OriginalArticle

OriginalArticle
Relationship of Human Papilloma Virus
Infection and Abnormal Pap Smear in Human
Immunodeficiency Virus Infected Women and
Tendency to Develop Cervical Intraepithelial
Neoplasia
Amornpun Wiratchai, M.D., Charoensuk Atsavapipit, N.Sc., Areewan Charoenruen, N.Sc., Preecha Tantanatip, M.D.,
Karoon Kuntiranont, M.D., Poochit Meeprasertsakul, M.D., Achara Choavavanich, M.D.
Division of Obstetrics Gynecology, Bamrasnaradura Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand.
ABSTRACT
In HIV infected women, persistent human papilloma virus infection in their cervical tissue was found to have a direct
relationship with the development of cervical intraepithelial neoplasia in their Pap smear examinations. In this study, we
recruited 150 HIV infected women, whose major age-range was found to be between 20-35 years old (63.3%). HPV-DNA
testing was positive in 55 cases, while Pap smear examinations were found to be abnormal in 25 cases (43.3%). Abnormal Pap
smears were found atypical squamous cell of undeterminated significant (ASCUS) in 7 cases, low-grade squamous intraepithelial
lesion (LSIL) 14 cases, and high-grade intraepithelial lesion 6 cases. A cervical biopsy was done in only 16 cases. Among them,
6 were found to have either moderate or higher-grade dysplasia. This study indicated that HIV infected women who had positive
HPV-DNA testing were more likely to have abnormal Pap smears and had a tendency to develop moderate or higher grade of
cervical dysplasia.
Keywords: Human papilloma virus; Abnormal Pap smear; Cervical intraepithelial neoplasia
Siriraj Med J 2006;58: 658-662
E-journal: http://www.sirirajmedj.com
°
“√µ‘¥‡™◊ÕÈ ‚√§‡Õ¥ å (human immunodeficiency virus, HIV)
µ≈Õ¥®π°“√µ√«®√—°…“ºŸâ∑’ˇªìπ‚√§‡Õ¥ å ‰¥â¡’°“√»÷°…“
·≈–æ—≤π“°“√√—°…“¡“µ≈Õ¥®π∂÷ßªí®®ÿ∫—π „π√–¬–‡√‘Ë¡
·√°°“√µ‘¥‡™◊ÈÕ„π‰∑¬¡’ “‡Àµÿ®“°°“√„™â¬“‡ æ¬åµ‘¥ (intravenous
drug user = IVDU) „πªí®®ÿ∫π— °“√µ‘¥‡™◊ÕÈ ‡°‘¥®“°°“√¡’‡æ» —¡æ—π∏å
µà“ß‡æ» (heterosexual transmission)1 ´÷Ë߇ªìπªí≠À“ ”§—≠¢Õß°“√
·æ√à‡™◊ÈÕ‚√§‡Õ¥ å ®÷ß∑”„À⺟â∑’˵‘¥‡™◊ÈÕ·≈–ºŸâ∑’ˇªìπ‚√§‡Õ¥ å´÷Ë߇ªìπ
µ√’¡®’ ”π«π¡“°¢÷πÈ ‡√◊ÕË ¬ Ê ‚√§‡Õ¥ 凪ìπ‚√§∑’¡Ë ¿’ ¡Ÿ §‘ ¡ÿâ °—π∫°æ√àÕß
„π√à“ß°“¬®–¡’º≈„À⇰‘¥°“√µ‘¥‡™◊ÈÕ‚√§Õ◊Ëπ Ê ‰¥âßà“¬¢÷Èπ ‚¥¬‡©æ“–
‡™◊ÈÕ‰«√— µà“ß Ê ®“°°“√»÷°…“„πµà“ߪ√–‡∑» µ√’∑’Ë¡’°“√µ‘¥‡™◊ÈÕ
human papilloma virus (HPV) ®–¡’Õ—µ√“°“√µ√«®æ∫°“√µ‘¥‡™◊ÈÕ
HIV Ÿß¢÷Èπ2,3
Human papilloma virus (HPV) ‡ªìπ‰«√— „πµ√–°Ÿ≈ papovaviridea ∑’Ë “¡“√∂‡¢â“‰ª‡®√‘≠‡µ‘∫‚µ„π squamous cell ¢ÕßÕ«—¬«–
