明显差异。ASC-US以50~59岁组197例(3.5%)最高，30~39岁组134例(2.6%)最低；LSIL以<30岁组12例(1.5%)和30~39岁组76例(1.5%)最高，50~59岁组50例(0.9%)最低。不同细胞学病变的组织活检结果有明显差异。活检正常者(χ²=113.536，P<0.001)在ASC-US中所占比(75.4%)最高，而HSIL所占比(9.8%)最低；活检结果为宫颈上皮内瘤变1(cervical intraepithelial neoplasia，CIN1) (χ²=37.817，P<0.001)在LSIL所占比(44.4%)最高，而HSIL所占比(6.6%)最低；活检结果为CIN2/3/原位腺癌(adenocarcinoma in situ，AIS) /鳞状细胞癌(squamous cell carcinoma，SCC) (χ²=603.863，P<0.001)则在ASC-US中所占比(4.0%)最低，而HSIL所占比(83.6%)最高。不同细胞学病变(χ²=7.946，P=0.019)和组织学活检结果(χ²=3.925，P=0.048)的hrHPV阳性率也有明显差异。ASC-US/ASC-H/AGC、LSIL和HSIL的阳性率分别为34.5%、58.3%和87.5%；组织学活检正常、CIN1和CIN2/3/AIS/SCC的阳性率分别为37.5%、60.0%和75.0%。

细胞学筛查能有效地发现癌前病变和宫颈癌，且细胞学病变的严重程度、hrHPV的阳性率高低与组织学活检结果的严重程度有较好的一致性，这能为制定该地区宫颈癌筛查策略提供一定依据。

To analyze the cervical cancer screening results of married women in Dongming County of Shandong Province, and to provide scientific evidence for cervical cancer prevention in this region.

A retrospective study on the cytological results of 23 088 married women in Dongming County, from September 2016 to June 2017 was performed. Cervical swabs of 23 088 married women were referred to Jinan KingMed Diagnostics. The age of these married women is 19~90 years old. They were divided into 5 groups: 810 cases in group<30 years old, 5174 cases in group 30~39, 9301 cases in group 40~49, 5707 cases in group 50~59 and 2096 cases in group of over 60 years old. At the same time, 61 cases of high risk human papillomavirus (high-risk human papillomavirus, hrHPV) and 438 cases of abnormal cytology with tissue biopsy were followed up, and analyzed.

A total of 1177 women (5.1%) were interpreted as cytological abnormalities, including 729 cases (3.2%) of atypical squamous cells of unknown significance (ASC-US), 43 cases (0.2%) of atypical squamous cells cannot exclude HSIL (ASC-H)/atypical glandular cells (AGC), 289 cases (1.3%) of low grade squamous intraepithelial lesions (LSIL), and 116 cases (0.5%) of high grade squamous intraepithelial lesions (HSIL). Of these cases with abnormal cytological results, 31 cases (50%) had hrHPV testing positive, and 200 cases (45.6%) had follow-up histological positive. The positive rates of ASC-US (χ²=5.502, P=0.019) and LSIL (χ²=3.956, P=0.047) significantly varied among different age groups. The highest positive rate of ASC-US was found in the 50~59 years old group (197 cases, 3.5%), while the lowest positive rate was found in the 30~39 years old group (134 cases, 2.6%). The highest positive rate of LSIL was observed in<30 (12 cases) and 30~39 (76 cases) years old groups (1.5% for both groups), while the lowest positive rate was observed in the 50~59 years old group (50 cases, 0.9%). Histopathologic follow-ups demonstrated obvious variations in different cytological results. Normal biopsy (χ²=113.536, P<0.001) accounted for the highest proportion in ASC-US (75.4%) and the lowest proportion in HSIL (9.8%); cervical intraepithelial neoplasia 1(CIN1) (χ²=37.817, P<0.001) was the most frequent in LSIL, but the least frequent in HSIL; CIN2/3/AIS/SCC (χ²=603.863, P<0.001) was the most common in HSIL but the least common in ASC-US. Significant variations in hrHPV testing were also observed in different cytological abnormalities (χ²=7.946, P=0.019) and different histopathologic results (χ²=3.925, P=0.048). The hrHPV-positive rates were 34.5%, 58.3% and 87.5% for ASC-US/ASC-H/AGC, LSIL and HSIL, respectively, and 37.5%, 60% and 75% for normal biopsy, CIN1 and CIN2/3/AIS/SCC, respectively.

The present study showed that cervical cytology screening can effectively detect cervical invasive cancer and its precancerous lesions. The severity of cytological abnormalities and the hrHPV-positive rates correlated well with the severity of histological abnormal findings. These results can provide a scientific basis for establishing cervical cancer screening strategies in this region.