RESUMO
Objective To analyze the genotypes distribution and clinical significance of human papillomavir-us(HPV) infection in atypical squamous cells of undetermined significance (ASC-US) ,low squamous intraepi-thelial lesion (LSIL) and high squamous intraepithelial lesion (HSIL) of uterine cervix ,meanwhile to conduct the cervical histopathological diagnostic analysis in the patients with ASC-US、LSIL and HSIL .Methods The gene amplification technique (PCR) combined with gene-chips technology were adopted to conduct the 23 kinds of HPV genotype detection on 236 cases of cervical ASC-US ,36 cases of cervical LSIL and 61 cases of cervical HSIL specimens .All cases of ASC-US ,LSIL and HSIL were performed the cervical biopsy his-topathological diagnosis .And then the subjects related data were analyzed .Results Among 236 cases of cervi-cal ASC-US specimens ,139 cases of HPV infection were detected with the total HPV infection rate 58 .90％(139/236) ,in which the single genotypes infection rate was 38 .14％ (90/236)and the multiple genotypes infec-tion rate was 20 .76％ (49/236);26 cases of HPV infection were detected from 36 cases of cervical LSIL speci-mens with the total HPV infection rate of 72 .22％ (26/36) ,in which the single genotypes infection rate was 52 .78％ (19/36) and the multiple genotypes infection rate was 19 .44％ (7/36);61 cases of HPV infection were detected from 58 cases of cervical HSIL specimens with the total HPV infection rate of 95 .08％ (58/61) , in which the single genotypes infection rate was 68 .85％ (42/61)and the multiple genotypes infection rate was 26 .23％ (16/61) .The total infection rates had statistically significantly differences among the cervical ASC-US group ,LSIL group and HSIL group (P<0 .05) .Conclusion HPV16 ,52 ,58 are the main types in the patients with cervical ASC-US ,LSIL and HSIL .The gene-chip technology can be used in the HPV genotypes detection of cervical cells ,which has an important clinical significance for further distribution management on ASC-US patients and should draw great attention of gynecologist .
RESUMO
O câncer de colo uterino é um tumor de natureza multifatorial que persiste como um importante problema de saúde pública. Aderência à linha de cuidado é fator associado ao controle desse câncer. O objetivo deste estudo foi avaliar fatores associados à "Não aderência" ao seguimento preconizado para mulheres com lesão intraepitelial de alto grau (HSIL), atendidas em um serviço de saúde da Baixada Fluminense, no Rio de Janeiro. Este estudo do tipo coorte retrospectivo incluiu mulheres rastreadas por citologia, matriculadas entre 01/01/2002 e 31/12/2005 e submetidas à colposcopia. A coleta de dados terminou em 31/12/07. Foram revisados 1496 prontuários e identificadas 641 mulheres elegíveis com diagnóstico de HSIL obtido por excisão da zona de transformação do colo uterino. Após a aplicação dos critérios de exclusão, a população de estudo foi constituída por 537 (84 por cento) mulheres, classificadas em dois grupos: "não aderentes" (29,4 por cento), que abandonaram o seguimento, e "aderentes" (70,6 por cento), que permaneceram no seguimento até a alta. A análise estatística foi realizada pelo teste do qui-quadrado, teste t e regressão logística. O modelo final incluiu as variáveis: ser fumante (OR 1,72), dona de casa (OR 1,56), ter realizado o exame com o uso do vídeo-colposcópio (OR 1,80), idade (OR 0,97) e antecedente de três ou mais gestações (OR 0,49). O estudo revelou um perfil de vulnerabilidade apontando para determinantes de ordem individual e organizacional. Estratégias para melhorar a aderência ao seguimento devem contemplar medidas dirigidas a fatores modificáveis do estilo de vida, como o tabagismo, e estruturais característicos dos serviços de saúde da região.
Cervical cancer is a tumor of multi-factorial nature that remains nowadays an a serious important public health problem. Adherence to health care procedures is a factor related to uterine cervical cancer control. The aim of this study was to evaluate factors associated with non-adherence to the prescribed follow-up in women with high-grade squamous intraepithelial lesions (HSIL), attending a public health care service in the "Baixada Fluminense", Rio de Janeiro, Brazil. This was a retrospective cohort study including women screened through cytology, entering the health care service between 01/01/2002 and 12/31/2005 and submitted to a colposcopy. Data collection ended on 12/31/07. Through the revision of 1496 medical records, 641 eligible women with a histopathological diagnosis of HSIL obtained after excision of the transformation zone were identified. After application of the exclusion criteria, the study population comprised 537 (84 percent) women, classified into two groups: "non-adherent" (29.4 percent), who abandoned the follow-up procedures and "adherent" (70.6 percent) who remained in follow-up along the required period. Statistical analysis was carried out though qui-square and t-tests and logistic regression. The final model contained the variables smoker (OR 1.72), not having a job outside the house (OR 1.56), having the examination carried out with a videocolposcopy (OR 1.80), age (OR 0.97) and history of three or more gestations (OR 0.49). The study disclosed a vulnerability profile pointing to individual and organizational-level determinants. Strategies to attain better follow-up must be aimed to modifiable life style factors as smoking and to structural characteristics of health care services in the studied area.