µà“ß Ê ´÷Ëßæ∫‰¥â∫àÕ¬„π genital tract °“√µ‘¥‡™◊ÈÕ HPV π’È ‡°‘¥®“°
Correspondence to: Amompon Wiratchai
658
°“√¡’‡æ» —¡æ—π∏å‚¥¬µ√ß ‡¡◊ËÕ‡°‘¥°“√µ‘¥‡™◊ÈÕ HPV „π squamous
cell ·≈â« ‡™◊ÕÈ ®–§ßÕ¬Ÿ„à π‡´≈≈剥âπ“π À√◊ÕÕ“®®–°≈à“««à“°“√µ‘¥‡™◊ÕÈ
π—πÈ §ßÕ¬Ÿµà ≈Õ¥‰ª (persistent infection)4 ´÷ßË ®–°àÕ„À⇰‘¥°“√‡ª≈’¬Ë π
·ª≈ߢÕ߇´≈≈å ∑”„À⇰‘¥‡´≈≈å¡–‡√ÁߢÕßÕ«—¬«– à«π∑’Ë¡’°“√µ‘¥‡™◊ÈÕ
π—Èπ‰¥â ‚¥¬‡©æ“–‡´≈≈媓°¡¥≈Ÿ° (cervical cell) ∑’Ë®–‡°‘¥ cervical
intraepithelial neoplasia (CIN)
¡–‡√Áߪ“°¡¥≈Ÿ°‡ªìπ‚√§∑’Ë ”§—≠∑’Ë∑”„À⇰‘¥°“√‡ ’¬™’«‘µ„π§π
‰∑¬´÷ßË ªí®®ÿ∫π— ¡’°“√√≥√ߧå„Àâ¡°’ “√µ√«®¡–‡√Áߪ“°¡¥≈Ÿ°‡ªìπª√–®”
‡æ◊ÕË „Àâ “¡“√∂«‘π®‘ ©—¬¡–‡√Áߪ“°¡¥≈Ÿ°„π√–¬–‡√‘¡Ë ·√°∑’ Ë “¡“√∂„Àâ
°“√√—°…“‚¥¬°“√ºà“µ—¥‰¥â ªí®®ÿ∫—πæ∫«à“°“√µ‘¥‡™◊ÈÕ HPV type 16,
18, 31, 33, ·≈– 35 ®–‡ªì𠓇Àµÿ ”§—≠∑’Ë∑”„À⇰‘¥¡–‡√Áߪ“°
¡¥≈Ÿ°‰¥â Ÿß5 ‚¥¬‡©æ“– type 16 ´÷Ëßæ∫ Ÿß∂÷ß√âÕ¬≈– 44.44 6
„πªí®®ÿ∫π— ¡’§«“¡ π„®»÷°…“§«“¡ —¡æ—π∏å √–À«à“ß°“√µ‘¥‡™◊ÕÈ
HIV ·≈– HPV °—∫°“√‡°‘¥ cervical intraepithelial neoplasia (CIN)
´÷ßË æ∫«à“¡’Õµ— √“°“√‡°‘¥ cervical dysplasia ·≈– cervical carcinoma
‡æ‘Ë¡¡“°¢÷Èπ7 „πª√–‡∑»‰∑¬¡’°“√»÷°…“æ∫§«“¡ —¡æ—π∏åπ’È∑’Ë‚√ß欓∫“≈»‘√‘√“™„πªï æ.».2540-25411 æ∫«à“¡’ abnormal Pap smear
59.6% „πºŸâªÉ«¬ HIV ·≈–√âÕ¬≈– 9.6 ¢Õß Pap smear µ√«®æ∫
cellular change of HPV („™â‡°≥±å Õà“πº≈ Pap smear º‘¥ª°µ‘
‡¡◊ËÕ√“¬ß“πº≈‡ªìπ grade 2 - grade 4) à«π°“√»÷°…“∑’Ë‚√ß欓∫“≈
∫”√“»π√“¥Ÿ√„π ªï æ.». 2537-2538 °“√µ√® Pap smear „π µ√’
µ‘¥‡™◊ÈÕ‡Õ¥ å æ∫«à“¡’ abnormal Pap smear 6.7%8 („™â‡°≥±å°“√
Õà“πº≈ PAP smear º‘¥ª°µ‘ ‡¡◊ËÕæ∫ Dysplasia ∑ÿ°√–¥—∫ À√◊Õ æ∫
HPV change) µ—Èß·µàªï æ.». 2534 ¡’§«“¡ π„®»÷°…“‡√◊ËÕßπ’È„πºŸâ∑’Ë
‡ªìπ‚√§‡Õ¥ å¡“°¢÷πÈ ¡“‡√◊ÕË ¬ Ê9 ‡π◊ÕË ß®“°ºŸªâ «É ¬‚√§‡Õ¥ å¡Õ’ µ— √“°“√
µ√«®æ∫«à“‡ªìπ cervical carcinoma ‡æ‘Ë¡¢÷Èπ ·≈–æ∫«à“ §«“¡
√ÿπ·√ߢÕß CIN ∑’Ëæ∫ ®–¡“°°«à“ºŸâ‰¡àµ‘¥‡™◊ÈÕ HIV10
∂÷ß·¡â«à“®–¡’°“√»÷°…“„πª√–‡∑»‰∑¬∑’Ë· ¥ß∂÷ߧ«“¡ —¡æ—π∏å
¢Õß°“√µ‘¥‡™◊ÕÈ HPV °—∫°“√‡°‘¥°“√‡ª≈’¬Ë π·ª≈ߢÕ߇´≈≈媓°¡¥≈Ÿ°
¥â«¬°“√µ√«® Pap smear ∑’ÕË “®µ√«®æ∫À≈—°∞“π¢Õß°“√µ‘¥‡™◊ÕÈ HPV
„πºŸâ∑’˵‘¥‡™◊ÈÕ HIV ¥—ß°≈à“«¡“·≈â« ·µà¬—߉¡à¡’°“√»÷°…“≈–‡Õ’¬¥∂÷ß
√–¥—∫ HPV-DNA „πºŸâªÉ«¬∑’˵‘¥‡™◊ÈÕ HIV ´÷Ëß®–‡ªìπ°“√µ√«®∑’Ë
™à«¬¬◊π¬—𧫓¡ —¡æ—π∏å¢Õß°“√µ‘¥‡™◊ÈÕ HPV ‰¥â¥’¬‘Ëߢ÷Èπ4 „πµà“ß
ª√–‡∑»¡’°“√µ√«®æ∫¡’ HPV-DNA Ÿß∂÷ß√âÕ¬≈– 73 „πºŸªâ «É ¬ HIV11
¥—ßπ—Èπ°“√»÷°…“π’È®÷ß¡’§«“¡ª√– ߧå∑’Ë®–· ¥ß§«“¡ —¡æ—π∏å¢Õß
°“√‡ª≈’ˬπ·ª≈߇´≈≈å¡–‡√Áߪ“°¡¥≈Ÿ° (CIN) °—∫°“√µ‘¥‡™◊ÈÕ HPV
„πºŸâµ‘¥‡™◊ÈÕ HIV ¥â«¬°“√»÷°…“º≈¢Õß°“√µ√«® Pap smear √à«¡
°—∫°“√µ√«® HPV-DNA „π‡´≈≈宓°ª“°¡¥≈Ÿ°
«—µ∂ÿ·≈–«‘∏’°“√
µ√’∑µ’Ë ¥‘ ‡™◊ÕÈ ‡Õ¥ åÀ√◊Õ‡ªìπ‚√§‡Õ¥ å∑¡’Ë “µ√«® ·≈–µ‘¥µ“¡ °“√
