高危型HPV-DNA检测对ASCUS分流监测的临床价值  

Value of High-risk HPV DNA Testing in the Triage of ASCUS

作　　者：朱熠[1] 张国楠[2] 姚宇琪[3] 

机构地区：[1]广西医科大学,南宁530021 [2]四川省肿瘤医院妇瘤科,成都610041 [3]四川省肿瘤医院病理科,成都610041

出　　处：《肿瘤预防与治疗》2012年第3期140-143,共4页Journal of Cancer Control And Treatment

基　　金：广西2010年研究生教育创新计划资助项目(编号:2010105981002M208)

摘　　要：目的:评价高危型人类乳头瘤病毒(HPV)检测对未明确意义的不典型鳞状细胞(Atypical squamouscells of undetermined significance,ASCUS)分流监测的临床价值。方法:对376例初筛结果为ASCUS病例,3个月后进行宫颈液基细胞学复查和高危型HPV-DNA检测,并根据检查结果将病例分为4组:A组,细胞学+/HPV+;B组,细胞学-/HPV+;C组,细胞学+/HPV-;D组,细胞学-/HPV-。对A、B、C组病例进行了阴道镜检查及活检,比较3组间宫颈上皮内瘤变(cervical intraepithelial neoplasma,CIN)发生率的差异。由于D组发展成为肿瘤的风险极低,不纳入比较。结果:A组(细胞学+/HPV+)患者CINⅡ/Ⅲ发生率为41.59%,B组(细胞学-/HPV+)为23.75%,而C组(细胞学+/HPV-)为3.70%。高危型HPV在ASCUS患者中感染率随年龄增长而降低,其中30岁以下年龄组高危型HPV-DNA阳性率为71.43%,而50岁以上年龄组仅为26.80%。结论:在二次筛查中增加高危型HPV-DNA检测较单纯重查宫颈液基细胞学检测可提高CINⅡ/Ⅲ检出率。ASCUS临床意义可随年龄增长而出现明显变化。高危型HPV-DNA检测可对ASCUS进行有效的分流监测。Objective： To evaluate high-risk human papilomavirus DNA （HR-HPV DNA） testing in triage of women with a- typical squamous cells of undetermined significance （ASCUS）. Methods： A total of 376 women with a diagnosis of ASCUS from the primary screening were selected for triage. Their cervical smears were collected and evaluated by using conventional cytological exami- nation in combination with a high-risk HPV-DNA test （ hybrid capture 2）. The women were categorized into four groups ： Group A, Cy- tology ＋/HPV ＋ ; Group B, Cytology -/HPV ＋ ; Group C, Cytology ＋/HPV - ; and Group D, Cytology -/HPV -. Women within Group A-C were admitted for eolposcopy and cervical biopsy. Group D was considered as a low-risk group for tumor development, and was not brought into comparison. Results： In women in Group A（ n = 113 ） , the prevalence of histological verified CIN lI/m was 41.59% , in Group B （n =80） 23, 75% , and in Group C （n =27） 3.70%. The prevalence of a high-risk HPV infection decreased with age in women with ASCUS. It was 71.43% in women 〈 30 years and 26. 80% in women i〉50 years. Conclusion： Adding a high-risk HPV-DNA test in secondary screening increases the identification of women with CIN I] / III lesions by 46. 15 % in comparison with repeat cytology. The clinical significance of the ASCUS diagnosis varies with age of the women. HR-HPV DNA testing is a feasible method for triage of ASCUS.

关 键 词：未明确意义的不典型鳞状细胞 高危型人类乳头瘤病毒检测 宫颈上皮内瘤样病变 

分 类 号：R737.33[医药卫生—肿瘤] R730.4[医药卫生—临床医学]