常用宫颈上皮内瘤变筛查方法对比分析  

Comparative analysis of common screening methods for cervical intraepithelial neoplasia

作　　者：张龙华[1] 陈京芳[2] 

机构地区：[1]无锡市妇幼保健院妇产科,江苏省无锡214002 [2]南京市第一医院妇产科

出　　处：《中国基层医药》2013年第8期1154-1156,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨传统巴氏涂片、膜式液基薄层细胞学技术、全自动细胞DNA定量分析系统、人乳头瘤病毒检测、盲点活检及阴道镜下染色活检对宫颈细胞病变筛查的临床价值。方法选取妇科门诊患者8780例作为研究对象，分四组统计不同筛查方法检测的阳性率及准确率；同时比较阴道镜下染色活检与盲点活检的阳性率，活检阳性、阴性患者中HPV阳性率及阳性患者各级病变中HPV感染率。结果（1）四组（宫颈刮片组、TCT组、DNA组、HPV组）间阳性检出率呈递增趋势（P〈0．05），两两比较：除宫颈刮片组阳性与TCT组检出率差异无统计学意义（P〈0．05）外，其余差异均有统计学意义（均P〈0．05）；（2）四组间准确率亦呈递增趋势（P〈0．05），两两比较：除宫颈刮片组准确率低于与TCT组，但差异无统计学意义（P〉0．05）外，其余差异均有统计学意义（均P〈0．05）。（3）阴道镜下醋酸染色活检阳性检出率高于盲点活检（P〉0．05）；（4）活检阳性者HPV阳性率高于活检阴性者（P〈0．05）；（5）阴道镜下醋酸染色活检组各级病变中HPV阳性率呈递增趋势（P〈0．05），盲点活检组各级病变中HPV阳性率呈递增趋势（P〈0．05）。结论（1）HPV在宫颈防癌筛查中敏感性最高、特异性最强，细胞DNA定量法次之，传统巴士涂片最差，HPV及DNA检测在临床应用中更有价值。（2）阴道镜下醋酸染色活检与盲点活检在临床应用上无明显差别，但HPV感染是宫颈上皮内瘤变发生、发展，并逐步进展为宫颈癌的关键因素。Objective To explore the clinical value of cervical lesion screening,which was detected by Pap smears, thinprep cytologic test （TCT）, full automatic cellular DNA quantitative analysis system, human papilloma virus detection, colposcopy staining biopsy and blind biopsy. Methods 8 780 peoples were as the study object, divided into four groups, positive rate and accuracy of different screening methods;In addition ,which were the positive rate of colposcopy staining biopsy and blind biopsy, the positive rate of HPV in all positive biopsy people and negative biopsy people, and the HPV infection rate of various lesions in positive patients were compared,respectivey. Results （ 1 ） The positive rates between the four groups showed an increasing trend （ P 〈 0.05 ）. The positive rate of Pap smears and TCT had no statistical difference between every two of them （ P 〈 0.05 ）, the rest were statistically significant （ P 〈 0. 05 ）. （2）The accuracy rates between the four groups showed an increasing trend （P 〈 0. 05 ）. The accuracy rate of Pap smears and TCT had no statistical difference between two of them（ P 〉 0.05 ）, the rest were statistically significant （P 〈 0.05）. （ 3 ） The positive rate of colposcopy biopsy under vision inspection with acetic acid （VIA） was higher than that of blind biopsy （P 〉 0.05 ）. （4）The positive rate of HPV detection of positive biopsy people was higher than that of negative biopsy people（P 〈0.05 ）. （5）In colposcopy biopsy under vision inspection with acetic acid （VIA） group, the HPV positive rates of inflammation showed an increasing trend （ P 〈 0.05 ） ; in blind biopsy group, the HPV positive rates also showed an increasing trend（P 〈 0.05）. Conclusion （ 1 ） HPV test has the highest sensitivity and strongest specificity,cellular DNA quantitative analysis is second, Pap smears is worst, so HPV and DNA detection have more valuable in clinical. （2）There is no significant difference between colposcopy b

关 键 词：宫颈上皮内瘤变 诊断 方法学 

分 类 号：R737.33[医药卫生—肿瘤]