√—°…“∑’·Ë ºπ°Õ“¬ÿ√°√√¡ ¢Õß ∂“∫—π∫”√“»π√“¥Ÿ√ µ—ßÈ ·µà‡¥◊Õπµÿ≈“§¡
2546 ∂÷ß °ÿ¡¿“æ—π∏å 2547 ®–‰¥â√—∫°“√Õ∏‘∫“¬∂÷ß°“√»÷°…“§«“¡
—¡æ—π∏å√–À«à“ß‚√§‡Õ¥ å ‚√§µ‘¥µàÕ∑“ß‡æ» —¡æ—π∏å ·≈–‚Õ°“ ∑’Ë®–‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ° ºŸâªÉ«¬∑’Ë ¡—§√„®¬‘π¬Õ¡®–‰¥â√—∫°“√
µ√«®µ“¡¢—πÈ µÕπ ´—°ª√–«—µ‘ µ√«®√à“ß°“¬ µ√«®‡≈◊Õ¥À“ CD4 count
µ√«®¿“¬„π µ√«®¡–‡√Áߪ“°¡¥≈Ÿ° (Pap smear), HPV- DNA test
°“√µ√«® high risk HPV-DNA test ∑”‚¥¬°“√‡°Á∫µ—«Õ¬à“ß
cervical discharge ®“° internal cervical os ¥â«¬·ª√ߢÕß™ÿ¥µ√«®
„ à„ππÈ”¬“ àßµ√«®¥â«¬ «‘∏’ hybrid capture technology ‚¥¬∑” DNA
hybridization
à«π°“√µ√«®¡–‡√Áߪ“°¡¥≈Ÿ° (Pap smear) „™â«‘∏’ conventional method ·≈–Õà“πº≈µ“¡ Bethesda system ‡¡◊ËÕ°“√Õà“πº≈
Pap smear ¡’§«“¡º‘¥ª°µ‘ µ—Èß·µà ASCUS (atypical squamous cell
of undeterminated significant) ¢÷Èπ‰ª ®–‰¥â√—∫°“√µ—¥™‘Èπ‡π◊ÈÕª“°
¡¥≈Ÿ° (cervical biopsy) ‡æ◊ËÕ«‘π‘®©—¬∑“ß欓∏‘«‘∑¬“µàÕ‰ª ´÷Ëßµ“¡
¢—ÈπµÕπ°“√«‘π‘®©—¬ cervical intraepithelial neoplasia (CIN) ®–
àßµ√«® Colposcope ‡æ◊ËÕ∑” cervical biopsy ·µà∑’Ë ∂“∫—π∫”√“»
π√“¥Ÿ√‰¡à¡’ colposcope ®÷ß∑” directed cervical biopsy ‚¥¬„™â«‘∏’
Schillerûs test („™â Lugolûs solution ªÑ“¬∑’Ë ª“°¡¥≈Ÿ° ·≈â«∑”
biopsy ®“°∫√‘‡«≥∑’ˉ¡àµ‘¥ ’)
∂⓺≈µ√«®∑“ß欓∏‘«∑‘ ¬“¢Õß cervical biopsy ¡’§«“¡º‘¥ª°µ‘
µ—Èß·µà CIN II (cervical intraepithelial neoplasia II) À√◊Õ moderate dysplasia ¢÷Èπ‰ª ºŸâªÉ«¬®–∂Ÿ°√—∫‰«â„π‚√ß欓∫“≈‡æ◊ËÕ∑”ºà“µ—¥
§«â“𪓰¡¥≈Ÿ°‡ªìπ√Ÿª°√«¬ (conization) ‡æ◊ËÕ«‘π‘®©—¬·≈–√—°…“
À≈—ß∑√“∫º≈™‘Èπ‡π◊ÈÕ∑“ß欓∏‘«‘∑¬“ ®–„Àâ°“√√—°…“µ“¡¢—ÈπµÕπ
¢Õß°“√√—°…“ cervical intraepithelial neoplasia (CIN) µàÕ‰ª
à«πºŸâªÉ«¬∑’Ë¡’º≈°“√µ√«®™‘Èπ‡π◊ÈÕª“°¡¥≈Ÿ° (cervical biopsy) ∑“ß
欓∏‘«‘∑¬“‡ªìπ CIN I À√◊Õ mild dysplasia ®–‰¥â√—∫°“√µ√«® Pap
Siriraj Med J, Volume 58, Number 2, February 2006
smear ∑ÿ° 3 ‡¥◊Õπ ∂â“æ∫¡’°“√‡ª≈’ˬπ·ª≈ß∑’˺‘¥ª°µ‘¡“°¢÷Èπ ®–
∑”°“√µ—¥™‘Èπ‡π◊ÈÕµ√«®µ“¡¢—ÈπµÕπ°“√√—°…“ CIN ‡™àπ‡¥’¬«°—π
¢π“¥°≈ÿࡵ—«Õ¬à“ß 150 √“¬
µ“√“ß∑’Ë 1. ¢âÕ¡Ÿ≈∑—Ë«‰ª¢Õß µ√’µ‘¥‡™◊ÈÕ HIV ∑’Ë¡“√—∫°“√µ√«®
¢âÕ¡Ÿ≈∑—Ë«‰ª
Õ“¬ÿ
Õ“™’æ
CD4 count
<20
20-35
>35
√«¡
√—∫®â“ß
·¡à∫â“π
§â“¢“¬
√—∞«‘ “À°‘®
Õ◊Ëπ Ê
√«¡
<200
200-400
>400
√«¡
®”π«π
2
95
53
150
50
38
33
27
2
150
65
49
36
150
√âÕ¬≈–
1.3
63.3
35.3
100
33.3
25.3
22.0
18.0
1.3
100
43.3
32.7
24.0
100
µ“√“ß∑’Ë 2. º≈°“√µ√«® Pap smear ´÷Ëß¡’ abnormal Pap smear 25 √“¬
Pap smear
µ√«®æ∫ cellular µ√«®‰¡àæ∫ cellular
change of HPV change of HPV
®“° Pap smear ®“° Pap smear
Normal
125
ASCUS 2
5
Abnormal LSIL 10
2
HSIL 1
5
√«¡ abnormal
13
12
√«¡∑—ÈßÀ¡¥
®”π«π √âÕ¬≈–
125
7
12
6
25
150
83.3
4.6
8.0
4.0
