宫颈癌门诊机会性筛查方法效果的比较  

The study on the effect of opportunistic screening forout-patient with difference ways for cervical cancer

作　　者：欧亚梦兰[1] 李力[1] 张洁清[1] 韦玉鸾[1] 高琨[1] 

机构地区：[1]广西医科大学附属肿瘤医院妇瘤科广西区域高发肿瘤防治重点实验室,南宁530021

出　　处：《现代妇产科进展》2013年第2期115-120,共6页Progress in Obstetrics and Gynecology

基　　金：广西科技厅攻关项目(桂科攻10124001A-34);广西区教育厅科研课题(201012MS045);广西壮族自治区卫生厅项目(S200826);中华医学会分子生物学临床应用研究专项资金(CAMB022010)

摘　　要：目的:研究宫颈液基薄层细胞学检查(TCT)、人乳头瘤病毒(HPV)检测、人类染色体端粒酶(hTERC)基因和C-MYC基因、醋酸/碘染色肉眼观察法(VIA/VILI)在宫颈癌筛查中的应用价值,以期得到更有效的筛查方案;同时探讨hTERC基因和C-MYC基因的异常扩增对于宫颈病变患者的临床意义。方法:收集2010年11月至2011年7月在我院行机会性宫颈癌筛查的患者1010例,分为25～34岁、35～44岁、45～54岁、55～64岁4个年龄组。患者均进行TCT、HPV、TERC基因、C-MYC基因、VIA/VILI肉眼观察法检测。以组织病理学诊断为金标准,评价5种筛查方法单独或联合应用时诊断宫颈上皮高级别病变(≥CINⅡ)的灵敏度、特异度、假阳性率、假阴性率、正确率、阳性似然比和阴性似然比。比较分析在不同年龄组中5种筛查方法诊断≥CINⅡ的准确性。采用SAS8.0软件包构建联合诊断模型,对TCT、HPV采用串、并联组合方法,比较分析所得方案诊断≥CINⅡ的准确性。结果:(1)TCT、HPV、TERC基因、C-MYC基因、VIA/VILI肉眼观察法单独筛查≥CINⅡ病变时,TCT阳性似然比较大而阴性似然比较小,灵敏度与特异度分别为80.9%,98.0%;(2)TCT在45～54岁年龄组阳性似然比较大,35～44岁组阴性似然比较小;HPV在55～64岁年龄组中阳性似然比较大,25～34岁组阴性似然比较小;TERC基因在35～44岁年龄组中阳性似然比较大而阴性似然比较小;C-MYC基因在35～44岁年龄组中阳性似然比较大,在55～65岁年龄组中阴性似然比较小;VIA/VILI肉眼观察法在25～34岁年龄组中阳性似然比较大而阴性似然比较小。(3)联合筛查诊断模型为Logit(P)=5.757-4.055×TCT-3.724×HPV。TCT和HPV检测组合方案中,TCT并联HPV筛查方法优于TCT初筛HPV分流方法和HPV初筛TCT分流方法(AUCTCT并联HPV=0.956;AUCTCT初筛HPV分流=0.891;AUCHPV初筛TCT分流=0.764)。结论:5种筛查方法中TCT诊断宫颈上皮高级别病变的准确性高,但易受Objective ： To assess the accuracy of thinprep cytology test （ TCT）, human papillomaviruse （HPV） testing, telomeranse RNA （ TERC gene ） , C-MYC gene, and visual in- spection with acetic acid/Lugol＇s iodine（VIA/VILI） and find a more effective cervical screen- ing strategy. To explore the clinical significance of TERC gene, C-MYC gene amplification for cervical lesions. Methods： TCT, HPV testing, TERC gene, C-MYC gene testing, and VIA/VILI were applied to cervical screening respectively in 1010 cases with out-patients and agreed to participate in cervical cancer screening from Nov. 2010 to July 2011. Those patients were divid- ed into four age groups,25 -34 years old （yr）, 35 -44 yr,45 -54 yr,55 -64 yr. With histology as the gold standard,we tested the sensitivity, specificity, false-positive rate, false negative rate, diagnostic odds ratio, positive likelihood ratio and negative likelihood ratio of the aforementioned 5 strategies of identifying CIN II or worse（ I〉 CIN II ）, and then compared those datas above. In different age groups, we also compared the accuracy of the diagnosis of the five screening strate- gies. The joint diagnostic model was built by using SAS 8.0 software package, and was used to assess the accuracy of TCT and HPV for indentifying I〉 CIN 11. Results： （ 1 ） When TCT, HPV, TERC gene, C-MYC gene, VIA/VILI alone screening, the positive likelihood ratio of TCT was greater, but negative likelihood ratio was smaller, the sensitivity, specificity was 80.9 % ,98.0% respectively. （2） The positive likelihood ratio of TCT was greater in 45 - 54 yr, but negative likelihood ratio was smaller in 35 -44 yr. The positive likelihood ratio of HPV was greater in 55 64 yr, but negative likelihood ratio was smaller in 25 -34 yr. The positive likelihood ratio of TERC gene was greater in 35 -44 yr, but negative likelihood ratio was smaller in this group. The positive likelihood ratio of C-MYC gene was greater in 35 -44 yr, but negative likelihood ratio was smaller in 55

关 键 词：子宫颈肿瘤 癌前状态 子宫颈 原位癌 治疗学 

分 类 号：R737.33[医药卫生—肿瘤]