HR—HPV检测及阴道镜检查对ASCUS的临床意义  

Clinical significance of HR-HPV testing and colposcopy in diagnosis of cervical atypical squamous cell of undetermined significance

作　　者：胡静熠[1] 吴江平[1] 

机构地区：[1]南京医科大学附属南京妇幼保健院妇女保健科,江苏南京210004

出　　处：《中国妇幼健康研究》2013年第1期86-88,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨高危型人乳头状瘤病毒（HR-HPV）检测和阴道镜检查对意义不明确的宫颈不典型鳞状细胞（ASCUS）的临床意义。方法对膜式液基薄层细胞学技术（TCT）诊断为ASCUS的236例患者进行了HR—HPV检测和阴道镜检查及宫颈活检。对结果进行分析。结果在236例患者中，宫颈上皮内瘤变（CIN）发生率为45．3％（107／236），高级别CIN和浸润癌发生率（≥CINⅡ）为14．0％（33／236）。HR—HPV阳性组中CIN检出率为72．2％（96／133），HR—HPV阴性组中cIN检出率为10．7％（11／103），两组比较有显著性差异（X。=88．591，P〈0．01）。HR．HPV阳性组发生cIN和浸润癌的风险是阴性组的21．7倍（OR：21．7，95％cf：7．416～42．052，P〈0．01）；正常及良性反应者HR—HPV两型及以上感染率为8．1％（3／37），≥CINI两型及以上的感染率为32．3％（31／96），两者比较有显著性差异（X2=8．211，P〈0．01）。阴道镜检查拟诊CIN和宫颈癌143例，其中≥CINI与病理组织检查结果符合率为85．0％（91／107），高级别CIN和宫颈癌诊断符合率为（≥CINII）87．9％（29／33）。结论HR—HPV感染可增加ASCUS发生CIN及浸润癌的风险，且与病变程度密切相关，对ASCUS患者进行HR—HPV检测和阴道镜检查，可提高宫颈病变的检出率，对宫颈早期病变的防治有重要意义。Objective To investigate the clinical significance of high-risk human papillomavirus （HR-HPV） testing and colposcopy in diagnosis of cervical atypical squamous cell of undetermined significance （ASCUS）. Methods A total of 236 cases diagnosed with ASCUS by thinprep liquid-based cytology test （TCT） underwent HR-HPV testing, colposcopy and cervical biopsy. The resuhs were analyzed（ Results Among 236 cases the incidence of cervical intraepithelial neoplasia （CIN） was 45.3% （ 107/236）, and the incidence of high level CIN（ ≥CIN Ⅱ） and invasive carcinoma was 14.0% （33/236）. The detection rate of CIN in HR-HPV positive group and in negative group was 72.2% （ 96/133 ） and 10.7 % （ 11/103 ）, respectively, and the difference was significant （X2 = 88.591, P 〈 0.01 ）. The risk of CIN and invasive carcinoma in HR-HPV positive group was about 21.7 times of that in HR-HPV negative group （OR = 21.7,95% CI： 7. 416-42. 052,P 〈 0.01 ）. The infection rate with 2 or more types of HPV in normal cases and cases with benign reaction was 8.1% （3/ 37） , and that with 2 or more types of HPV in cases with CIN I or higher level was 32.3% （31/96）. There was significant difference between them （X2 = 8.211 ,P 〈 0.01 ）. There were 143 cases diagnosed with CIN and invasive carcinoma by colposcopy. The coincidence rate with cytologic diagnosis for cases 〉~CIN I was 85.0% （91/107）, and that for cases with high level CIN （ ≥CIN Ⅱ ） and cervical cancer was 87.9% （29/33）. Conclusion HR-HPV infection increases the risk of CIN and invasive carcinoma, and it is closely related with lesion severity. HR-HPV testing and colposcopy for patients with ASCUS can improve the detection rate of cervical lesions, which is important to prevent and cure cervical lesions at early stage.

关 键 词：高危型人乳头状瘤病毒 意义不明确的宫颈不典型鳞状细胞 宫颈上皮内瘤变 阴道镜 

分 类 号：R173[医药卫生—妇幼卫生保健]