16.6
100
µ“√“ß∑’Ë 3. º≈°“√µ√«®¡–‡√Áߪ“°¡¥≈Ÿ°, °“√µ√«® HPV-DNA ·≈–®”π«π∑’ˉ¥â∑”
cervical biopsy
Pap smear
HPV-DNA
positive
Normal
34(61.2%)
ASCUS 5
Abnormal LSIL
10
HSIL
6
√«¡
abnormal 21(38.2%)
√«¡∑—ÈßÀ¡¥
55
HPV-DNA
negative
91(95.8%)
2
2
0
4 (4.2%)
95
®”π«π Chi P-value
Square
125
28.94 <0.01
7
12
6
25
150
µ“√“ß∑’Ë 4. º≈°“√µ√«®∑“ß欓∏‘«‘∑¬“¢ÕߺŸâªÉ«¬ 16 √“¬ ∑’ˉ¥â√—∫°“√µ—¥™‘Èπ‡π◊ÈÕª“°
¡¥≈Ÿ° (directed cervical biopsy with Schillerûs test)
Pap
smear
ASCUS
LSIL
HSIL
√«¡
‰¥â∑” º≈ cervical biopsy
®” cervical no
mild moderate severe CIS √«¡
π«π biopsy dysplasia dysplasia dysplasia dysplasia
7
4
3
1
12
6
3
2
1
6
6
2
1
1
2
25
16
8
2
2
2
2 16
659
µ“√“ß∑’Ë 5. º≈™‘Èπ‡π◊ÈÕ∑“ß æ¬“∏‘«‘∑¬“ µ“¡¿“«– dysplasia µ—Èß·µà moderate dysplasia ¢÷Èπ‰ª ·≈– mild dysplasia ≈ß¡“
Pap smear
ASCUS +
LSIL
HSIL
√«¡
º≈ cervical biopsy
No + Mild
µ—Èß·µà moderate
dysplasia
dysplasia ¢÷Èπ‰ª
8 (80%)
2 (33.3%)
2 (20%)
10
Chi
square
P-value
3.48
0.092
4 (66.7%)
6
µ“√“ß∑’Ë 6. º≈°“√µ√«® Pap smear ‚¥¬·∫àßµ“¡√–¥—∫ CD4 count
Pap smear
CD4 count
<200cell/ mm3
Normal
54 (83.1%)
ASCUS 5
Abnormal LSIL 5
HSIL 1
√«¡ abnormal
11 (16.9%)
√«¡
65
CD4 count
Chisquare P-value
>200cell/ mm3
71 (83.5%)
0.005
0.056
2
7
5
14 (16.5%)
85
µ“√“ß∑’Ë 7. ®”π«πºŸâ∑’ˉ¥â√—∫°“√∑” cervical biopsy ‰¥âº≈ dysplasia ‚¥¬·∫àßµ“¡
§à“ CD4 count ¡“°°«à“À√◊ÕπâÕ¬°«à“ 200 cell/ mm3
Cervical biopsy
No dysplasia
Mild dysplasia
Moderate dysplasia
Severe dysplasia
Carcinoma in situ
√«¡
CD4 count
<200 cell/ mm3
3 5 (71.4%)
2
1
1 2 (28.6%)
0
7
CD4 count
Chisquare P-value
3
>200 cell/ mm
5 5 (55.6%) 0.423
0.451
0
1
1 4 (44.4%)
2
9
°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈
¢âÕ¡Ÿ≈∑’‰Ë ¥âπ”¡“√«∫√«¡ ·≈–«‘‡§√“–Àå∑“ß ∂‘µ‘ ·∫∫ descriptive (frequency, percent) ·≈–«‘‡§√“–À姫“¡·µ°µà“ß‚¥¬„™â Chisquare test, P - value
º≈°“√»÷°…“
®”π«πºŸµâ ¥‘ ‡™◊ÕÈ ‚√§‡Õ¥ å∑√’Ë ∫— ‡¢â“¡“»÷°…“ 150 √“¬ ¡’Õ“¬ÿµß—È ·µà
16 - 49 ªï à«π„À≠àÕ¬Ÿà„π«—¬‡®√‘≠æ—π∏ÿå (20-35 ªï) = 63.3% ¡’
Õ“™’æ√—∫®â“ß (33.3%) ·≈–·¡à∫â“π (25.3%) ºŸâªÉ«¬∑—ÈßÀ¡¥¡’º≈°“√
µ√«®√–¥—∫ CD4 count ·∫à߇ªìπ√–¥—∫µà“ß Ê ¥—ß· ¥ß„πµ“√“ß∑’Ë 1
º≈°“√µ√«® Pap smear æ∫«à“ ¡’§«“¡º‘¥ª°µ‘ ®”π«π 25 √“¬
(16.6%) ¥—ßµ“√“ß∑’Ë 2
‡¡◊ËÕ¥Ÿº≈°“√µ√«® HPV-DNA test ®“° cervical discharge
æ∫«à“ HPV-DNA positive (high risk) ¡’®”π«π 55 √“¬ (36.7%)
¥—ß· ¥ß„πµ“√“ß∑’Ë 3 „π®”π«ππ’È ¡’º≈ Pap smear ª°µ‘ 34 √“¬
(61.8%) ·≈–º‘¥ª°µ‘ 21 √“¬ (38.2%) à«πºŸâ∑’Ë¡’º≈ HPV-DNA
negative ¡’º≈ abnornaal Pap smear ª°µ‘ 4 √“¬ (4.2%) µ√’µ‘¥
‡™◊ÈÕ‡Õ¥ å„π°≈ÿà¡π’È ®”‡ªìπ∑’Ë®–µâÕßµ√«® Pap smear ‡æ◊ËÕµ‘¥µ“¡¥Ÿ
