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[目的]分析醋酸染色肉眼观察(VIA)筛查宫颈病变的效果,并初步探讨其误判的影响因素。[方法]将3179名进行HPV检测、VIA检查的联合筛查妇女纳入分析,任意一种筛查方法阳性妇女和10%随机抽取的所有筛查试验阴性的1112名妇女进行阴道镜检查,阴道镜下可见病变处直接取活检,不可见病变且筛查阳性时四象限随机活检+宫颈管搔刮术(ECC),以病理诊断为金标准。[结果 ]在3179名纳入分析的筛查对象中,HPV感染率为24.6%(782/3179),VIA阳性率为6.2%(197/3179)。VIA检出宫颈高度以上病变(CIN2+)病变的灵敏度仅为31.5%,特异性为94.2%,漏诊率为68.5%,误诊率为5.8%。多因素分析结果显示,绝经妇女行VIA检查更容易被漏诊;而年龄小、鳞柱交界满意和有宫颈炎的妇女行VIA检查更容易被误诊。[结论]影响VIA检查准确性的因素较多,临床判断的主观性较大,需要对临床医生开展标准化培训,对于绝经和有生殖道炎症的妇女行VIA检查时更需慎重。
[Objective] To analyze the effect of acetic acid staining visual inspection (VIA) in screening cervical lesions and to explore the influencing factors of its miscarriage of justice. [Methods] A total of 3179 women who were screened for HPV test and VIA test were included in the analysis. All women with positive screening method and all 1112 women randomly selected from all screening tests were negative for colposcopy. Visible lesions directly under the biopsy, the lesions are not visible and screening positive four quadrant random biopsy + cervical scraping (ECC), pathological diagnosis as the gold standard. [Results] The HPV infection rate was 24.6% (782/3179) and the VIA positive rate was 6.2% (197/3179) among 3179 subjects who were included in the analysis. The sensitivity, specificity and specificity of VIA in diagnosing CIN2 + lesions were only 31.5%, 94.2%, 68.5% respectively, and the misdiagnosis rate was 5.8%. Multivariate analysis showed that VIA examination in postmenopausal women was more likely to be missed and that VIA examination was more likely to be misdiagnosed in women with younger age, squamocolumnar junction and cervicitis. [Conclusion] There are many factors that affect the accuracy of VIA examination, the subjectivity of clinical judgment is large, and standardized training for clinicians is needed. It is more necessary to be cautious in VIA examination for menopausal and reproductive tract inflammation.