高危型HPV-DNA检测在宫颈癌筛查中的临床研究  

A clinical research on high-risk HPV-DNA testing in screening of cervical disease

作　　者：李香娟[1] 赵秀敏[1] 杨继洲[1] 卢彩玲[1] 

机构地区：[1]浙江省台州市第一人民医院,浙江台州318020

出　　处：《中国农村卫生事业管理》2011年第11期1180-1182,共3页Chinese Rural Health Service Administration

摘　　要：目的:分析基层医院中使用高危型HPV检测筛查宫颈癌的可行性,探索一种经济、实用、合理的筛查方案。方法:回顾性分析2009年7月-2010年08月间,在台州市第一人民医院妇产科行宫颈疾病筛查的患者,其中行液基薄层细胞学检查(Thinprep cytological test,TCT)的患者12 858例,行高危型HPV DNA检测的患者11 982例(二代杂交捕获法,hybrid capture-,HC-),TCT初筛与HPV分流(即TCT阳性则行HC-检测,HC-同时阳性则行阴道镜活检)。并最终以阴道镜下活检病理诊断为金标准。分析不同筛查方案诊断宫颈上皮内瘤样变(CervicalIntraepithelial Neoplasia,CIN)的灵敏度、特异度、阳性预测值、阴性预测值,以受试者工作特征曲线(ROC)下面积分析不同筛查方案。结果:TCT、HPV及TCT+HPV最终检出CIN的灵敏度、特异度、阳性预测值、阴性预测值分别为:65.7%、97.0%、58.5%;99.3%、83.5%、99.3%;71.2%、14.7%、69.9%;99.3.%、99.9%、98.8%。HPV阳性,TCT阴性患者共1 557例,接受活检者618例,阳性者109例,阳性率17.6%,发现≥CIN2病变者39例,阳性率6.3%。经ROC分析,HPV检测筛查方法明显优于TCT初筛及TCT初筛+HPV分流法(P=0.004,P=0.002)。结论:第二代杂交捕获技术(HC-)高危型HPV检测是本地区宫颈癌初次筛查的首选方法。Objective To analyze the feasibility of high-risk HPV testing in screening of cervical cancer in primary hospital,finally explore an economical,practical,rational screening program.Methods There were 12,858 cases which received TCT,11,982 cases received high-risk HPV DNA testing,all patients received TCT screening with HPV triage（positive TCT received HPV test,both positive received colposcopy biopsy）.Eventually we took colposcopic biopsy diagnosis as the gold standard,analyzed the sensitivity,specificity,positive predictive value,and negative predictive value of different screening programs for the diagnosis of CIN.Furthermore,we used ROC to analyze efficiency of different screening programs.Results Final sensitivity,specificity,positive predictive value,negative predictive value for TCT,HPV and TCT ＋ HPV in detection of CIN were 65.7%,97.0%,58.5%;99.3%,83.5%,99.3%;71.2%,14.7%,69.9%;and 99.3%,99.9%,98.8%,respectively.Furthermore,there were 1557 cases with HPV-positive,TCT-negative.Among them,618 cases received biopsy,and 109 cases found suffering with CIN（17.6%）,and CIN2 lesions were found in 39 cases（6.3%）.ROC analysis demonstrated that HPV testing was superior to TCT or TCT ＋ HPV screening method（P=0.004,P=0.002）.Conclusion High-risk HPV testing is the prior method for screening of cervical cancer in this region.

关 键 词：宫颈上皮内瘤样病变 液基薄层细胞学检查(TCT) 第二代杂交捕获技术(HC-Ⅱ) 高危型HPV 筛查方法 

分 类 号：R737.33[医药卫生—肿瘤]