°“√‡ª≈’ˬπ·ª≈ߢÕ߇´≈≈媓°¡¥≈Ÿ°‡ªìπ√–¬–«à“®–‡°‘¥‡ªìπ CIN
À√◊Õ‰¡à ‡æ◊ËÕ∑’Ë®–„Àâ°“√¥Ÿ·≈ √—°…“ ·≈–«‘π‘®©—¬µàÕ‰ª
®“°®”π«π 25 √“¬ ¢ÕߺŸâ∑’Ë¡’º≈µ√«® Abnormal Pap smear
660
¡’º≈°“√µ√«® HPV-DNA test positive (high risk) 21 √“¬ ·≈–º≈
negative 4 √“¬ „π 4 √“¬ º≈ Pap smear ‡ªìπ ASCUS 2 √“¬
LSIL 2 √“¬ ´÷Ë߇¡◊ËÕ à߉ª∑” cervical biopsy „π°≈ÿà¡ HPV-DNA
test positive 21 √“¬ ‰¥â∑” 16 √“¬ °≈ÿà¡∑’Ë HPV-DNA test negative ‰¡à¡“∑” biopsy µ“¡π—¥∂÷ß·¡â®–µ‘¥µ“¡„Àâ¡“µ√«® º≈°“√
µ√«®∑“ß欓∏‘«‘∑¬“¢Õß ™‘Èπ‡π◊ÈÕª“°¡¥≈Ÿ°∑’ˉ¥â∑” cervical biopsy
„πºŸâªÉ«¬∑—Èß 16 √“¬ æ∫‡ªìπ no dysplasia 8 √“¬ ¡’ dysplasia 8 √“¬
¥—ß· ¥ß„πµ“√“ß∑’Ë 4
‡¡◊ËÕ·∫àß°≈ÿࡵ“¡º≈ dysplasia µ—Èß·µà moderate dysplasia ¢÷Èπ
‰ª 6 √“¬ ∑’˵âÕßµ√«®«‘π‘®©—¬µàÕ ·≈–µ—Èß·µà mild dysplasia ≈ß¡“
8 √“¬ ´÷Ëß„™âµ‘¥µ“¡µ√«® Pap smear ·≈–®—¥°≈ÿà¡ Pap smear ‡ªìπ
ASCUS + LSIL ·≈– HSIL ∑’˵âÕßµ√«®«‘π‘®©—¬ ‡æ◊ËÕ¡“«‘‡§√“–Àå
∑“ß ∂‘µ‘ æ∫«à“°≈ÿà¡∑’ˇªìπ ASCUS + LSIL ¡’º≈‡ªìπ mild dysplasia ≈ß¡“ 8 √“¬ (80%) ·≈–°≈ÿà¡∑’ˇªìπ HSIL ¡’º≈‡ªìπ moderate dysplasia ¢÷Èπ‰ª 4 √“¬ (66.7%) ¥—ßµ“√“ß∑’Ë 5
„π®”π«ππ’ȉ¥â√—∫°“√∑”ºà“µ—¥ conization 4 √“¬ Õ’° 2 √“¬
¢“¥°“√µ‘¥µàÕ √“¬∑’ˉ¥â√—∫°“√∑” conization ¡’º≈°“√µ√«®∑“ß
欓∏‘‡ªìπ carcinoma in situ with gland involvement 2 √“¬ ´÷Ëß
‰¥â∑”ºà“µ—¥ hysterectomy µàÕ‰ª à«πÕ’° 1 √“¬ ‡ªìπ moderate
dysplasia ´÷ßË ºŸªâ «É ¬¢Õ‰ª„™â ∑‘ ∏‘∫µ— √ª√–°—π ÿ¢¿“æ∑’‚Ë √ß欓∫“≈Õ◊πË
Õ’° 1 √“¬ ‡ªìπ invasive squamous cell carcinoma ´÷Ë߉¥â àßµàÕºŸâ
ªÉ«¬‰ª√—∫°“√√—°…“∑’Ë ∂“∫—π¡–‡√Áß
°“√¥Ÿ·≈√—°…“ºŸªâ «É ¬‚√§‡Õ¥ å®–∑”°“√µ√«®¥Ÿ°“√欓°√≥å¢Õß
‚√§ ‚¥¬Õ“»—¬¥Ÿ√–¥—∫¢Õß viral load À√◊Õ ª√‘¡“≥¢Õß CD4 count
´÷Ëß®–Õ“»—¬®“°‡°≥±å viral load ¡“° À√◊Õ CD4 count <200 cell/
mm3 ®–∑”„Àâ¡’‚Õ°“ ‡ªìπ‚√§‡Õ¥ åÀ√◊Õ¿“«–µ‘¥‡™◊ÈÕµà“ß Ê ‰¥â‡√Á«
¢÷Èπ „π°“√»÷°…“§√—Èßπ’È®–¥Ÿ°“√‡ª≈’ˬπ·ª≈ߢÕ߇´≈≈媓°¡¥≈Ÿ°„π
µ√’µ‘¥‡™◊ÈÕ‡Õ¥ å ®÷߉¥âµ√«® CD4 count ¥â«¬ ·≈–æ∫«à“ºŸâ∑’Ë¡“µ√«®
¡’ CD4 count <200 cell/ mm3 Õ¬Ÿà∂÷ß 65 √“¬ (43.3%) ¥—ßµ“√“ß∑’Ë 1
‡¡◊ÕË ¥Ÿº≈ Pap smear ‚¥¬·∫àß°≈ÿ¡à µ“¡§à“ CD4 count ‡™àπ‡¥’¬«°—π
æ∫«à“¡’ Abnormal Pap smear ∑’Ë¡’§à“ CD4 count <200 cell/ mm3
11 √“¬ (16.9%) ·≈– CD4 count >200 cell/mm3 14 √“¬ (16.5%)
¥—ß· ¥ß„πµ“√“ß∑’Ë 6
‡¡◊ÕË æ‘®“√≥“º≈°“√∑” cervical biopsy ‚¥¬·¬°º≈‡ªìπ °≈ÿ¡à
no dysplasia ·≈– mild dysplasia °—∫°≈ÿà¡ moderate dysplasia
¢÷Èπ‰ª ·≈–·¬°°≈ÿࡵ“¡√–¥—∫§à“ CD4 count <200 À√◊Õ >200 cell/
mm3 ‡æ◊ËÕ¥Ÿ«à“§«“¡ ¿“«–§«“¡√ÿπ·√ߢÕß°“√µ‘¥‡™◊ÈÕ HIV ®–¡’º≈
Õ¬à“߉√°—∫ °“√‡ª≈’ˬπ·ª≈ߢÕ߇´≈≈媓°¡¥≈Ÿ° æ∫«à“°≈ÿà¡∑’ˇªìπ
moderate dysplasia ¢÷Èπ‰ª 2 √“¬ (28.6%) ¡’ CD4 count <200 cell/
mm3 ·≈– 4 √“¬ (44.4%) ¡’ CD4 count>200 cell/mm3 ¥—ß· ¥ß„π
