人乳头瘤病毒负荷量与宫颈病变关系的研究  

Study on the relation between HPV viral load and cervical lesions

作　　者：王建捷[1] 靳家玉[1] 冯玲[1] 郝薇[1] 张玲[1] 

机构地区：[1]首都医科大学附属北京友谊医院妇产科,北京100050

出　　处：《临床和实验医学杂志》2013年第20期1642-1644,1646,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的 探讨杂交捕获II代法人乳头瘤病毒DNA检测（HPV-HCII）病毒负荷量与宫颈病变的关系.方法 2010年4月至2011年5月因可疑宫颈病变就诊的1 240例患者行HPV-HCII及阴道镜下活检、病理组织学检查.结果 高危型HPV-DNA阴性34.0%（422/1 240）,阳性66.0%（818/1 240）.病理组织学结果为：慢性炎症45.2%（561/1 240）;上皮内瘤变（CIN） I级35.6%（442/1 240）;CIN II 级10.3%（128/1 240）;CIN III级 6.8%（84/1 240）;浸润癌1.7%（21/1 240）;腺癌0.2%（3/1 240）;宫颈淋巴肉瘤1例,占0.08%（1/1240）.随病变程度加重,高危型HPV-HCII阳性率逐渐增高,CIN III达95.2%,宫颈鳞癌100%,各组间比较有显著性差异（χ2=142.4,P〈0.001）.HPV-HCII的敏感度为92.7%（205/221）,特异度40.5%（406/1 003）,阴性预测率96.2%（406/422）,阳性预测率25.0%（205/818）.慢性炎症病毒负荷均值111.8,明显低于其他病变组,不同宫颈病变间病毒负荷均值无显著性差异（t=-5.534,P〉0.05）.HPV-DNA病毒负荷量〈1病例中,高度以上病变4.0%.随病毒负荷量增加,高度以上病变比率增高,从17.6%~39.1%,各组间比较差异显著（χ2=227.2,P〈0.001）.结论 HPV-HCII检测宫颈病变敏感度高,特异度低,有良好的阴性预测率.HPV-DNA病毒负荷量与宫颈病变有关.Objective To study the relation between HPV viral load and cervical lesions. Methods From April 2010 to May 2011, 1 240 patients with suspected cervical lesions were examined with HPV HCII test and colposcopy directed biopsy. Results The positive rate and negative rate of high risk HPV DNA were 66.0% （818/1 240） and 34.0% （422/1 240）, respectively. Pathological diagnoses were 45. 2% （561/1 240） chronic inflammation; 35.6% （442/1 240） CIN I; 10.3% （128/1 240） CIN II; 6.8% （84/1 240） CIN III; 1.7% （21/ 1 240） invasive carcinoma; 0.2% （3/1 240） adenocareinoma and 0.08% （ 1/1 240） granulocytic sarcoma of the uterine cervix. Positive rate of high risk HPV DNA increased with the severity of cervical lesions; it was 95.2% in CIN III and 100% in squamous cell carcinoma. There was significant difference in the positive rate of high risk HPV DNA among groups （X2 = 142.4, P 〈 0. 001 ）. The sensitivity, specificity, negative predictive value and positive predictive value of HPV HCII test were 92.7% （205/221） , 40.5% （406/1 003 ） , 96.2% （406/422） and 25. 0% （205/818）, respectively. The mean viral load in inflammation group was 111.8, significant lower than other groups. In the cases of HPV DNA viral load 〈 1, high grade lesions was 4.0%. Rate of high grade lesions increased from 17.6% -39.1% with the increase of viral load and there was significant difference among groups （ X2 = 227.2, P 〈 0. 001 ）. Conclusion HPV HCII test has high sensitivity and negative pre dictive value, but low specificity for the diagnosis of cervical lesions. HPV viral load is relative to cervical lesions.

关 键 词：宫颈病变 杂交捕获Ⅱ代检测 人乳头瘤病毒负荷量 

分 类 号：R737.33[医药卫生—肿瘤]