高危型人乳头瘤病毒检测在宫颈癌筛查中的应用价值  

Value of high risk human papillomavirus detection in routine cervical carcinoma screening.

作　　者：王彤[1] 李亚里[1] 张全[1] 

机构地区：[1]解放军总医院妇产科,北京100853

出　　处：《中国实用妇科与产科杂志》2006年第6期435-437,共3页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨将HR-HPV检测作为宫颈癌筛查手段的意义和价值。方法2004-12-2005-04对301医院妇产科门诊就诊的1231例患者,进行HPVDNA的杂交捕获法二代(HPV-HCⅡ)和液基细胞学(Thinprepcytol-ogytest,TCT)的检测,作为宫颈癌及其癌前病变的初筛。131例因细胞学异常,或细胞学正常而HPV检测阳性,或细胞学正常HPV阴性、而临床高度怀疑病变的患者行阴道镜下多点活检,结合病理结果进行分析。结果(1)1231例样本中,经TCT检测正常者1077例(87·43%),ASCUS32例(2·60%),ASCUS-H34例(2·76),LSIL73例(5·93%),HSIL15例(1·22%)。131例阴道镜下多点组织活检,病理证实炎症68例(51·91%),CINⅠ20例(15·27%),CINⅡ18例(13·74%),CINⅢ16例(12·21%),浸润癌4例(4·35%),湿疣5例(3·82%)。(2)HPV总感染率34%,HPV阳性者418例,年龄平均(36·93±10·8)岁,HPV阴性者813例,年龄平均(39·68±11·8)岁,HPV阳性组的年龄明显小于HPV阴性组,P<0·01。各病理组HPV感染率分别为:炎症58·82%,CINⅠ80%,CINⅡ72·22%,CINⅢ100%,浸润癌100%,湿疣60%。(3)阴道镜下多点活检结果:TCT和HPV均(-)者,无高度病变的发生;TCT(-)和HPV(+)者中,≥CINⅡ的检出率11·1%(1/9),TCT异常和HPV阳性同时存在的病例中,≥CINⅡ的检出率最高40·5%(32/79);仅TCT异常而HPV(-)者13·2%(5/38),且5例均为CINⅡ,无原位癌和浸润癌的发生。结论持续的HR-HPV感染与宫颈病变的演进有关;HR-HPV检测是有价值的辅助诊断技术,与细胞学联合检测,为最佳宫颈癌筛查方案。Objective To investigate the significance and value of HPV （ human papillomavirus） testing in the screening of cervical carcinoma. Methods From Oct. 2004 to Apr. 2005,1231 women were performed Thinprep Cytology Test （TCT） and HPV DNA detection by the method of HPV - Hybridization Capture Ⅱ （ HPV - HC Ⅱ ）to initially screen the cervical carcinoma,and 131 patients with abnormal cytological screen test result, normal but highly suspected abnormality in clinics and normal but HPV DNA （ ＋ ） were further examined by colposcope and performed multiple biopsies. The pathological results were andyzed. Results TCT results： normal （ 1077/1231,87.43% ）, ASCUS （32/1231 2.60% ）, ASCUS - H（34/1231 2.76% ）, LSIL（73/1231 5.93% ）, HSIL（ 15/1231 1.22% ）. The cdposcopy results： inflammation （68/131 51.91% ）, CIN Ⅰ （20/131 15.27% ）, CIN Ⅱ （ 18/131 13.74% ）, CIN Ⅲ （ 16/131 12.21% ）, invasive carcinoma （4/131 4.35% ）, condyloma （5/131 3.82% ）. The overall prevalence of HPV infection was 34%. 418 patients were HPV positive with the mean age of 36.93 ± 10.8, while 813 patients were HPV negative and their mean age was 39.68 ±11.8 ; the former was siginificantly younger than the later （ P 〈 0.01 ）. HPV was detected in 58.82% of inflammation, 80% of CIN Ⅰ , 72.22% of CIN Ⅱ , 100% of CIN Ⅲ, 100% of invasive carcinoma, 60% of condyloma. There was no high grade lesion in the specimens with TCT and HPV negative. In the specimens with TCT （ - ） and HPV （ ＋ ）, 11.1% （ 1/9 ） were found to be ≥CIN Ⅱ ; in the specimens with TCT（ ＋ ）and HPV （ ＋ ） , it was 40.75% （32/ 79） and in TCT（ ＋ ）and HPV （ - ）, 13.2% （5/38） were CIN Ⅱ ; no carcinoma in site and no invasive carcinoma was detected. Conclusion High risk HPV infection is related to cervical lesion progress. HR - HPV test is a valuable diag- nosing technique, which ,combined cytology test, is the best screening project.

关 键 词：乳头状瘤病毒 人 宫颈癌 宫颈上皮内瘤变 阴道镜 

分 类 号：R71[医药卫生—妇产科学]