µ“√“ß∑’Ë 7
«‘®“√≥å
ºŸâªÉ«¬∑’˵‘¥‡™◊ÈÕ HIV ‡¡◊ËÕ‡°‘¥°“√µ‘¥‡™◊ÈÕ HPV √à«¡¥â«¬®–¡’
°“√§ßÕ¬Ÿà¢Õ߇™◊ÈÕ (persistent infection) „π squamous cell ¢Õß
ª“°¡¥≈Ÿ°´÷Ëß¡’º≈∑”„À⇰‘¥°“√‡ª≈’ˬπ·ª≈ߢÕ߇´≈≈媓°¡¥≈Ÿ°‰¥â
Ferenzy A ·≈–§≥– æ∫«à“ µ√’µ‘¥‡™◊ÈÕ HIV ∑’Ë¡’ immunosuppression ®–¡’‚Õ°“ ‡ªìπ lower genital tract neoplasia ¡“°°«à“ºŸâ∑’ˉ¡à
µ‘¥‡™◊ÈÕ HIV ∂÷ß 5 ‡∑à“13
®“°°“√µ√«® µ√’µ¥‘ ‡™◊ÕÈ HIV ∑’ Ë ¡—§√„®‡¢â“√à«¡°“√»÷°…“§√—ßÈ
π’Èæ∫«à“ à«π„À≠ଗßÕ¬Ÿà„π«—¬‡®√‘≠æ—π∏ÿå §◊ÕÕ“¬ÿ√–À«à“ß 20-35 ªï
‡ªìπ®”π«π∂÷ß 63.3% º≈°“√µ√«® Pap smear æ∫«à“¡’§«“¡™ÿ°
¢Õß abnormal Pap smear 16.6% (´÷Ëß„™â°“√Õà“πº≈ Pap smear
µ“¡ Bethesda system §◊Õ ASCUS, LSIL, HSIL) ´÷Ë߇æ‘Ë¡¢÷Èπ°«à“
º≈°“√»÷°…“∑’Ë ∂“∫—π∫”√“»π√“¥Ÿ√‡¡◊ËÕªï æ.».2538 ´÷Ëßæ∫‡æ’¬ß
6.7%8 „π¢≥–∑’Ë°“√»÷°…“¢Õß‚√ß欓∫“≈»‘√‘√“™„πªï æ.».2540
æ∫ abnormal Pap smear Ÿß∂÷ß 59.6%1 (‡π◊ËÕß®“°„™â‡°≥±åÕà“πº≈
Pap smear ·∫∫‡¥‘¡) ‡ªìπ‰ª‰¥â«à“ºŸâµ‘¥‡™◊ÈÕ HIV „πª√–‡∑»‰∑¬°Á
¡’°“√‡ª≈’¬Ë π·ª≈ߢÕ߇´≈≈媓°¡¥≈Ÿ°‰¥âß“à ¬¢÷πÈ ·≈–‡√Á«¢÷πÈ ‡™àπ‡¥’¬«
°—∫∑’Ëæ∫®“°°“√»÷°…“„πµà“ߪ√–‡∑»2,3
‡¡◊ËÕ¥Ÿº≈°“√µ√«®æ∫«à“¡’°“√µ‘¥‡™◊ÈÕ HPV ®“°°“√µ√«® Pap
smear “¡“√∂æ∫ cellular change of HPV ‡æ’¬ß 13 √“¬ µ“¡
µ“√“ß∑’Ë 2 „π¢≥–∑’Ë°“√µ√«® cervical discharge À“ HPV-DNA
test ‰¥âº≈∫«° (high risk) ∂÷ß 55 √“¬ µ“¡µ“√“ß∑’Ë 3 °“√µ√«®
æ∫ HPV ®“° Pap smear ∑’Ëæ∫ cellular change of HPV ®÷ß
‡ªìπ°“√µ√«®„π‡∫◊ÈÕßµâπ‡∑à“π—Èπ12 ‡™àπ‡¥’¬«°—∫º≈°“√µ√«®∑’Ë ‚√ß
欓∫“≈»‘√‘√“™´÷Ëßæ∫ cellular change of HPV „π Pap smear
9.6%1 à«π°“√µ√«®¢Õßµà“ߪ√–‡∑»‚¥¬„™â HPV-DNA æ∫º≈∫«°
¡“°∂÷ß 73%11 „πª√–‡∑»‰∑¬ªí®®ÿ∫π— ¬—ß¡’¢Õâ ®”°—¥„π‡√◊ÕË ß√“§“¢Õß
°“√µ√«® HPV-DNA ´÷ßË ¬—ß¡’√“§“ ŸßÕ¬Ÿ¡à “° ·≈–¢âÕ®”°—¥¢Õߧ«“¡
“¡“√∂¢ÕßÀâÕߪؑ∫—µ‘°“√„π°“√µ√«® HPV-DNA¬—ß¡’πâÕ¬
Ferency ·≈–§≥– æ∫«à“„π°≈ÿ¡à ºŸ∑â ¡’Ë º’ ≈µ√«® HPV-DNA test
‡ªìπ∫«° (high risk) ®–¡’‚Õ°“ ‡ªìπ advance grade ¢Õß CIN
‰¥â13 ·≈– Levi JE ·≈–§≥– æ∫«à“¡’Õ—µ√“°“√µ√«®æ∫ HPVDNA test positive 87%14 ®“°µ“√“ß∑’Ë 3 º≈°“√µ√«® Pap smear
æ∫«à“¡’ abnormal Pap smear „π°≈ÿà¡∑’Ë¡’ HPV-DNA positive 21
√“¬ (38.2%) ·≈– normal Pap smear „π°≈ÿ¡à ∑’¡Ë ’ HPV-DNA negative
91 √“¬ (72.8%) · ¥ß«à“ºŸâ∑’Ë¡’ abnormal pap smear ¡’·π«‚πâ¡∑’Ë
®–¡’ HPV-DNA positive ‡¡◊ËÕ«‘‡§√“–Àå∑“ß ∂‘µ‘·≈â«æ∫«à“¡’§«“¡
—¡æ—π∏å Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (Chi- square = 28.94, P-value
= <0.01) Õ¬à“߉√°Á¥’ °“√µ√«® Pap smear ‡ªìπ°“√µ√«®®“°§«“¡
º‘¥ª°µ‘¢Õ߇´≈≈媓°¡¥≈Ÿ°∑’ËÀ≈ÿ¥≈Õ°ÕÕ°¡“„π¡Ÿ°∑’˪“°¡¥≈Ÿ°
°“√µ‘¥‡™◊ÈÕ HPV ¢Õ߇´≈≈媓°¡¥≈Ÿ°®–§ßÕ¬Ÿà (persistent infection) ´÷Ëß®–∑”„À⇰‘¥°“√‡ª≈’ˬπ·ª≈ߢÕ߇´≈≈媓°¡¥≈Ÿ°‰¥â ¥—ßπ—Èπ
