高危型人乳头瘤病毒以及病毒载量检测在诊断宫颈上皮内瘤变Ⅱ级及以上病变中的应用  

High-risk Human Papillomavirus and the Detection of Viral Load in the Diagnosis of CINⅡ and Ⅲ or Cervical Cancer

作　　者：游珂[1] 耿力[1] 郭艳利[1] 乔杰[1] 沈晓野[1] 姚燕君[1] 范晓红[1] 司胜丹[1] 白丽[1] 

机构地区：[1]北京大学第三医院妇产科,北京100083

出　　处：《中国微创外科杂志》2007年第11期1096-1098,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨高危型人乳头瘤病毒(high-risk human papillomavirus,Hr-HPV)在液基细胞学异常患者中对宫颈上皮瘤变Ⅱ级(cervical intraepithelial neoplasia,CINⅡ)及以上病变(CINⅢ、宫颈癌)的辅助诊断作用。方法选择2179例宫颈液基细胞学异常并行Hr-HPV检测以及阴道镜检查加宫颈活检的患者进行回顾性分析,统计采用χ2检验,并行单因素Logistic回归分析。不能明确意义的不典型鳞状细胞(atypical squamous cells undetermined significance,ASC-US)占46.5%(1013/2179),不除外高度上皮内瘤变的不典型鳞状细胞(atypical squamous cell which cannot exclude high grade squamousintraepithelial lesion,ASC-H)4.1%(89/2179),低度鳞状上皮内病变(low squamous intraepithelial lesion,LSIL)34.7%(757/2179),高度鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)及以上占11.6%(253/2179),非典型腺细胞(atypical gland cells,AGC)3.1%(67/2179)。结果经阴道镜下宫颈活检病理诊断CINⅡ10.3%(224/2179),CINⅢ6.4%(140/2179),鳞癌1.2%(27/2179),腺癌0.4%(9/2179),其余81.6%(1779/2179)为宫颈低度病变(包括CINⅠ与湿疣)或慢性宫颈炎。在各种细胞学中,高危型HPV阳性时检出CINⅡ及以上病变的机会增加,在ASC-US、ASC-H、LSIL、≥HSIL中,差异有显著性。当Hr-HPV病毒负荷量在0～0.9、1.0～9.9、10.0～99.9、100.0～999.9、≥1000.0时,CINⅡ及以上病变占2.2%(13/588)、9.7%(21/216)、24.9%(97/389)、29.8%(182/611)、23.2%(87/375)。将HPV载量做10的对数转化行Logistic回归检验,HPV载量每增加一个对数单位,CINⅡ及以上病变的机会增加1.325倍。结论在宫颈细胞学异常的患者中检测Hr-HPV能辅助诊断CINⅡ及以上病变。Objective To explore the role of high-risk human papillomavirus （Hr-HPV） DNA testing in the detection of cervical intraepithelial lesions （CIN） Ⅱ and Ⅲ, or cervical cancers for patients with abnormal cervical cytology. Methods A total of 2197 patients with abnormal cervical liquid-based cytology, who had received Hr-HPV detection and eolposeopy, were enrolled into this study. The data were analyzed using x^2 -test and Logistic regression. Among the patients, 1013 （46.5%） had atypical squamous cells undetermined significance （ASC-US） , 89 （4. 1% ） had atypical squamous cell which cannot exclude high grade squamous intraepithelial lesion （ASC-H） , 757 （34.7%） low squamous intraepithelial lesion （LSIL） , 253 （ 11.6% ） high-grade squamous intraepithelial lesion （HSIL） , and 67 （ 3.1% ） atypical gland cells （ AGC ）. Results Pathological examination showed CIN Ⅱ in 224 patients （10.3%）, CIN Ⅲ in 140 （6.4%）, cervical cancer in 27 （1.2%）, and adenoeareinoma in 9 （0.4%）. The other patients （1779/2179, 81.6% ） had CIN Ⅰ , eondyloma, or chronic eervieitis. The detection rate of CIN Ⅱ and Ⅲ, and cervical cancer was increased in the patients with Hr-HPV. The differences in the rate among ASC-US, ASC-H, LSIL, and HSIL patients were significant. The incidence rate of CIN Ⅱ and Ⅲ , or cervical cancer was 2.2% （13/588） , 9.7% （21/216） , 24.9% （97/389） , 29.8% （182/611）, and 23.2% （87/375） for the patients with a Hr-HPV load of 0-0.9, 1.0-9.9, 10.0-99.9, 100.0- 999.9, and ≥ 1000.0. Logistic regression showed that the risk of CIN Ⅱ and Ⅲ , and cervical cancer increased by 1. 325 folds with the log of the HPV load. Conclusions Hr-HPV DNA test is helpful for the detection of CIN Ⅱ and Ⅲ or cervical cancer in patients with abnormal cervical cytology.

关 键 词：宫颈细胞学 宫颈病变 高危型HPV人乳头瘤病毒 

分 类 号：R737.33[医药卫生—肿瘤] R730.261[医药卫生—临床医学]