高危型人乳头瘤病毒检测在宫颈未明确诊断意义的不典型鳞状上皮细胞中的价值  

The Value of High-risk Human Papillomavirus Detection in Women with Atypical Squamous Cell of Undetermined Significance

作　　者：杜蓉[1,2] 陈志芳[1,2] 丁岩[1] 

机构地区：[1]新疆医科大学第一附属医院,新疆乌鲁木齐830054 [2]中南大学

出　　处：《实用妇产科杂志》2011年第8期603-606,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:评价人乳头瘤病毒(HPV)分型检测在宫颈未明确诊断意义的不典型鳞状上皮细胞(ASCUS)分层处理中的临床价值。方法:对宫颈液基细胞涂片结果判读为ASCUS的351例患者行高危型HPV分型检测、阴道镜下宫颈活组织检查及宫颈管内膜诊刮术。分析ASCUS患者病理检查结果与HPV分型检测结果的关系。结果:①351例ASCUS病例中,病理证实宫颈上皮内瘤变(CIN)共69例(69/351,19.6%),其中CINⅡ及以上检出26例,占总数的7.4%(26/351)。②351例ASCUS病例中,高危型HPV阳性率为55.6%(195/351)。高危型HPV阳性及HPV感染阴性组CINⅡ及以上病变检出率分别为11.8%(23/195)、2.1%(3/142),相比差异有统计学意义(P<0.05)。高危型HPV阳性对检出CINⅡ及以上病变的敏感度、特异度、阳性预测值及阴性预测值分别为88.46%,48.00%,11.79%,98.07%。③195例高危型阳性病例中,HPV16亚型及58亚型阳性率分别为45.6%及21.0%。HPV16亚型及58亚型阳性组中CINⅡ及以上检出率分别为7.7%(15/195)、2.6%(5/195),相比差异有统计学意义(P<0.05)。结论:高危型HPV检测在ASCUS患者分层处理中有重要价值,尤其是HPV16亚型阳性患者需立即行阴道镜检查。低危型阳性及HPV感染阴性患者仍需密切随访。Objective：To evaluate the value of high-risk human papillomavirus（HPV） detection in women with atypical squamous cells of undetermined significance （ASCUS）.Methods：High-risk HPV detection, multi-spot biopsy and endocervical curettage under colposcopy were performed on 351 patients whose thin-prep-1iquid-based cytology test（TCT） had been interpreted as ASCUS. The relationship between biopsy and HPV infection results were reviewed and analyzed.Results：①Of the 351 patients with cytological ASCUS, 69 cases were histologically confirmed as cervical intraepithelial neoplasia（CIN） （69/351,19.6%）.Of the 69 cases,26 cases were histologically diagnosed as CINⅡ and high levels, accounting for 7.4%（26/351）. ②Of the 351 cases,195 （55.6%） and 142（40.5%） were positive and negative respectively by high-risk HPV testing. The detection rate of CINⅡ or high levels in high-risk HPV positive group and negative group were 11.8% and 2.1%,respectively. There was significant difference between them（P0.05）. The sensitivity, specificity, positive-predictive value and negative-predictive value of high-risk HPV detection for high grade cervical lesions were 88.46%, 48.00%, 11.79% and 98.07% respectively. ③Of the 195 cases with high-risk HPV positive,45.6% （89/195） were positive for HPV type 16 and 21.0%（41/195） were positive for HPV type 58. The rates of high grade lesions in patients with positive HPV16 were 7.6%, which were higher than those with positive HPV58（7.7% and 2.6%,P 0.05）.Conclusions：High-risk HPV testing is an effective method in detection of high grade cervical lesions of ASCUS,especially colpscopy is proposed for all patients with positive HPV16,and the patients who has HPV negative or low-risk HPV positive need the regular closely follow-up.

关 键 词：未明确诊断意义的不典型鳞状上皮细胞 人乳头瘤病毒 分型检测 

分 类 号：R711.74[医药卫生—妇产科学]