°“√µ‘¥µ“¡µ√«® ºŸâµ‘¥‡™◊ÈÕ HIV ∑’ˉ¥âµ√«®æ∫«à“ HPV-DNA positive ·µàº≈°“√µ√«® Pap smear ª°µ‘ ´÷Ëß°“√»÷°…“π’Èæ∫Õ¬Ÿà 34 √“¬
(61.2%) §«√‰¥â√∫— °“√µ√«®µ‘¥µ“¡∑ÿ° 6 ‡¥◊Õπ ‡æ√“–°“√»÷°…“¢Õß
Branca M ·≈–§≥–15 æ∫«à“ „πºŸâ∑’˵‘¥‡™◊ÈÕ HIV ·≈–µ√«®æ∫¡’°“√
µ‘¥‡™◊ÈÕ HPV √à«¡¥â«¬ ¡’°“√‡ª≈’ˬπ·ª≈ߢÕ߇´≈≈媓°¡¥≈Ÿ° ‰ª
‡ªìπ CIN ‰¥â‡√Á«°«à“ µ√’∑‰’Ë ¡àµ¥‘ ‡™◊ÕÈ HIV ∑—ßÈ π’°È “√µ√«® HPV-DNA
¡’°“√»÷°…“„πµà“ߪ√–‡∑»æ∫«à“ “¡“√∂™à«¬„π°“√«‘π®‘ ©—¬ advance
grade of CIN ‰¥â16,17 ·µà„πª√–‡∑»‰∑¬ °“√µ√«®π’Ȭ—ß¡’¢âÕ®”°—¥
¥—ßπ—Èπ °“√µ√«® Pap smear „π µ√’µ‘¥‡™◊ÈÕ‡Õ¥ å Õ¬à“ßπâÕ¬ªï≈– 1
§√—ßÈ ®÷߇ªìπ ‘ßË ∑’‡Ë À¡“– ¡°—∫ª√–‡∑»°”≈—ßæ—≤π“ „π°“√‡ΩÑ“√–«—ß °“√
‡ª≈’ˬπ·ª≈ߢÕ߇´≈≈媓°¡¥≈Ÿ°„π µ√’µ‘¥‡™◊ÈÕ‡Õ¥ å
‡¡◊ËÕ∑” direct cervical biopsy „π°≈ÿà¡∑’Ë¡’º≈ abnormal Pap
smear æ∫«à“ °≈ÿà¡∑’Ë¡’‡ªìπ HSIL ‰¥âº≈‡ªìπ moderate dysplasia
¢÷Èπ‰ª 4 √“¬ (66.7%) ¥—ßµ“√“ß∑’Ë 5 · ¥ß«à“ ∂⓺≈µ√«® Pap
smear ‡ªìπ HSIL ¡’·π«‚πâ¡∑’Ë®–¡’°“√‡ª≈’ˬπ·ª≈ߢÕ߇´≈≈媓°
¡¥≈Ÿ° ‡ªìπ CIN µ—ßÈ ·µà moderate dysplasia ¢÷πÈ ‰ª‰¥â¡“°°«à“°≈ÿ¡à ∑’Ë
Pap smear ‡ªìπ ASCUS ·≈– LSIL ·µà‡¡◊ËÕ«‘‡§√“–À姫“¡
—¡æ—π∏å∑“ß ∂‘µ‘·≈⫉¡à¡’§«“¡·µ°µà“ßÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘
(Chi-square = 3.84, P-value = 0.092)
¿“«–§«“¡√ÿπ·√ߢÕß°“√µ‘¥‡™◊ÈÕ‚√§‡Õ¥ å®–ª√–‡¡‘π‚¥¬∑“ß
Siriraj Med J, Volume 58, Number 2, February 2006
ÕâÕ¡®“°°“√¥Ÿ§à“ CD4 count ¢ÕߺŸâµ‘¥‡™◊ÈÕ HIV ∂â“§à“ CD4 count ¡’
º≈ <200 cell/ mm3 · ¥ß«à“ ºŸâµ‘¥‡™◊ÈÕ HIV π—ÈπÕ“®¡’‚Õ°“ ‡ªìπ
‚√§‡Õ¥ 剥â‡√Á« ·≈–‡¡◊ËÕµ√«®æ∫ HPV-DNA positive ®–¡’‚Õ°“ ‡ ’ˬß∑’Ë®–‡°‘¥‡ªìπ cervical intraepithelial neoplasia (CIN) ‰¥â Ÿß13
´÷ßË °“√»÷°…“„πµà“ߪ√–‡∑»°Áæ∫§«“¡ —¡æ—π∏å¥ß— °≈à“«15 ·µà®“°¢âÕ¡Ÿ≈
„π°“√»÷°…“§√—Èßπ’È ‡¡◊ËÕ¥Ÿº≈°“√µ√«® Pap smear, cervical biopsy
‚¥¬·¬°°≈ÿࡺ≈ CD4 count <200 cell/ mm3 ·≈– >200 cell/ mm3
·≈â« à«πº≈°“√µ√«®∑’ˇªìπ abnormal Pap smear „π°≈ÿà¡∑’Ë CD4
count <200 cell/ mm3 ¡’Õ¬Ÿà 54 √“¬ (83.1%) ·≈– >200 cell/ mm3
71 √“¬ (83.5%) ´÷ßË ‰¡à¡§’ «“¡·µ°µà“ß∑“ß ∂‘µ‘ (chi square= 0.005,
P-value=0.556) ¥—ßµ“√“ß∑’Ë 7 ·≈–æ‘®“√≥“®“°º≈ cervical biopsy
°≈ÿà¡∑’Ë¡’º≈‡ªìπ moderate dysplasia ¢÷Èπ‰ª·≈–¡’ CD4 count <200
cell/ mm3= 2 √“¬ (28.6%) ·≈– >200 cell/ mm3 = 4 √“¬ (44.4%)
‡¡◊ÕË π”¡“À“§«“¡ —¡æ—π∏å∑“ß ∂‘µæ‘ ∫«à“‰¡à·µ°µà“ß°—π (Chi square
=0.423, P-value=0.451) ¥—ßµ“√“ß∑’Ë 8 ®“°¢âÕ¡Ÿ≈¥—ß°≈à“«„π°“√
»÷°…“§√—Èßπ’ȉ¡àæ∫«à“„π°≈ÿà¡∑’Ë CD4 count <200 cell/ mm3 ®–∑”„Àâ
µ√«®æ∫ abnormal Pap smear À√◊Õ°“√‡ª≈’ˬπ·ª≈ߢÕ߇´≈≈å
ª“°¡¥≈Ÿ°‰ª‡ªìπ CIN À√◊Õæ∫«à“¡’°“√µ‘¥‡™◊ÈÕ HPV „π√–¥—∫∑’Ë
Ÿß¢÷πÈ ‡À¡◊Õπ°—∫°“√»÷°…“¢Õßµà“ߪ√–‡∑»15 ·≈–º≈°“√»÷°…“¬—߉¡à
“¡“√∂™’„È Àâ‡ÀÁπ∂÷ߧ«“¡ —¡æ—π∏å√–À«à“ß°“√¡’ CD4 count µË” ∑”„Àâ
¡’‚Õ°“ ‡°‘¥ CIN ‰¥â14 ‡π◊ËÕß®“°°“√»÷°…“§√—Èßπ’È ‰¥â∑”°“√µ—¥™‘Èπ
