CIN ??? ????????? ??? ???????? ???????? ??? ????????
????? ?????? ???????? ??? ?? ????????? ????????? ??? ???????? ???????? ??? ????????, ??? ????? ? ??? ??????? ??????????? ?????, ??????????? ???? ??? ??? ???-????????? ?????? ??? ?????, ???? ?? ??????? ??????? ????????????? ??? ????????. ???? ?? ?????? ??? ?? ?????????? ????? ????? ?????? ?? ????????? ?????????????? ????????? (CIN) ??? ?????????? ????? ?? ?? ?????????? ???? ?????????? ??? ??????????? ????????. [??????? ?? ?? ???????? 3 – ????????????? ??? ??????????]
? ???????? ??? CIN ???????? ??? ??????? ??? ????????? ?????????? (CIN1) ??? ????? ??? ????????? ???????? ??? ????????? ????? ??? ??????? ??? ?????? ??? ????????? ???? ????? ?????? ???????? (CIN3) ??? ?? ????????? in situ (????? 4.1).
????? 4.1. ????????? ?????????? ??? ????????? CIN (??? ????? 1 ??? ???? Kelloff & Sigman 2007
- CIN1, CIN2 ??? CIN3 ???????????? ???????? ??????? ???????? ?? ??????? ??? ???????? ?????????? ??????? ??????????
- ? ???????? ??????????????? ??? CIN ?? ?????? ?? ?????????????? ?? ?? ????? ??? ?? CIN1 ??????? ?????????????? ???????????? ??????? ??? ??? ?? ??? ?????????? ????????? (HPV)
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????? 4.2 (a-c). CIN1
FIGURE
(a) CIN1 ?? ?????? ???????? (b) LSIL ?? ????????? ????????? ???????????? (c) LSIL ?? ?????????????? (??? ??????? 9c-2a and 9c-3b ??? ???????? 9c ??? ????????? ???????????????? ?????? ??? ?????????? ?? ???? ?? ????????).
CIN1 ????????????? ?? ??? HPV ??????? ??? ??????? ???????? ???????? ????? 9-12 ?????. ???????? ??????????? ??????? ??? ?? CIN1 ???????????? ???? ???????? ?????? ??????? ???????? ?? CIN2-3 ??? ?????????? ??????? ?????????? ???????? ?? ??? ????? ?????????? ??? ??????? (Ostör 1993; Holowaty 1999; Bansal et al. 2008).
??? ?????? ?????????? ???????????? (follow-up) ?????? ???????, ??????? ??? ??????? ?????????? ??? ???? Holowaty et al. ?????? ??? ? ??????????? ??? ??????????? ??????? (62.2%) ??? ??????? ?????????? (53.7%) ??????????? (??? ???????? ??????????? ????? 2 ????) ??? ? ??????? ?? ?????? ????????? ? ????????? ???? ???? ?????????? 25% ?? ????? 5 ????, ??????? ??? ???????? ?? ????? ???????.
??????? ??? ??????? ?????????? (??? Holowaty et al.)
?????? ??????+
????? 2 ???? 11.1% 2.1%
????? 5 ???? 20.4% 5.5%
????? 10 ???? 28.8% 9.9%
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? ?????????? ???????? ????????? ??? ??? ??????? ??? HPV, ??? ?????????? ??? ??? ?????? ??? ??????? ??? ??? ??? ???? ??? (Jaisamrarn et al. 2013).
- HPV16 ??? 33 ????? ??? ?????????? ??????? ???????? ?? CIN3
- HPV16 ??? 31 ????? ??? ???????? ?????????? ??????????
??????-?????? CIN
CIN2 ??? CIN3 ???????????????? ?? «??????-??????» CIN ??? ??????? ???????????? ?? ???????? ? ?????????? ???? ??????????????? ???? ????????????.
CIN2 ????? ??? ????????? ????? ??? ??????? ?????????? ??? ??? ?????? ALTS ??? ??????? 40% ???????? ???????? ???? ???? ????? ???????? ??????? ???? ?????????? ?? ??? HPV16 (Castle et al. 2009). ? ?????????? ?????? ??? ???? Holowaty et al. (1999) ?????? ??? ? ??????????? ??? ??????? ?????????? ?????????? (53.7%) ??? ? ??????? ????? ??????????? ?????? ?? ????? ?? ??? ?????? ?????????.
??????? ??? ??????? ?????????? (??? ???? Holowaty et al.)
??????+
????? 2 ???? 16.3%
????? 5 ???? 25.1%
????? 10 ???? 32.0%
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? ??????????? ????????????? ??????? ???????? ??? 5 ??? ??? 100 ???????? ??? ??????? ?????????? (1.2) ?? ????????? ??????? ???? ?????????? ?????? ??????? (0.4) ??? ??????? ?????????? (3.9). [??? Holowaty et al. 1999 ??? ????? ???????? ?? «?????????? ????????????» (confidence intervals).]
CIN2 ??????????? ??? ???????? ?????????? ?? ???????? ????????????? ??????????? ??? ??????? 2/3 ??? ?????????. ??????? ??????? ???? ? ??????? ??????????????.
????? 4.3 (a-b). CIN2 (?????? ?????????): ?????????? ???????? ????????
FIGURE
(a) HSIL, ??????? ?? CIN2 ?? LLETZ (b) HSIL (??????? ?? CIN2) (??? ????? 9c-7b ??? ????????? ???????????????? ?????? ?? ??????? ?? ?? ???????? 9c)
?? ??? ?????? ??? ?????????? ????? ?????? CIN1 ??? CIN3 ??? ??????? ??? ???????? ???????? ??? ??? ???????? ???????? ?? ???? ??? ??????? ??? CIN2 ?? ?????? ?? ?????????????? ?? ??? ?????????? ???????????? ?????, ?????????? ?????? ???? ??? ? ????? ???????????????? ?? ??? ?????????? ??? ??????? ????????? ??????? p16INK4A, ?? ????? ?? ????????? ? ??????????? ??? ????????? ??? ? ?????????? ??? ??????????? ????????? CIN (Galgano et al. 2010; Darragh et al. 2012).
P16INK4A ????? ??????? ???? ?????????? CIN2 ???
- CIN1 ?? ??????? ?????????
- ?? ????????????? ???????? ???? ? ??????? ??????? ?????????, ???????? ????????? ??? ?????????? (repair)
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CIN3 ??????????? ??? ???????? ?????????? ??????????????? ??? ??????? ??? ?????? ??? ????????? ????????? ?? ???????? ????????????? ?? ??? ?? ???????. CIN3 (??? ?????? ?????????) ???????????? ??? ?? ????????? in situ, ??? ?? ???? ?????? ??????? ???????????????.
? ???????? ???????? ????? ??????????? ??? ??? CIN3 ??? ? ???-???????????? ????????? ????? ????????? ????????? ?? ????? ?? CIN1 ? CIN2 (Stoler et al. 2001). ?????? ??????? ??????????? ?????????????? ????????? ??? ??????? ??? ?????? ??????????? CIN3 ??????????????? ????????? ??? ??????? ?????????. ? ??????? ???????? ????? ??????? ?? ???????? ????? ?? ??????????? CIN3/??????????? in situ ???????????? ???? ???????????????.
????? 4.4 (a-c). CIN3 ??? ???????? ????????
(a) ????? ????????? ???????? ??? ?????????
(b) ???????????? HSIL (CIN3) ??? ??? ???? ?????????
(c) ?????? ?? ????????? (??????????????) ??? ???????????? ?? ?????? ?????????? CIN3.