高危型人乳头状瘤病毒DNA检测联合液基细胞学检查在宫颈病变筛查中的价值  

The value of high-risk human papillomavirus DNA test and Thinprep liquid based cytology for the screening of cervical lesions

作　　者：张梦真[1] 乔玉环[1] 史惠蓉[1] 孔祥东[1] 万爱红[1] 赵先兰[1] 赵学平[1] 

机构地区：[1]郑州大学第一附属医院妇产科,河南郑州450052

出　　处：《中国妇幼保健》2008年第27期3891-3893,共3页Maternal and Child Health Care of China

基　　金：河南省医学科技创新人才工程资助项目(项目号2004016)

摘　　要：目的:评价高危型人乳头状瘤病毒(HPV)DNA检测联合宫颈液基细胞学检查在宫颈病变筛查中的价值。方法:采用宫颈超薄液基细胞学检测及第二代杂交捕获试验(HC-Ⅱ)对14 861例妇女进行宫颈病变筛查,以宫颈组织病理学检查结果作为确诊的金标准。结果:HR-HPV感染3 595例,感染率24.19%;细胞学检查发现非典型鳞状细胞202例,非典型腺细胞1例,LSIL303例;HSIL92例;病理学证实CINⅠ90例、CINⅡ65例、CINⅢ86例、宫颈鳞状细胞癌7例、腺癌2例。高危型HPV DNA在不同宫颈病变中的阳性率分别是:HSIL 92.05%(139/151)、LSIL 52.22%(47/90)和无宫颈上皮病变26.70%(25/939),各组间比较有显著性差异。高危型HPV DNA检测CIN的敏感度是91.05%,特异度是81.35%,阴性预测值为99.55%。宫颈液基细胞学筛查CIN的敏感度、特异度和阴性预测值分别是88.92%、95.56%和99.20%。高危型HPV DNA检测联合细胞学检查筛查CIN的敏感度、特异度和阴性预测值分别是96.12%、82.56%和100.00%。结论:高危型HPVDNA检测在宫颈癌的筛查中有很高的敏感度和阴性预测值,高危型HPV DNA检测联合细胞学检查可使敏感度和阴性预测值有所提高,其结果对宫颈病变有预警作用。Objective： To evaluate the significance of high- risk human papiUomavirus （HPV） DNA test and Thinprep liquid based cytology for the screening of cervical lesions. Methods： 14 861 women were monitored by Thinprep liquid based cytology and hybrid capture Ⅱ, taking biopsy pathology result as golden standard. Results： In 14 861 women, 3 595 （24. 19% ） were positive for HR - HPV DNA. By Thinprep liquid based cytology, ASCUS/AGCUS, ESIL and HSIL were found in 202,303 and 92 women, respectively. By biopsy under the celposcope, 90, 65 and 86 women were diagnosed as CIN Ⅰ , CIN Ⅱ and CIN Ⅲ, respectively, while 7 women were diagnosed as squamous cervical cancer and 2 cervical adenocarcinoma; 939 women were negative for intraepithelial lesion or malignancy. The positive rate of HR-HPVwas52.22% （47/90） inCIN Ⅰ , 92.05% （139/151） inCINⅡ/Ⅲ, and26.7% in NILM. The sensitivity, specifici- ty and negative predictive values ofHR - HPV were 91.05% , 81.35% and 99. 55% , respectively. For Thinprep liquid based cytology, the sensitivity, specificity and negative predictive values were 88.92% , 95. 56% and 99. 20% , respectively. Additionally, the sensitivity, specificity and negative predictive values were 96. 12%, 82. 56% and 100% by HR - HPV combined Thinprep liquid based cytology. Conclusion： Combining Thinprep liquid based cytology with HR - HPV DNA test may increase the sensitivity and negative predic- tive value for detecting cervical lesions.

关 键 词：人乳头状瘤病毒DNA 液基细胞学 第二代杂交捕获试验 宫颈病变 

分 类 号：R737.33[医药卫生—肿瘤]