‡π◊ÈÕ‰ª‡æ’¬ß 16 √“¬ ®“° 21 √“¬ ®”π«πµ—«Õ¬à“ßπâÕ¬‡°‘π‰ª®÷߉¡à
“¡“√∂ √ÿª§«“¡ —¡æ—π∏套߰≈à“«‰¥â
√ÿª
°“√µ√«® Pap smear, CD4 count, HPV test „πºŸâ∑’˵‘¥‡™◊ÈÕ
HIV ‡ªìπ ‘Ëß∑’˧«√µ√«®„π ∂“π∑’Ë∑’Ë “¡“√∂µ√«®‰¥â‡æ◊ËÕ æ¬“°√≥å
‚Õ°“ ‡°‘¥ CIN ¢Õß µ√’‡À≈à“π’È ∑’Ë¡’‚Õ°“ ‡ªìπ¡–‡√Áߪ“°¡¥≈Ÿ°
Ÿß°«à“ºŸâ∑’ˉ¡à‰¥âµ‘¥‡™◊ÈÕ HIV ·µà„πª√–‡∑»°”≈—ßæ—≤π“ °“√µ√«®
HPV test ®–¡’ª≠
í À“‡√◊ÕË ß§à“„™â®“à ¬„π°“√µ√«® ®÷ßµâÕß„™â°“√µ√«®
Pap smear ‡ªìπ√–¬– ¡Ë”‡ ¡Õ„π°“√‡ΩÑ“√–«—ß°“√‡ª≈’ˬπ·ª≈ß
¢Õ߇´≈≈媓°¡¥≈Ÿ°‰ª‡ªìπ CIN ·≈–‡π◊ËÕß®“°‚√§‡Õ¥ 凪ìπ‚√§∑’Ë
‡√◊ÕÈ √—ß·≈–∫—πË ∑Õπ ÿ¢¿“æ¢ÕߺŸªâ «É ¬À“°‰¡à‰¥â√∫— °“√¥Ÿ·≈√—°…“Õ¬à“ß
¡Ë”‡ ¡Õ‚¥¬‡©æ“–ºŸâ∑’Ë¡’ªí≠À“∑“߇»√…∞°‘® ∂Ⓡ°‘¥¡–‡√Áߪ“°
¡¥≈Ÿ°√à«¡¥â«¬®–∑”„À⡺’ ≈µàÕ°“√¥”√ß™’«µ‘ ¢ÕߺŸªâ «É ¬„Àâ¡Õ’ ªÿ √√§
¡“°¢÷Èπ ®÷ߧ«√„À⺟â∑’˵‘¥‡™◊ÈÕ HIV §«√‰¥â√—∫°“√µ√«® Pap smear
¡Ë”‡ ¡ÕÕ¬à“ßπâÕ¬ªï≈– 1 §√—ßÈ ·≈–„π∑’∑Ë ’Ë “¡“√∂µ√«® CD4 count,
HPV-DNA test ‰¥â ºŸ∑â µ’Ë ¥‘ ‡™◊ÕÈ HIV §«√‰¥â√∫— °“√µ√«®‡æ◊ÕË ª√–‡¡‘π
‚Õ°“ ‡ ’ˬߢÕß°“√‡°‘¥ CIN ¢Õߪ“°¡¥≈Ÿ°‰¥â¥’¢÷Èπ
‡Õ° “√Õâ“ßÕ‘ß
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§«“¡ —¡æ—π∏å√–À«à“ß°“√µ‘¥‡™◊ÈÕ Human papilloma virus °—∫ §«“¡º‘¥ª°µ‘¢Õß Pap smear „π µ√’
∑’˵‘¥‡™◊ÈÕ‚√§‡Õ¥ å ·≈–·π«‚πâ¡°“√‡ª≈’ˬπ·ª≈ߢÕ߇´≈≈å¡–‡√Áߪ“°¡¥≈Ÿ°√–¬–‡√‘Ë¡·√°
Õ¡√æ—π∏ÿå «‘√—™™—¬ æ.∫., ‡®√‘≠ ÿ¢ Õ—»«æ‘æ‘∏ æ.¬∫., Õ“√’«√√≥ ‡®√‘≠√◊Ëπ æ.¬∫., ª√’™“ µ—π∏π“∏‘ª æ.∫., °“√ÿ≥¬å §ÿ≥µ‘√“ππ∑å æ.∫.,
¿Ÿ™‘™¬å ¡’ª√–‡ √‘∞ °ÿ≈ æ.∫., Õ—®©√“ ‡™“««≥‘™ æ.∫.
ß“π Ÿµ‘-π√’‡«™°√√¡, ∂“∫—π∫”√“»π√“¥Ÿ√, °√¡§«∫§ÿ¡‚√§, °√–∑√«ß “∏“√≥ ÿ¢ , ππ∑∫ÿ√’ 11000, ª√–‡∑»‰∑¬.
°“√µ‘¥‡™◊ÈÕ human papilloma virus(HPV) ¢Õ߇´≈≈媓°¡¥≈Ÿ°∑’ˇ°‘¥‡ªìπ persistent infection „π squamous cell ®–¡’§«“¡ —¡æ—π∏å°—∫°“√‡ª≈’ˬπ·ª≈ß
¢Õ߇´≈≈å¡–‡√Áߪ“°¡¥≈Ÿ° ´÷Ëß µ√’µ‘¥‡™◊ÈÕ‡Õ¥ åÀ√◊Õ‡ªìπ‚√§‡Õ¥ å ®–¡’‚Õ°“ ‡°‘¥ persistent HPV infection‰¥â Ÿß°«à“ºŸâ∑’ˉ¡àµ‘¥‡™◊ÈÕ °“√»÷°…“π’È®÷߉¥âµ√«®
HPV-DNA¢Õß cervical discharge ·≈– pap smear „π µ√’µ‘¥‡™◊ÈÕ‡Õ¥ å®”π«π 150 √“¬ à«π„À≠àÕ¬Ÿà„π«—¬‡®√‘≠æ—π∏ÿå (Õ“¬ÿ 20-35 ªï, 63.3%) µ√«®æ∫
HPV-DNA positive 55 √“¬ „π®”π«ππ’È¡’ abnormal pap smear 25 √“¬ ´÷Ëß¡’§«“¡º‘¥ª°µ‘ µ—Èß·µà Atypical squamous cell of umdeterminated significant
(ASCUS) 7 √“¬, low grade squamous intraepithelial lesion (LSIL) 12 √“¬ ·≈– high grade squamous intraepithelial lesion (HSIL) 6 √“¬ ‰¥â∑”
cervical biopsy 16 √“¬ º≈‡ªìπ moderate dysplasia ¢÷Èπ‰ª 6 √“¬ (42.8%) ¢âÕ¡Ÿ≈∑’ˉ¥âæ∫«à“ µ√’µ‘¥‡™◊ÈÕ‡Õ¥ å∑’˵√«®æ∫ HPV-DNA ¡’§«“¡ —¡æ—π∏å°—∫
°“√µ√«®æ∫ Abnormal Pap smear Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ·≈–¡’·π«‚πâ¡∑’Ë®–‡ªìπ higher grade dysplasia ¢Õß cervical cell
662