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目的目前对于低度宫颈鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)自然史的研究,LSIL转归情况存在差异。本研究采用meta分析的方法,评价LSIL自然消退及进展率,为制定LSIL人群的防治措施提供依据。方法计算机检索PUBMED、CNKI、VIP、CBM及万方数据库,并辅以参考文献追溯和手工检索方法,查找LSIL自然转归随访研究的文献,检索时间范围为1980-09-28-2015-09-28。由2位研究者按照纳入排出标准独立筛选文献、提取资料并交叉核对,使用R 3.2.2软件进行Meta分析。结果最终纳入21篇文献,共16 717例LSIL病例。结果显示,LSIL年消退率为20.24%(95%CI为17.01%~24.09%),LSIL进展为高度宫颈鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)的年进展率为3.29%(95%CI为1.78%~6.08%)。Meta回归及亚组分析发现随访时间与观察例数是主要异质性来源(P<0.05);敏感性分析表明本研究所得结果较为稳定。结论 LSIL自然年消退率比进展率要高,建议此类患者以随访观察为主,并视病情进展程度进行适当的治疗。
Objective To study the natural history of low-grade squamous intraepithelial lesion (LSIL), there are differences in the outcome of LSIL. In this study, meta-analysis of the method used to assess the natural regression and progression rate of LSIL, to provide the basis for the prevention and treatment measures to develop LSIL population. Methods A computer-based online search of PUBMED, CNKI, VIP, CBM and Wanfang databases was performed with reference retrospective and manual retrieval methods to find out the literature of LSIL natural outcome follow-up study. The retrieval time range was 1980-09-28-2015-09- 28. Two researchers independently screened the documents according to inclusion criteria, extracted data and cross-checked them, and used the software R 3.2.2 for meta-analysis. The results eventually included 21 articles, a total of 16,717 cases of LSIL. The results showed that the annual regression rate of LSIL was 20.24% (95% CI: 17.01% ~ 24.09%), and the annual progression rate of LSIL to high-grade squamous intraepithelial lesion (HSIL) was 3.29% 95% CI 1.78% ~ 6.08%). Meta-regression analysis and subgroup analysis showed that follow-up time and observed cases were the main sources of heterogeneity (P <0.05). Sensitivity analysis showed that the results obtained in this study were stable. CONCLUSIONS: The spontaneous regression rate of LSIL is higher than the rate of progression. It is suggested that follow-up observation should be the mainstay of these patients and appropriate treatment should be made according to the progression of LSIL.