肉眼观察(VIA、VILI)在中国农村地区宫颈癌筛查中的应用评价  

The Value of Visual Inspection with Acetic Acid and Lugol's Iodine in the Screening of Cervical Cancer in the Rural Areas of China

作　　者：李凌[1] 李隆玉[1] 乔志强[1] 乔友林[2] 于晓红[1] 张敏芳 张洵[2] 安云婷[1] 

机构地区：[1]江西省妇幼保健院肿瘤科,330006 [2]中国医学科学院肿瘤研究所流行病学研究室,100021 [3]江西省修水县医院妇产科,332418

出　　处：《实用癌症杂志》2008年第6期599-601,604,共4页The Practical Journal of Cancer

基　　金：美国比尔.梅达琳.盖茨基金资助项目(GAT.1134-01557-LPS)

摘　　要：目的评价醋酸、碘着色肉眼观察在中国农村地区宫颈癌筛查中的应用价值及可行性。方法对子宫颈癌高发区江西省修水县大桥乡妇女进行以人群为基础的研究,对2499例年龄为30～49岁农村已婚妇女进行了人乳头瘤病毒(HPV)的检测,薄层液基细胞学(TCT),醋酸、碘染色后肉眼观察(VIA、VILI)以及电子阴道镜检查。各种方法独立进行,均为双盲。对VIA、VILI或电子阴道镜中任何一项存在阳性病变进行宫颈组织活检,或行颈管刮术(ECC),另HPV或TCT阳性的妇女也给予活检。宫颈组织病理诊断均经国际癌症研究所病理检查确诊,将CIN2以上(含CIN2)病变纳入阳性结果。结果2499例受检妇女中有2432例列入研究,共检出CIN237例,CIN359例,宫颈癌3例。HPV,TCT,HPV+TCT,VIA,VILI,VIA+VILI和阴道镜检查等筛查方法的敏感度分别是96.67%,89.47%,97.98%,56.57%,36.36%,63.64%和39.39%;特异度分别为85.00%,96.91%,86.97%,94.60%,96.23%,92.97%和98.14%。结论VIA、VILI的灵敏度低于HPV或TCT,但因其简单、廉价、易掌握等特点,故更适合在农村地区推广应用。Objective To evaluate the feasibility and value of visual inspection with acetic acid and lugol＇s iodine in the screening of cervical cancer in the rural areas of China.Methods We sequentially conducted human papillomavirus（HPV）DNA test by hybrid capture-2（HC-2）with cervical cells,liquid-based thinprep cytology test（TCT）,visual inspection with acetic acid（VIA）and lugol＇s iodine（VILI）,colposcopy respectively in 2 499 married women between 30 and 49 years old from Xiushui country of Jiangxi province.All the methods were performed independently under double-blind design.Cervical biopsy or endocervical curettage（ECC）was performed in case of positive VIA and/or VILI or suspected colposcopy,positive result of HPV or TCT test.The pathological diagnoses were confirmed by IARC,and patients with ≥CIN 2 were identified as positive.Results 99 women had pathologically confirmed CIN or cervical cancer,including 37 cases with CIN 2,59 cases with CIN3 and 3 cases with cervical cancer.The sensitivity rate of HPV,TCT,HPV＋TCT,VIA,VILI,VIA＋VILI and colposcopy was 96.67%,89.47%,97.98%,56.57%,36.36%,63.64% and 39.39%,respectively,and the specificity rate was 85.00%,96.91%,86.97%,94.60%,96.23%,92.97%,and 98.14%,respectively.Conclusion Although the sensitivity is lower than that of HPV or TCT,VIA and VILI seem to be appropriate methods in the screening of cervical cancer in the rural areas of China,owing to their rapid,cheap and easy to use feature.

关 键 词：宫颈癌筛查 肉眼观察 中国农村 

分 类 号：R737.33[医药卫生—肿瘤]